Hello Uterus

#40: Forget Ozempic, Get Pelvic Floor Therapy! with Dr. Juan Michelle Martin

Episode Summary

In this episode, we are joined by the brilliant Dr. Juan Michelle Martin to discuss why pelvic floor therapy is so powerful for those with chronic pelvic pain. Thanks for listening, uterinekind!

Episode Notes

Are you willing to inject your leg with an unresearched drug for TEMPORARY weight loss? Thanks to societal beauty standards and toxic social media, the urge to lose weight continues to skyrocket and affect many worldwide. So when a drug becomes famous for its weight loss capabilities, people will go above and beyond to get a taste of what pharmacies are selling despite its misleading title. Ozempic is buzzing all over social media for being an easily accessible drug meant for those with diabetes, but thousands are using it for weight loss without reading deeper into this drug and its side effects. We break down what Ozempic is and why you should forget about using it and turn toward better approaches for your health!
 

Regarding better approaches to health, we have the best recommendations for uterine kind today! Have you ever heard of pelvic floor therapy?  Sadly, this practice gets overlooked or ignored completely when it could be the solution for many living with chronic pain. It also gets a bad rep for being a scary or even painful procedure when that is not the case! This is a practice that is so powerful that it should be a common occurrence in every patient's routine! We are so excited to be joined by Dr. J Michelle Martin, an amazing pelvic floor therapist, to help paint a picture of how a pelvic floor therapy session really goes and why you shouldn’t be nervous about pelvic floor therapy! 

 

Lastly, we end on a brilliant high note. People are getting educated more than ever. 
 

Thanks for listening, learning, and being you. And join us back here every Tuesday for all things uterus, in service to you, uterinekind.

Episode Transcription

Carol: Don't turn your nose up at pelvic floor therapy, but please just say no to ozempic for weight loss. I'm Carol Johnson and this is Hello Uterus

 

Today we are thrilled to be joined by Dr. J, the real deal. Pelvic floor therapist, not the basketball player. I mean, I know I have a sports background, but you know, I'm talking Dr. Joanne Martin, who is. A gift to anyone who needs pelvic floor therapy. And for the purposes of this podcast, anyone who's really nervous about booking a pelvic floor therapy appointment, because you're not sure what all's gonna go on in that appointment, like do you go.

 

In there, and according to Dr. J, only if you're comfortable, but trust me, had I known about pelvic floor therapy, I would've been like open sesame, y'all. She is yours, especially with a therapist like Dr. J. So stay tuned. To listen to that conversation, but first uterus in the news

 

who injects a substance into their thigh without knowing what it is. Chelsea handler, that's who, and thank goodness she's willing to admit it. I love her for her honesty. Always. I mean, if, if you remember way back when she had her first show, I think it was on the Echa, and she used to throw her underwear out the window and then watch and see what happens when somebody would pick it up off the sidewalk.

 

She is just lovely and she admitted something and it's gotten the conversation going. What was she injecting? Oze. Or if the active ingredient, semaglutide, sem, semaglutide, semaglutide, there's probably a few ways to pronounce it, that is the active ingredient in ozempic, which is a drug for type two diabetes and wey, which is.

 

The same active ingredient, but the F d A has approved that specifically for weight loss and, uh, re ulous, you know, there I wanna meet the group of people who take random letters and put them together in random orders in order to create. Drug and chemical names. I wanna meet them. So anyway, Chelsea Handler was given this syringe, you have to inject this drug in into your thigh or your butt.

 

I don't know. But she got it from her doctor because she needed to drop some weight kind of quickly. In advance of an awards show, and I mean, Chelsea Handler, she doesn't need to lose any weight. That was the first thing that struck me was like, good God, how far have we fallen? Like we really need. To unwind the extraordinary and damaging beauty standards that have been thrust upon girls and women.

 

We gotta stop doing that. But anyway, back to Ozempic. This is a, a tale of caution. So the research on Ozempic is pretty interesting. As I said, it's a drug that was first approved for diabetes, so it in one of the unexpected positive benefits of using this drug during the clinical trials was that the people enrolled in the trials lost weight.

 

Yay. . If you have diabetes, oftentimes you are overweight and that extra weight can be pretty significant and it can really mess with your insulin levels and your blood sugar. And so getting diabetics to reduce their weight is really important. And in a lot of cases, diabetics are not in a position to embark on a CrossFit training routine or what have you.

 

And the diet is. , you know, their, their diet in general is, is difficult to manage. So this was a real strong added benefit to people living with diabetes to be able to drop a few pounds over the course of their treatment and they need to stay on this drug forever. It is designed for that, right? So for a diabetic, this drug is used long term.

 

So in the clinical research, what was reported, Was that over a period of 68 weeks? In combination with nutritional counseling and exercise, those people who were enrolled in the clinical trial lost on average 15% of their weight. So let's do some math. Let's pick a pretty sizable weight. Let's go with 200 pounds.

 

You know, it's probably an average, right? Of people that would need to lose weight. They're at about 200 pounds and now they're gonna take Ozempic. So what can they look forward to? Well, a 200 pound person over a period of 68 weeks could lose 30 pounds. That's, that's pretty big, right? 30 pounds, that's like almost three sizes in clothing speak, but when you do the math, it just doesn't add up cuz that equals less than a half a pound a week.

