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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

An Australian Success story: Olive & Bee – A new intimate cream

This week’s blog is about a new intimate cream called Olive and Bee. It has been on the market for over 2 years but I recently attended a conference in Hobart for the Continence Foundation of Australia and Claire Osterstock, an Adelaide based pelvic health physiotherapist and inventor of Olive and Bee, had a space there and I went and had a chat to her and learned more about her product. Soon after I went to an Australian Physiotherapy Association lecture night with the wonderful Dr Susan Evans, a pain doctor who shares her time between Adelaide and Brisbane. Susan was waxing lyrical about Olive and Bee at that lecture night. Fortunately I had asked Claire to write me a blog (when at the conference) and tonight that blog (see below) has popped into my inbox. I started trialling Olive and Bee with patients during this last week and I think it has an important role, particularly for those women suffering with vaginal dryness who are not able to use local oestrogen due to breast cancer concerns. (It is always important to check with your oncologist about using local oestrogen because many times you will be allowed to use it but it is up to the oncologist). Claire’s blog about her journey developing her product follows below.

Claire Osterstock

I am a Physiotherapist in Adelaide, Australia, with a special interest in helping women and men with management of pelvic pain. One part of my roles is to advise on personal lubricants, but I was disappointed with what was currently on the market. Almost all lubricants contain synthetic chemicals and preservatives which sometimes cause irritation. They can interfere with the sensitive vaginal tissues and clients would often report burning and itching after their use.  Most women are also not comfortable buying lubricants, mostly due to their names and packaging. So I teamed up with a compounding pharmacist and went about creating a new all-natural intimate cream.

Simply Olive and Bee was born!

26 recipes later, the perfect product was created! Extra virgin Olive Oil was chosen as a base, as it is naturally antibacterial and anti-fungal and is high in antioxidants and is self-preserving without the need to add chemical preservatives. Olive Oil also has a low comedogenic rating, hence it is less likely to block pores than other oils such as coconut oil. It was formulated with beeswax as this is a natural thickener with anti-inflammatory properties. Both substances are anhydrous, which means they have low water activity and therefore don’t grow nasty bacteria, fungi or mould. The low water content also means that they won’t interfere with vaginal pH as other substances can.

Why an Intimate Cream?

We have decided to use the term “Intimate Cream” as opposed to “Personal Lubricant”. Firstly, this has less of a sexual connotation and we feel it makes the purchase easier. Secondly this product has multiple uses apart from intercourse! Women can experience vaginal dryness or itching from several causes such as menopause, breastfeeding, and skin issues. This product is safe to use as a vaginal moisturiser or for moisturising of sensitive mucosal tissues such as a protruding prolapse. It may be used to help insert a pessary, dilator or even a suppository. In fact it can be used anywhere on the body – we also use it as a body moisturiser and heel cream! Those people who need to keep their skin moist, such as people suffering from eczema will find it moisturises their skin to lock the bad bacteria out. It also makes a great massage oil without leaving a greasy feeling on the skin.

 100% NATURAL.  100% ORGANIC.

ABSOLUTELY NO chemicals, preservatives, flavours, colourings or additives.

100% Australian Made.

I hope you enjoy my new product and find it soothing and helpful for vaginal tissues. 

Thanks Claire for your blog and I hope some women who are suffering with an incompatibility with other lubricants or are after an organic product may be interested in trying Olive and Bee.

It is available from Olive and Bee website.

I am hoping the next blog will have some nuggets from the Melbourne Explain Pain conference (EP3) I am attending at the moment. This is the fourth EP course I have attended and each time there are multiple new gems of information which I hope to share with you.

It has been a sad weekend in Melbourne with the horrific incident in Bourke street.

An incident like this focusses your attention on the importance of saying plenty of “I love you’s” to those who you love when you finish a phone call or leave the house/country and to realise so much about life is luck.

I (foolishly) say to my kids who are overseas travellers “Always keep your wits about you” “Look behind you” “Be aware”…… when they walk around London and other European cities but as I was in the city yesterday to buy some food it was bleeding obvious that when it’s crowded (and it was crowded) there is no opportunity to really see stuff like that coming.

It’s just all about luck.

That restaurant owner of Pellegrini’s (who appears to have just gone out to help someone he thought was in need) was oblivious to the potential horror and was just doing what he’d done hundreds of times before – offered a helping hand to someone.

Unfortunately bad stuff went down and a much-loved man died. Such an abominable waste.

I was amazed at watching the bravery of the police officers and civilians. I hope they are able to keep contributing and don’t suffer too much with the absolute horror of that 10 minutes……….