 

Which is one and a half pounds less than a healthy weight loss plan suggests is safe and achievable. When you combine nutritional guidance and movement, they say two pounds a week. Maintaining that until you get to your desired weight is safe and achievable. and it is, you look at the amount of energy that you're consuming in calories and the amount of energy that you're outputting and exercise and, and it should all work out.

 

And again, this is for people who are otherwise healthy. So it, it starts to get even a little bit more dicey when, when they talk about what happens when those people stop taking the drug, they gain the weight back. So now for 68 weeks, you've been taking a drug that has reported side effects of diarrhea, nausea and constipation, pancreatic problems, kidney problems, and I'm sure rare, but.

 

For thyroid cancer. So you're gonna, so you're gonna look at the pros and cons there, and you're like, Hmm, let's see. I can inject myself in in my thigh with a drug that has not been studied for its long-term impact on the female reproductive system. And over a period of a year plus, I will be able to lose approximately a half a pound a.

 

if I also factor in nutritional changes to, you know, what I'm eating and how much I'm eating and include movement or exercise in my program, , I mean, I don't see The only people gaining in this scenario are the people that work for Novo Nordisk. Who launched Ozempic with a seventies vibe. You, you've heard it, right?

 

It's, it's like an earworm Oh, oh, oh. It's magic. That song except oh, oh, oh. Ozempic . I, there's nothing magic from a weight loss perspective about what Ozempic does. I expect that. The real benefit to Ozempic is for those who are living with the debilitating symptoms of diabetes, right? And so there you're looking at the pros and cons and you're like, well, I've got diabetes.

 

You know, I can either work to control the insulin production and my blood sugar, and. Be able to also lose weight so that I can give my body the best sort of optimal environment to process the hormones and food, et cetera. You know, I can do that as a diabetic. Weigh those pros and cons and say, yep, Ozempic for life, because otherwise I could die.

 

And then there's the person who's like, you know, I'd really like to drop 10 pounds. I can fit into Marilyn Monroes dress. And they're, by the way, I don't know. Kim Kardashian to Ozempic. I'm just riffing. Um, but we all know people who are like, I need to lose 10 pounds and then jab their thigh with this drug.

 

And I would get it if the drug was like, you know, delivered this remarkable weight loss. There's nothing remarkable. About a half a pound a week. It's really great. It is great and doable with slight modification to your diet and movement patterns. For the week, a half a pound is probably somewhere around 1,750 calories.

 

Spread over seven days. That's about 170 plus calories a day that you would need to cut and then throw in a little extra movement. You might be losing a pound a week without ozempic, without the need to get your thyroid tested to make sure that you're not getting thyroid cancer and your pancreas throwing out a whack.

 

But beyond the side effects that they list. It, it is, and this is why it's uterus in the news. We only have a basic or rudimentary understanding of the female system, and we lack long-term data on the impact of multiples of drugs, including ozempic. And these drugs are all, well, not all of them, but certainly Ozempic in this case, and the other drugs that use the same active ingredient, they're designed to alter the communications of hormone.

 

And hormones communicate with effect and regulate our reproductive organs and we, we've been having. Amazing conversations here and, and making ourselves aware of endocrine disrupting chemicals and how they alter the way our hormones are communicating with the various organs in the body and, and how they make all of our systems operate.

 

And, you know, it just occurred to me also like we often on this. Show we do, but I don't know if, if really out in public in general, people are talking about the mood altering impact of these drugs because mood gets dismissed. I, I, that word mood really irks me because of its connotation with women and being moody and all that stuff.

 

It is your mental wellbeing, your mental health, and our mental. Our brain is literally impacted by these drugs because our brain has the hypothalamus and the pituitary gland, and they're part of the whole endocrine system, and we just have to stop messing with this stuff. Like I really wish if I had magic powers, oh man, I would press pause on anything that wasn't absolutely required.

 

For the management of a, a medical condition and require these pharmaceutical companies to write giant checks with many, many, many zeros to independent research laboratories and, and send them anonymously, , just, just fund research. that you're not crossing your fingers and hoping makes it so that you know your drug can be a billion dollar drug.

 

We have to have a better understanding of our system before we do stuff like this. And you know, I don't blame Chelsea Handler. You can kind of see how this goes down. You know, it's irresponsible in the part of doctors who push these meds. And what's wildly infuriating is the conditioning that we are to believe and trust our doctors.

 

So Chelsea handler's, doctor Hanser, an injectable drug and says, here, use this. She's clearly not obese. That really ha, that's gotta, that gives me pause. Definitely makes me wonder. You know, what's going on here? It's like we've just gotten out of control with, with this. And, and the thing, the secret to the reason why pharmaceutical companies, personal care product companies, all these companies can continue doing what they're doing is because there's been no accountability, there's been no requirement that these compounds be tested on female systems and over the long.

 

So that we have an understanding of what the long-term impact is on the female body, which is different from the male body, and no assumptions should be made. You know, 68 week trial and you're like, okay, we're good to go. What, ah, that just doesn't sit right with me. It just, it just doesn't, you know, it's like the process of designing drugs and seeking the billion dollar market hasn't changed, but it needs to, pharmaceuticals can totally save lives.

 

Definitely not Antip pharmaceuticals, but profits are as alluring as a size six dress I would imagine. So we get a diabetes drug repurposed as a weight loss drug with no long-term studies on the impact and a wait and see approach to how it's tolerated. And the next thing you know, it takes off on social media and people are buying the wrong creds online.

 

And injecting themselves with it. I did a quick search on wey. I, I don't even care if I'm pronouncing it, actually, I hope I'm pronouncing it wrong. And so this is the, the version of this compound that's been been approved for weight loss. But again, this is weight loss for people who already failed diet, uh, or nutritional and movement counseling, and they have other conditions that are negatively impacting their health, and it's essential that they lose weight now.

 

That was not Chelsea Handler, you know, or any of the other people who, who you know, who you, who they are, who are taking these drugs. So I went online and just did a quick Google search on the wagony, and two ads popped up right at the top. Right at the top of the results book, a 15 minute Doctor call RX sent to your pharmacy.

 

Physicians diagnose, treat, and prescribe prescribed medications via the phone or video consultation. Now, I mean for like, you know, a sinus infection, I get that, but you're gonna send an injectable to somebody's house who's like, doctor, I've tried everything and I can't lose weight. The second ad was, this one floored me.

 

$99. Wey. Buy now. Same day prescription. Online members lose 53 plus pounds without diet or exercise. Wey. Order now. . Oh my god. Like that is horrifying. Quick fix. Drugs aren't new, but what is new is the proliferation of virtual clinician appointment services that promote prescribing drugs in their ads, and we should all be collectively alarmed AF it is.

 

Out of control and it's driven by profits. So I'm pretty sure that we're all done being test subjects and profit makers for pharma. And the way to push back against this is to get educated to, to be able to connect the dots on the reasoning behind why you should not take a drug that is in fact approved for the thing that you wanted to.

 

Right, and, and it's, it's common sense after you get, get yourself out from under the marketing allure and you realize like, oh, yeah. You know what I mean? They may say the side effects are rare, but you know, the fact that I'm injecting a drug into my body that's altering the way my endocrine system operates and the how the hormones communicate with my system, and, and I know.

 

because I'm paying attention and I'm being a good citizen scientist of my own body. I know that we have a very basic understanding of the female system and that these drugs have not been tested on the female system, and there's no long-term data, so I'm not gonna do it. It's really exciting. I really wish that I could jab my thigh with a needle and drop weight, but I'm not gonna do it.

 

I'm gonna resist because I'm gonna be a smart. That's what I hope happens. But the other thing that I just can't get over and then I'm gonna move on, I just can't get over the fact that the weight loss is a half a pound a week. I mean,

 

I am proud of my track record of losing about 40 pounds and keeping it off, and I believe that I operated at about a two pound a week weight loss, and I did it by cooking my own food and swimming.

 

Those are the only two things. I cooked my own food, which I'm not a great cook, so I didn't really, you know, eat that much. And, uh, and I swam, I didn't swam crazy amounts. I just swam and I lost about two pounds a week, 40 pounds, 20 weeks. But you too can pay money to. Put a drug into your body and drop a half a pound over 68 weeks and, and then gain it all back and I have not gained it back.

 

So there you have it now on to something doctors should be prescribing, which is pelvic floor therapy. We'll be right back with Dr. J.

 

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Carol: Dr. Martin is a licensed physical therapist with 13 years of experience helping people with chronic pelvic pain, and is the owner of J M M Health Solutions in Duluth, Georgia. You know, it seems when given the typical options of medications, Surgery or physical therapy.

 

People give more weight to meds and surgery than physical therapy. It's as if we think it can't work as well as meds and surgery, and I have a feeling we are way wrong about that and there is no more perfect person to guide us. Then Dr. Joanne Martin, thank you for being here. I'm so excited to talk to.

 

Dr. J Michelle Martin: Thank you so much for having me ,

 

Carol: and thank you for choosing to practice in this underserved area. And I know how busy it must be to run a practice where a lot of your work is one-on-one, but you also make yourself available to educate people online and to help people understand what pelvic physical therapy is and, and so we're very, very grateful.

 

So thank you. Well,

 

Dr. J Michelle Martin: it's my pleasure and I love what I.

 

Carol: I'm so glad you, you can tell when you, when you come across one of your videos, it's so obvious. So before we dive into what someone can expect in a session with you, can you talk about the power of pelvic floor therapy for the person who thinks physical therapy is what you get when there are no other options?

 

Dr. J Michelle Martin: So unfortunately a lot of people don't know what physical therapy is. P people associate physical therapy with knees, ankles, everything else, but they fail to recognize the pelvis, the pelvic floor, the pelvic region as a part of the body that functions in just the same way we've got joints, ligaments, muscles, nerves, all the same things that we have in the rest of the body.

 

And so why not, right? Um, ultimately though, when we're thinking. Pelvic floor physical therapy. I usually tell people it's seldom the issue that you're coming in with, so it's seldom the urinary incontinence. It's seldom the fecal incontinence or the pain with sex, because oftentimes by the time people come to get help or they're ready to get help, this has gone on for such a long time.