 

We have no need to be afraid

……..For those who’ve come across the seas
We’ve boundless plains to share……

I met a wonderful nun recently who works with refugees and we were both despairing about the children on Nauru situation and she was telling me some wonderful stories about refugees who she has helped in her work. I asked her to write some down for me. I feel so many Aussies don’t have contact with refugees and so when there is negative diatribe from the papers, the shock jocks and politicians trying to stir up fear and hatred, it is easy for the general public to follow along without questioning the truth of the comments.

I have watched many an ABC show on the wonderful contribution many refugees have made to Australia and particularly outback Australia and have seen whole towns rally together to make representations to Immigration Ministers on behalf of different refugees to prevent their deportation.

Refugee success story in Toowoomba

Here are some of her stories to make you stop and think about how much refugees may have to offer our great big brown land.

  • In the early nineties among those refugees who arrived in Brisbane was an Eritrean woman who had been a guerrilla fighter in her country’s war to gain independence from Ethiopia.

Her close friend here at that time, however, was actually an Ethiopian woman forced to flee her country with her youngest child. For these two, hostilities abroad were not to be entertained here.

This Eritrean woman is an outstanding leader in her community and more widely among women from many African nations. She has shown great resilience, imagination and determination over so many years. From early on she has worked to help immigrants settle into their new home. She heeded a later request to help women find work. In her words: I asked myself what was the one skill that so many of these women bring with them and that could help them succeed? Cooking!”

She set up a restaurant in 2004 called Mu’ooz Restaurant and also provided training in hospitality for such women preparing them for future work. Over 150 women have passed through the course. Her restaurant is a popular meeting place for many groups – the next will be an occasion for refugees and others in the community to meet and to share over a meal through the Welcome Dinner movement. The restaurant also caters for outside events.

She believes that everyone wants the same thing for themselves and their families – to have peace, to be loved and accepted.

Food preparation at Mu’ooz

  • Her friend from Ethiopia had been forced to leave behind her husband and three older children when she fled to a neighbouring country with her baby. This child began school here in suburban Brisbane. The struggle then was how to reunite the family from whom she had been separated for around six years. Her husband had meantime died. When official permission was given for the children to come, the next hurdle was finding the money for the fares. The primary school her son attended was approached and took on the task of helping to raise the funds.  The teenage son had meanwhile taken off at this critical time and had to be found. When the mother who prayed nightly for hours was asked how she found the boy, she replied: I didn’t find him, God did. Finding him happened in part through the help of an Australian religious Sister running a health clinic in their town.

A very excited boy featured on the ABC breakfast programme of the time telling how his school had succeeded in raising the money and announcing the imminent arrival of his fellow pupil’s brothers and sisters. Out to the airport went a welcoming party – mother looking, as someone remarked, like the Queen of Sheba in the stunning white, gold trimmed national dress, along with the youngest child, the school principal and several others. It was a happy, tearful occasion.

  • Poignantly among those welcoming the three children arriving from Ethiopia was another mother with her child from Tigray. As I looked at her, I saw a mixture of emotions – happiness for her friend but pain that her own partner was still far away. Eventually he was able to join her. As an eight year old, their daughter was prone to correcting her mother’s English and when reminded  that her mother spoke two languages (it was actually three) declared very authoritatively : It’s not important to speak the language where you come from but only to speak the language here!

The family now with two boys born in Brisbane, moved to Melbourne where the mother received an award from the top hotel where she works as the best employee over all levels of staff. When reminded many years later of her earlier comment, the daughter immediately conceded: ‘Yeah, sounds like me’ and went on with composing the valedictory address she was chosen to deliver at her High School’s Speech Night. Now with a degree in media,  she is studying international affairs and working in the Immigration Department.

  • Many of those forced to flee Afghanistan are from the persecuted ethnic minority, the Hazara who have been pushed into the least productive parts of their country where living is hard. Several school-age boys came as ‘unaccompanied minors’ sent by their parents to escape the clutches of the Taliban.

An English teacher at their Migrant School in Brisbane decided to form a soccer team to provide these boys, including other Kurdish, Iraqi and Sudanese members, who had no family support here and who often didn’t even know how or where their family members were, with a community. The Tiger 11 Football  team was born. As well as fulfilling their desire to succeed on the field, the boys made wonderful contacts with other young people as well as older citizens, many of whom did not know or even care about refugees and their uncertain situation as temporary visa holders.

As the manager of the nearby sporting club that the English teacher first approached for assistance and who kick-started the team’s endeavours remarked:

‘Well I was of the opinion that the boats should be turned around or even that they should be shot at … but then I had never actually met a refugee.’