 

Or by the time they found someone who could tell them what's going on, it's gone on for so long that it's now impacted other facets of their life. It's been impact. Physically, emotionally, maybe even financially, all different types of ways. And so when that's not something the medication is gonna fix, that's not something the doctor's visits are gonna fix.

 

So when you're coming to pelvic floor physical therapy, you're coming to a a, a professional. Who is taking a holistic approach, who is taking tr a true biopsychosocial mind, body, spirit, everything, you know, approach to what is going on and recognizing that this is impacting more than just maybe your pelvis a lot of the time.

 

The driving force for a lot of the things that people have, a lot of the injuries and things like that, maybe even outside of the pelvis, right? And. . If we're sometimes so zoned in and focused, we may miss something else. I've had quite a number of clients in the past who have had pelvic floor issues, but it's not necessarily been due to the pelvis directly.

 

It was a spinal cyst. Or it was, you know, in part due to a spinal or hip injury that preceded these issues. And then maybe that's, you know, how their pain started because of compensations and different things like that. It might have been due to an injury, it might have been due to something else. And so we really need to be skillful enough to look in areas outside of just the region where those symptoms may be

 

Carol: coming.

 

And when you describe it like that, it makes such perfect sense that it's all connected. Mm-hmm. , like everything in this system is connected and the things that we can see, the tendons, the muscles and all of those things, it again, it's wild. It seems like we dismiss that. Mm-hmm. and we kind of focus on this.

 

Stuff that we can't see, like these perceived, not perceived, but actual conditions that result in this chronic pain and, and we're trying to medicate them, medicate them, medicate them. Mm-hmm. . But I, I just love the way that you described that because in my mind it really connects it, it makes it logical that this should be a first line therapy.

 

Mm-hmm. for someone who's dealing with chronic pelvic pain to be able. Be in front of someone whose focus is just that, rather than identifying a disease state or a condition state and you know, bringing forward a pharmaceutical or a surgical option to treat it, my mind is blown. And we're just like two minutes into this.

 

Um, so can, can you, uh, cuz I'm one of those people that dismissed physical therapy like for my knees. Um, and, and. I was like, ah, come on. You are just making me do that until I can get to the surgery. And now I realize having done physical therapy for other conditions later in life, it's like, oh wow. I actually could have probably solved this, solved that without.

 

The surgery. It does work. Yeah, it does work. It's just like it's, it's just crazy. So what can someone expect in a pelvic therapy session? I think that is often something that stands in the way. You know, it's like we don't know what's on the other side of your door, so tell us about it.

 

Dr. J Michelle Martin: So a lot of people think, oh my God, they're going to stick their hands in my vagina.

 

I don't wanna go. And I'm like, okay, but before we get. . Hey, how you doing? Nice to meet you. Let's get to know each other a little bit. Right? . So, so what I like to tell people is I don't want people to think of pelvic floor therapy. As, you know, you go to the bar, you see somebody sitting at the counter and you just ask 'em to marry you, right?

 

Like, let's date a little bit, right? So let's just kind of take it back a a a couple of steps. When you come into pelvic floor therapy, your therapist is going to first and for. Here, what's going on? We're gonna sit there and we're gonna listen, right? Oftentimes when I talk to clients, when I teach students, when I, when I mentor, I tell people the answer, 90% of your answer is in whatever they're saying.

 

So if you listen, at least really give the first few minutes, you pretty much got your solution there, or at least a pathway to the solution because they're telling you what's wrong. Just trust them and listen to them. And that's not commonplace in our medical system, right? So we listen to the clients. We are taking a very thorough.

 

Often I am asking clients things as far back. Childhood. What were your bowel movements like? Did you have a history of childhood constipation? Did you have a history of bedwetting? When did your periods start? Did you always have pain with your period? When was the first time you had sex? Did you have pain with the first time?

 

You know, the first time you inserted a tampon? Did you ever use tampon? So I'm going way back even beyond the present issue, because sometimes that information also can give us a really good clue as to what all is happening. and also how long it's been happening. Cuz chances are a lot of these things might have been just dismissed over the years.

 

Mm-hmm. until they reached ahead and a breaking point where it's like, I can't, I can't ignore this anymore. And so we're listening for those things. We're finding out about the current issue, you know, who have they seen, where have they been, what's been done? Has it worsened? Has it gotten better? What's been, what have they done?

 

What have they tried? All the things after that. I usually take my clients through a, a movement. I wanna see how well you're moving. Sometimes this may be relevant, sometimes if it's just a hard and fast. Well, I've, you know, we've got some abdominal stuff going on. It seems more organ related, more visceral related, or more, you know, more pelvic organ related.

 

We may not do as much movement because we know that it may not impact that, but, we'll, we're still gonna do a little bit of movement because again, the pel. is a group of joints and muscles, and we've gotta see how those connect. We've, we wanna see how those are moving because that can play a part as well in what's going on, what's happening above and below this region.

 

How are the muscles and joints moving above and below? Then we go into the actual pelvic examination Now. A lot of people have heard pelvic floor therapists always do internal work. I work with a lot of clients who have histories of trauma. I work with a lot of clients who have chronic pelvic pain. It is not always appropriate.

 

It is not always warranted. Even though I can get a ton of information with an internal assessment, it's not going to be all times that that's gonna be. And I let my clients lead this session. It is very important for people to feel safe. If not, they're not coming back. So they need to feel safe. They need to feel like they're in an environment where they're not being pressured.

 

And I always tell my clients, you're the ones in charge. Right? You have the final say, even though you have consented to this. Is this something that you feel comfortable with doing right now? Right. We do an external assessment where I will look at. Once save this rolled. I look at the genitals because getting a good idea of what's happening there is important.

 

Are there tissue changes? Are there things we need to be mindful of? Um, in terms of the tissue. What does the clitoris look like? What does the labia look like? Do we have some scarring? Is there scar tissue? Is there redness? Anything like that. So getting an idea of what's going on with the tissue nerve and sensory testing.

 

So we're checking for. You know, the nerves, how are they functioning? Do we have appropriate sensation? Um, are you having pain when you shouldn't be? Are you feeling, you know, feeling like pins and needles when it shouldn't? Do you not have any sensation at all? And then if it's appropriate, if they've consented to it, We can do an internal assessment, and then we're looking at muscle strength, muscle coordination, uh, muscle endurance.

 

We're looking again at pain. You know, we're looking again at nerves. We're looking at the different levels of the muscles. So we have three layers of pelvic flare muscles. We're looking at the cervix, right? So we're gonna go all the way up to the cervix and we're looking at tissue mobility. How are the tissues moving?

 

Are you know, is there any pain? Is there anything going on? We're doing the assessment with and without hip. because now that I'm assessing this, how is this different when I move your hip? How is it not, you know, how is it different when I don't move your hip? And then we're gonna sit down after all that said and done, and we're going to discuss all these findings, and we're gonna talk about how this correlates to what their symptoms are and what's going on, and determine a plan of action.

 

Sometimes a rectal exam may be warranted, you know, if they're having a lot of bowel symptoms, if their symptoms are, um, certain condit. Prolapse, pain, bowel dysfunction, um, different things like that may also warrant a, a rectal exam. If it's a male client, they'll have a rectal exam as well. And so again, this may be something that might be done the first day.

 

It might not always be done on the first day, but once we gather this information, then we can get an idea of what's happening and then we can determine those next steps. Sometimes the next step may. that they need to be referred to a specialist. You know, I, I had someone come in recently who had to be referred to a VUL dermatologist because I suspected that this individual had lichens sclerosis, even though they'd seen like three doctors and another provider before they saw me.

 

And sure enough, they did have lichens sclerosis and we were able to get them started on the appropriate treatment and. , sometimes we may see, you know, dermatological changes. We may be able to pick up on those things. Sometimes we may be seeing things going on where it looks like the tissues may be estrogen, um, deficient, or their findings that the, the things they're complaining of and all that we are seeing may be consistent with that and we might need to refer them, um, maybe for some topical estrogen and things of that sort.

 

So it's really just a matter of gathering all of those different data points to, to figure out what's best for this individual.

 

Carol: I saw on a website that, I don't believe it was your website, but it was, it was one, uh, I think it was a pelvic floor guru or Pelvic Pelvic guru. Yeah. Where they talked about how an internal exam can be empowering and, and I thought that was a really fascinating way to describe something that can be really intimidating and scary for people.

 

Can you talk to us about how it can be empower? .

 

Dr. J Michelle Martin: Well, a lot of the times, most people assume that it's going to hurt. They assume that they're going to be in pain. And oftentimes my clients are very surprised when we do an internal exam and we're done and they go, that didn't hurt at all. And I go, why'd you expect it to hurt?

 

And they say, well, I've never been to a gynecologist appointment where I was not in pain. And I said, well, my job is not to put you in pain. My job is to make sure you feel comfort. . And when you're in a situation, an environment where you feel comfortable, I've explained everything to you, you understand what's happening.

 

You also have been given permission at any point in time to say, you know what? I'm not comfortable, and that's okay. And don't feel bad about that in any way. So once you've been empowered to that, to that level, it also makes it a little bit easier. And when we're doing, we're checking for specific things, telling you what's happening along the way.

 

And oftentimes most people are like, oh my. . That's amazing. So you mean I can do this? And I'm like, yeah, you totally. .

 

Carol: That is wild. So it's a combination of you taking the time to relax us and making sure that we feel comfortable so that we kind of release a bit. And then also taking the time to explain what's going on, which to me, it kicks off this opportunity to be curious about your system and kind of connect with it in a.

 

Partner kind of way, you know, rather than this feeling of, you know, my body's against me or I hate my uterus, or we get into these, um, kind of ruts or maybe it's not a rut. We, we sort of develop a relationship with our body that's not supportive. Mm mm-hmm. . With, with, with good reasons, you know? Yeah.

 

Because we're in pain all the time and, and so that is something I never connected with. Pelvic floor, physical therapy, the idea that it is kind of like relationship therapy for you and your body, , you know, to get you in in touch. Mm-hmm.

 

Dr. J Michelle Martin: in a sense.

 

Carol: Yeah. Very wild. Have you worked with people who have been, um, living with endometriosis or living with a chronic condition like that?

 

And, and if so, what have you discovered about working with these people and how, you know, how their body is impacted by the condition and then how you can help them? .