In case you are wondering where the verse originates at the beginning of this blog- that is from the second verse of the Australian anthem – Advance Australia Fair.

Click on the image if you want to read the words more clearly.

Thank you to Sister Genevieve who wrote the stories. I wish we could all understand the stories behind the people. We might all feel more compassion.

 

 

A personal story from a pelvic health physio: Nadine Brown

Many physios who go down the pathway of women’s health and pelvic health physiotherapy, do so after the birth of their own child/children.

Some do so because their experience has opened their eyes to the magic of understanding more about the birth process and the changes, many positive to their bodies and to their lives from producing another human being.

Others do so because the experience has been quite traumatic and has had a serious impact on their own well-being, both physical and psychological. One such pelvic health physio is Nadine Brown, who is happy to openly talk about her personal journey and hence there is her name and there are photos. I have chatted with Nadine at a couple of professional development gigs about issues and I asked Nadine would she be happy to share her story and write a blog for me and she has. Nadine’s story follows.

“The world breaks every one and afterward many are strong at the broken places.”
Ernest Hemingway

When Sue asked me to write a blog for her about my birth story, I had two thoughts. The first, “Wow, Sue wants ME to write a blog for HER website!”, and second, “How can I put into words, the emotions I have felt as a result of the physical changes I experienced since having my son nineteen months ago?”

My birth story goes like many others. Vaginal delivery, gas for pain relief, no major tearing or medical issues (small amount of internal stitches), discharged from hospital, healthy big baby, tick tick tick.

But it would seem, as time went on, things just weren’t right “down there”. It was not until many months after the birth, I was told that the birth of my healthy, robust, 9lb “steak n chips” baby boy, left me with anterior wall prolapse and levator avulsion (LA) – a complete detachment of one of the pelvic floor muscles from the pubic bone.

I was devastated.

Being a physiotherapist, with a special interest in pelvic health, I regularly treat women who bear the physical and ultimately, mental health ramifications of birth injuries. I get comments such as “No one told me this would happen”, and “I can’t do the things I used to do, I’m miserable, I had no idea it would be like this”.

They are grieving.

They grieve their pre-baby body.

They grieve their intimate relationships and sexual confidence.

They grieve not being able to just throw on the runners and go for a jog. They’ve lost confidence in their body. And they believe they can never go back. This is grief and it is very real. The realisation that I too had these birth injuries, put me into the cycle of grief.

What are the stages of grief, as we know it in the mainstream? Denial, Anger, Bargaining, Depression and Acceptance.  I know unequivocally, I went through each.

I was in denial. Denial that my baby came so fast, that even my midwives were shocked. Denial that I didn’t get the elective caesarean that I had planned.

There was anger, that despite trying my best to mitigate the risks of a vaginal delivery (because there are many, which are finally being brought to more mainstream attention thanks to social media), I was suffering physically and would for a long time post-birth. Anger that I fought SO. HARD. for an elective caesarean birth but I felt bullied by the midwife when I was vulnerable with horrible scare tactics and I didn’t get the caesar. Anger that I didn’t just bounce back. Anger that some friends didn’t quite understand why I wasn’t the old me.

Bargaining – “Well maybe I can just walk-jog instead of proper running” “Maybe I can just swing a lighter kettlebell?”.

Depression was the worst. It was a black hole, I described it to my girlfriends as quicksand. I could feel myself going down but I couldn’t stop it. I filled out depression questionnaire after questionnaire with medical professionals, they always came up as ‘Severe Postnatal Depression & Anxiety (PNDA)’. I knew it, I felt it, because I was a sleep deprived new mum with no village support and the realisation that my “self” was profoundly different – forever.

I put on 20kgs during my pregnancy, and lost 25 in the months following – I became unwell, and postnatal depression hit me like a freight train. I also lost confidence in being able to offer advice and help to other mums from a professional standpoint. How could I possibly help others if I couldn’t help myself? I had so much healing to do physically and mentally. My social media was that of a doting, yet very tired mum with a beautiful baby boy. Smiling happy faces, pram walks and a squishy sleeping infant. Yet, I was paralysed by PNDA, that had me struggling to even leave the house some days. I finally admitted that I needed help to come to terms with some of what I was feeling, as well as the rage and anger that sometimes comes with being a parent of a baby who never sleeps. I realised I couldn’t process my grief alone anymore. 

Right now, I’m working on acceptance. It is a process, but I’m ok with the healing, however long that takes. I see the purpose in my pain now, purpose in my journey. And like any good Women’s Health Physio, I’m diligently doing my pelvic floor exercises and slowly re-entering the exercise world that I loved so dearly before I had my son. I see hope, I see effective treatments that will give me my confidence and quality of life back. I see intimacy with my partner again. And running around with my son.