 

Dr. J Michelle Martin: Oh man. I love working with persons with endometriosis and I, and I do a part of my clinic. I mean, a lot of people know me for perinatal work and probably just as many people know me for chronic pelvic pain because those are my two loves.

 

And within that chronic pelvic pain bracket, I do see a lot of persons with endometriosis and a lot of other chronic pain conditions. Endo is interesting because a lot of the time persons are coming to me with endometriosis and it's been diagnose. You know, sometimes I'm the first person who has put all the, the symptoms and the findings together, and I'm referring them to the next step and saying, Hey, let's follow up here.

 

Here's what I think is going on. Here's what we need to do. And even so, sometimes they've already seen multiple providers and that's just the problem. They've been through so many people. , they feel like their body is failing them. They've dealt with this for such a long time. They're in chronic pain all the time, and a lot of people just assume that endo equals bad periods, and it's snot because endo.

 

For the most part, it's systemic. I mean, by the time, you know, you've been in pain for so many years, we're talking chronic pelvic pain. It affects more than just your pelvis. You know, they may be having pain not only during their, their menstrual cycle, but in between cycles as well. They may be having pain, um, elsewhere in the abdominal wall.

 

They may be having, um, difficulty with breathing at times because it's, you know, they may be one of those people who unfortunately are. Lesions in the thoracic cavity. The beauty of pelvic floor physical therapy though, is because we work in the pelvic region, because we understand just the way that the body is.

 

We understand that endometriosis impacts not just the uterus, like some people assume and believe, but it's really lesions and an inflammatory process within the. Which means it's going to impact the muscles, it's going to impact the nerves, it's going to impact the, you know, you're gonna have some, some people who have congestion.

 

So pelvic congestion syndrome may be a part of that. It's going to impact just the nervous system, and more often than not, we have these individuals with a very upregulated nervous system and everything is setting off, you know, their pain. And so I liken that too. You know, I always tell my. Think of it as your, your home alarm system, right?

 

When it's functioning well, if a burglar breaks in, then the alarm goes off. But if your little dog sparky is walking around in the house, the alarm shouldn't be going off. And if the leaves are blowing off the trees outside the alarm shouldn't be going off either. So if your alarm is going off or the leaves blowing or sparky walking around, we've got a problem cuz it's, it's on high alert for no good reason.

 

So when the burglar does break in, we don't know the. Right when, when the big stuff happens, we don't know the difference. And that's kind of like endo. The body is so wired, the inflammation is so, so significant that these individuals more often than not are having chronic pain, significant pain all the time, and everything seems to flare them up.

 

And part of our job is to kind of calm that down, help them to be in tune with their body, address the muscular issues, address some of the inflammatory stuff with my clients a lot of the time, because I have a health coaching background, we go through. a lot of the health coaching principles. So we're talking about, you know, lifestyle management and all of these different things as well.

 

We're talking about how to, you know, how is this impacting bowel and bladder, and we're addressing those things from a pelvic floor perspective. We're talking about how endo affects sex, and we are addressing that from a pelvic floor perspective. in addition to their pain, in addition to any movement abnormalities in addition to their abdominal wall.

 

Cuz sometimes people just forget the abdomen . Um, we need to make sure we've got, you know, we're, we're looking at that too. We're looking at the diaphragm. How are they breathing? Do they have good gut motility? Is there any manual work that we need to get in there and do, um, to those tissues to help them as well?

 

Things that we can teach them to continue at home, getting partners. A lot of the times I spend a lot of time educating partners and family members as well who are ready, willing, and available to help individuals who may be dealing with, uh, endo or other chronic diseases as well. So there's quite a lot that we can do and, and again, this is gonna be very dependent on what this person is coming in with.

 

Some people may be highly symptomatic and some people may not be. Some people's only symptom may be pain with sex. Some people may be having urinary issues, bowel issues, you know, the whole gambit, but whatever. You know, ultimately if it's between the belly button and the knees, we've got it covered. And so we're really working on making sure that all of those systems are appropriately restored.

 

We're making sure that this person's nervous system is calmed down so that it's not so flared up just at the slightest. Thing. And, and they also know how to manage it, right? So we want them to be in tuned with their body to know, Hmm, this doesn't feel right. I remember what Dr. Jay said, let me do this. Um, so that we're, we're also giving them the tools that when we're not there as pelvic therapists, that they can also manage these things while on their own.

 

Carol: Yeah, that was an amazing analogy that you used about the nervous system. And you know, these are things that we don't often get educated on when we're in a doctor's office, and I'm not throwing any blame there either. It's impossible in, you know, 15 minute consult to do a full anatomy deep dive and, you know, take care of everything else that they have to do.

 

So the. System. Can you talk to us about when it's, and I don't wanna say pa, when patients ignore pain, cuz that's really not what's going on. When people are having their pain complaints dismissed and they themselves may be minimizing their pain because of how they were raised or how they were taught to communicate about their bodies or their feelings and they're minimizing this pain and so, and the pain is continuing on.

 

Can you talk about that tipping point where the nervous system. Is, and maybe I'm not asking this question right. Uh, the, the tipping point where the pain becomes chronic pain, which is a different animal, and that is where the nervous system gets involved, right? So can you just speak to the, the person who might be dismissing those early signs?