I’m sharing my story as a way of reaching out to so many mums who are going through these changes. The 4th trimester – the postnatal period -is not a race, it’s not a competition. It’s not all #fitmum #blessed. It’s not even just about the baby. It’s about the birth of a mother. There can be overwhelming joy, but also polarizing grief.

If you are going through this right now, please know there is help. There is HOPE. Make self-care a priority. Start by talking to your GP. Find a good one who will listen. And most of all, be patient and kind to yourself, Mumma, this is one hell of a tough gig.

Thanks Nadine for this very personal blog. It’s always difficult and somewhat confronting ‘to come out’ with struggles such as PNDA and disclose the pelvic floor issues that you may be personally having, but as one who has had pelvic floor dysfunction for nearly 30 years, I do think it helps patients to understand that there is life after a birth which changes your anatomy and they feel somewhat comforted by the pelvic health physio who is living the symptoms the patient is experiencing.

Good luck on your continuing rehabilitation and remember it’s a life-long committment (your rehab AND your job- once the pelvic health bug gets you, you become passionate about it forever) and keep focussing on what you know you CAN do not what you think you CAN”T do. There is still lots of fun to be had from life -especially one enriched with a (non-sleeping) baby!!

If this blog has raised any issues for you contact Lifeline 131114 or Beyond Blue

The Australasian Birth Trauma Association (ABTA) not only has an active Facebook group which you can join and participate in conversations, but also has recently instituted a Peer2Peer counselling service to help support women who have suffered a birth trauma. Check out the facebook group page for more details.

Benefits of regular exercise

Today’s blog has been written by one of my physios Alexandra (Alex) Schafer who not only sees our pelvic health patients and musculo-skeletal patients but also teaches at my studio- Studio194. Even though we are closing the studio at the end of the year, Alex, Megan, Martine and Jane will still be conducting one-on-ones, two-on-ones and three-on-ones at the rooms at Hampstead Road, Highgate Hill. I asked Alex to write about the benefits of establishing a regular exercise programme – and while it is never too late to begin a regular programme, there are obviously long-term benefits of getting to love exercise early in life. Alex’s blog follows.

We all know that doing exercise regularly is valuable and evidence shows that exercise is very beneficial to living a healthier life. I am passionate about getting everyone to move and enjoy exercise regardless of what they decide to embark on. Starting an exercise regime earlier in life will help you to stay fit, strong, and embrace any physical challenges our life stages such as menopause may present.

From research we know that from around 30 years of age (!- yes that early), muscle mass, muscle strength and physical performance deteriorates. This results in a 10% decrease per decade in aerobic capacity (Gielen et al 2012). Ageing also affects the pelvic floor, which are striated muscles like the rest of our skeletal muscles and can lead to symptoms like urine leakage (Klauser et al 2004).

Decreasing strength overall may also lead to a higher risk of falls, more aches and pains as well as difficulties with everyday tasks. Here is the good news: exercise on a regular basis will help to keep the muscles fit and strong, it will make you feel happy and strengthen your bones. People who start with a higher aerobic capacity and keep up an active lifestyle will maintain a greater fitness level throughout their life (Ades at al 2005).

It is the little things done regularly that will have an impact on your physical health like choosing the stairs over the lift, leaving the car at home and walk or park the car further away from work. Making the effort to do a proper squat or lunge to pick up things from the floor will help to strengthen your legs. What we also know from research is that high intensity exercises, for example resisted upper and lower limb movements, are important to maintain or improve bone and muscle health (Russo 2009).

During Pilates classes at Studio 194 (and when we move the classes to Hampstead Road) we often use weights or other resistance (like theraband or pilates circles) to challenge our muscles in order to achieve muscle growth. If you load your muscles enough then your body will adapt after the workout and as a result the muscles grow bigger and more importantly stronger. Strong muscles, particularly around the trunk and the legs, are important for many everyday tasks and for balance.

Osteoporosis is a common disease that decreases bone density which increases the risk for fractures. Women have a higher risk of developing osteoporosis after menopause. Physical exercise is important for maintaining and improving bone density. Exercise has to be regular and with a certain amount of impact. During childhood and adolescence maximal bone strength is usually achieved and then optimised during early adulthood. Regular exercise reduces the risk of bone loss in older age.

What I am trying to say is that exercise throughout life is important and very beneficial, it is never too late to start but the earlier you start the better.