 

So

 

Dr. J Michelle Martin: ultimately, chronic pain is typically any pain that someone has dealt with for over six months. When we, we think about chronic. . Um, we think about people who've dealt with any type of pain for a long time. In our, you know, we know the stories of people being gaslit. We know the stories of people who've been dismissed.

 

Oh, you just need to relax. It's in your head. That kind of stuff. What it does is, one, it creates a situation where people may feel like, why I really don't know my body. They feel a little bit insecure in their body. They feel maybe a little bit insecure in their knowledge. Two, it can create a lot of mental.

 

And a lot of stress. The problem with that is though, is that the body is, everything is connected. So now if this person is over here being highly anxious, being highly stressed out, raising cortisol levels, right, it's adding to the inflammatory process in the body, which kind of then feeds into the pain anyway, so now we're, we're constantly having this.

 

Flare up and they don't know where it's coming from, and half of it is just the stress of the whole situation. The longer it goes on. So let's say, for example, I love using something as simple as like a the knee or a leg, because people can kind of see and relate to that. If I hit my knee and I hit it hard enough.

 

Sure my knee will hurt, but if now I'm not moving my knee because somebody's telling me, well, your knee doesn't hurt, you should just not move it, you're fine. So I'm like, well, maybe it doesn't hurt. Maybe it's all in my head. Maybe I just won't move it. Right. So now we're not, we're not moving the leg. So now our knee mobility is decreasing.

 

So now we've got decreased mobility. Well, now how is that affecting the structures around it when now the muscles around the knee? Well, they, they've gotta move, but now we're affecting their range of motions, so, , they're not moving, and that becomes an issue. So now when they do go to move, it's a little bit more achy.

 

So now it's feeding into that pain, but it's just hurting so much and the inflammation is continuing. So now the inflammation spreads and it's now not just the knee where you hit. It's all the structures around it. And so now the structures around it are getting irritated too, or like, I like to tell people, it's kind of like when you're in a studio apartment, it's just meant for one or two people.

 

It's not meant for 20, so it's like now the 20 people are in the studio, right? . It's

 

Carol: uncomfortable.

 

Dr. J Michelle Martin: And so it just continues to hurt and you've got more and more structures involved and the longer this. , the more structures become involved, such that when we do actually get it fixed, six, 12 months, a year, 10 years down the road, we're not fixing the fact that I hit my knee.

 

We're fixing all the other things that are involved, which is why when people are like, oh, I got back pain. I got this pain, I got that pain. I'm gonna have the surgery. And they think, oh, it should go away immediately. Well, the longer that you've lived with that, the longer you've dealt with. , the more problematic it becomes because it's not just that particular fix that's necessary.

 

We still have to address all the other things that were impacted. Yeah, and this is what happens with chronic pelvic pain. There are a lot of different structures that are impacted. The pelvis is not a huge area, so there are a lot of things that are impacted. And even if it starts out as one issue, let's say again endometriosis.

 

We've got endometrial lesion. The longer that they persist, the longer that they continue to manifest. The more inflammation develops, the more things become involved. The pelvic floor muscles get involved, the pelvic nerves get involved, the blood vessels get involved. We may have more, you know, some organs getting involved.

 

More things become involved, and so now we're dealing with a lot more than. Well, I've got this endo. Yeah. Cause I, that's kind of what people think of it as like a singular entity, but it's really a whole lot more going

 

Carol: on. You know, I, I know we, we need to wrap up, but I wanna squeeze in two questions. One is pelvic floor therapy for doctors.

 

Top of mind for them because I, I know that a lot of people who are dealing with Endo as an example, they may not be in a position to go on any kind of medications for it, and they may not be in a position to have surgery. Are these doctors saying, get the into a pelvic floor therapist's office now, and if not, why?

 

Dr. J Michelle Martin: oftentimes not. And I don't think that it's top of mind for a lot of doctors. Some people don't know, and I tell people all the time, people don't know what they don't know. So for some doctors, I feel like they should know, but for some doctors, they're just not recommended. I've heard some doctors even tell me, well, I didn't think it was gonna work, so I just didn't refer people.

 

And I'm like, well, it's kind of not what you think, because the medication half the time, didn't work. You still prescribe it, right? . So it's kinda like, and you know, but, and, and not to be in like a rude or cheeky way, but like, we can prescribe medication and that may not work. Why can't we prescribe something like pelvic floor physical therapy, which is non-invasive, scientifically proven for many of these pelvic issues.

 

And we know that it works. We know it works, and we know that people feel better. And so what I say to the doctors is this, definitely try connecting with the pelvic floor therapist in your area. . If there are things that people need to, to, you know, that you need to be educated on, then find somebody to help you understand why.

 

And you know, like I love educating, you know, I'm faculty with the American Physical Therapy Association. I love teaching. I teach PT students like. I'm happy to sit down and talk to you about these things because I think it's important at the end of the day for our clients to have all that they can have to address these issues so that they can get back to quality of life.

 

Quality of life is the thing that people want at the end of the day. .

 

Carol: Yeah. And oftentimes that's, you know, not really addressed. I mean, obvi in, in a, in a typical, um, appointment for something like fibroids, you know, it's, it's more like, let's, let's do the medications. Well, the medications are ruining my quality of life.

 

Mm-hmm. . And, and what I'm hearing from you is that like pelvic floor therapy, it's almost like I'm picturing. that in my pelvis exists, my brain, my heart, and my uterus and my intestines and, and colon and rectum and vagina and all of it. Right? Because it feels like, doesn't it feel like that is the center of the body?

 

Like when we, you know, it is our. core. And I feel like when we're hurting emotionally, we feel it in our core. Yeah. So, okay. Last thing, um, quickly, if, if this quickly, but I hope you'll come back on before you go. Can you leave us with a visualization that we can do or just something simple that we can practice that can help us connect better with our pelvic region?

 

Dr. J Michelle Martin: So oftentimes I think the biggest thing that people need to. Than, is that the pelvic floor muscle? Most people hear about Kegels all the time. They wanna tighten, tighten, tighten, tighten, tighten. And I'm like, sometimes we just need to let go. Our society is very busy, very fast paced, and sometimes we just need to relax and let go.

 

And so what I like to tell people is if you can lie down, fine. If you can't and you're sitting down, just place your. At your stomach, at your stomach, in your center, close your eyes. Just be still for a while. Just try doing nothing for a little while. And then once you feel comfortable, take some deep breaths.

 

Try to breathe into your hands. So if your hands are on your abdomen, try to take a big breath feeling that abdomen spam. But I want you to slow it down. . I want it to be very slow. I want it to be very intentional. And as you breathe in, think about what's happening at the vaginal opening. Can you open it or does it feel like it's clenching?

 

What it should be doing as you breathe in is opening. So I want you to think of just opening gently as you breathe in slowly, and then just exhale. See if you can keep it open a little longer. Take a deep breath, and again, open. And then ex ha. and do that at least about three to five times, wherever you are during the day, just trying to tap in.

 

Our muscles. Most people know how to shorten the pelvic floor. They know how to feel that vagina close and feel those muscles lift. And oftentimes they don't know how to do the reverse, which is really important. So just taking some time, slowing things down, connecting with the breathing, connecting with yourself.

 

It's okay to do nothing, y'all. It's really okay to .

 

Carol: Yes, we don't care it enough, but it's okay to do. Coming from a parent I and who's running her own business, I, I hope that you get a chance to do nothing. And so I'm gonna let you go. But before you leave, can you tell us where we can find you online?

 

Dr. J Michelle Martin: Absolutely. So you can find me at www.jammhealthsolutions.com. Um, every, all of our information is there. Email, contact, all the things. Um, you can schedule appointments online as well. You can call our. 7 7 0 7 9 0 1 4 6 0 and you can find me on Instagram at the pelvic

 

Carol: perspective. the pelvic perspective on Instagram, and we'll put all of those links when we post this on social media.

 

Dr. Jay, thank you so much for being here. That was a whirlwind, deep dive and exactly what I needed to imagine the benefits of pelvic floor therapy, so thank you.

 

Dr. J Michelle Martin: Thank you so much for having me.

 

Carol: We'll be right back with ending on a high note.

 

So the World Bank reports that almost all children in Western and Central Africa now attend primary school with enrollment rising from 50% in the 1990s to nearly 90%. Giant applause. That is, oh my gosh, that is something truly to celebrate. Enrollment in high school is increasing too. More than doubling in the last decade to 55%.

 

You know, education brings community stability. It brings personal stability, it adds to self-esteem. It adds to feelings of, um, being in control of one's self. It creates opportunities for the future for the person and their community. In the case of what we do here, education helps people pay attention to their health and get on a healthy track with support.

 

I mean, education for everyone means a planet that is best positioned to thrive. There are no downsides unless having an uneducated populace is the goal, which seems to be the goal of Taliban and Afghanistan where girls and women are prohibited from attending school. You know, don't fear educated girls and women, you'll survive.

 

It's okay. You'll survive and likely thrive. because of their achievements, because of what they contribute to our planet, to companies, to the communities that they live in, to the people that they surround themselves with, and the people that they help. And so it is so exciting to see in Western and central Africa this rise in enrollment and the fact that almost 90% are attending.

 

Congratulations. That is amazing. Thank you, angel, for producing this podcast. Thank you Maryelle, for helping produce this podcast too. And thank you to the team at Uterine Kind for everything all the time. Oh, I'd like to ask for you to do a favor. Could you please subscribe to Hello Uterus, wherever you get your podcasts.

 

This helps people discover the podcast, which can help those needing support and education because they're living. Symptoms of, of bad periods, which we know aren't a thing. And visit uterine kind.com to learn more about the U by Uterine kind app. It is now live. You can download it@uterinekind.com and take advantage of a seven day free trial.

 

I have been using the app now consistently for several months, and I'll talk about it on a podcast in the near future. Um, the changes have been really remarkable. The one thing that I will leave you with is that I feel more in tune with my body and I have a greater respect for my body, and I have more conversations with myself about my wellbeing.

 

So that has been super, super cool. Thank you for listening. And we will be back next week with another episode of Hello Uterus. So until then be well be cool, be kind.

 

Angel: The Hello Uterus podcast is for information use here is not used to or treat medical condition. Please ask your physician about your health and call 9 1 1 if it's an emergency. And thank you uterine kind for listening.