I would like to encourage everyone to exercise, move and have fun doing it! In my classes I try to challenge everyone and I might give different variations depending on the level of fitness and strength. The most important thing is that you enjoy what you do. This is the key to sticking to any programme which ultimately is the only way to improve and maintain strength, flexibility, healthy bones and joints. Sometimes it can be difficult to get started and initially it might be really hard work. But set yourself goals, like a 3 month plan and see what happens. There is a very good chance that you will love your exercise after doing it for a while and getting the hang of it. See you at Studio194 until early December and then at 47 Hampstead Road Highgate Hill after that.

Thanks Alex. While we will miss the studio, I am looking forward to saying to patients: “Make an appointment with the girls for some sessions downstairs”. I will show some photos once it’s set up in the New Year. Don’t worry- the Running Clinic will still be happening downstairs as well!

I am off to the National Continence Foundation of Australia Conference in Hobart next week, so hopefully I will be doing lots of posting of tit-bits (knowledge bombs sounds better) from the conference – as long as I don’t get too distracted by Fiona Rogers of Pelvic Floor Exercise a fabulous online website for all things pelvic health!

Until next time

Sue Croft

 

“I’m committed but not always compliant”

I saw a delightful patient today who came in full of apologies for not adhering to all the strategies we mapped out at our first meeting a month ago. Now I am totally understanding about time pressures, changes in circumstance, things that unexpectedly crop up to throw a spanner in the works of life. It happens many times to me and I totally get it. But when I questioned this patient more closely – these ‘spanners’ were of great significance. She had lost her darling Mum of 97, another friend from cancer and a younger woman was very ill with a serious cancer and the prognosis had just been spelt out leaving them all devastated.

It’s actually a wonder she could manage any of the strategies we had spoken about.

But in fact she had done her diary; she had started to do her pelvic floor muscle training; she had adopted the new position for voiding and defaecation and she had gone 100% decaf. So she had actually done some really major things but she was still apologising and feeling bad. And then she said it and it’s actually very meaningful!

“I’m committed but not very compliant”

Her honest answer sums a key ingredient in the pelvic health story.

Committing to a programme with a pelvic health physio is a giant step to take. It’s certainly very important, it’s getting the patient in the front door of your rooms. Did you realise that research undertaken via a survey of people in a doctor’s waiting room showed that 57% of people had moderately severe incontinence and yet only 29% of these patients had ever raised it with their doctor. Women and men often take years to raise these private problems with their GP, so if they are brave enough to seek your help you owe it to them to sell the ‘story’ of managing pelvic floor dysfunction in a palatable, encouraging, easy-to-understand way, with lots of reading material and notes to back all that information up.

Thought I’d slip an image of the new updated editions of my books in here

Adherence to conservative strategies by patients is also one of the biggest problems we physios have when ‘selling’ what we do in the medical world. All too often articles in medical journals like to point to the poor adherence by patients to the lifestyle changes and pelvic floor muscle training (PFMT) that embody conservative treatment strategies for some types of pelvic floor dysfunction after a period of say 12 months. This is an argument that a surgeon may put to a patient – have the surgery because you are not continuing to still do your PF exercises and your problem has returned.

But of course PF exercises should be a lifetime habit whether you have surgery or not. (A cautionary note: there are times when pelvic floor exercises may not be the answer such as when there is pelvic pain, or voiding dysfunction or defaecatory problems such as obstructed defaecation due to pelvic floor dyssynergia – when the pubo-rectalis and external anal sphincter muscles contract and tighten when they should relax and open to evacuate the stool/bowel motion. Your pelvic health physio will advise you about this.)

Following all that advice that the pelvic health physio taught you can help protect any surgery you have had and should be continued forever.  This concept of lifetime adherence makes or breaks the success a patient has with what we teach. It is one of the critical selling points we pelvic health physios need to impress on our patients. And we pelvic health physios owe it to our patients to be good at encouraging long-term compliance and adherence and sell the message of good pelvic health throughout the life-stages.

Levator Avulsion: It doesn’t have to be the end of the world as you know it!

I am a great believer in empowering women (well everyone) with knowledge. Knowledge is very important- particularly knowledge based on evidence. For example- the world is not flat, climate change is real (just ask any farmer and those living in Greenland) and being kinder to refugees will give us more back than they take.

There is a debate in the obstetric and gynaecology (medical) world and women’s health physio circles that telling women about the extent of their birth injury may be a worry for women and cause more problems than it helps. And I certainly see that when seeing patients for the first time- they are often very anxious from what they have read on the internet in the various forums on Facebook and other sites and sometimes they don’t even have the problems/ injuries they had imagined they had.

Of course sometimes, many times they do have levator avulsion or nerve damage or micro-trauma causing stretching of the vaginal walls or prolapse. Because we tend to glorify the birth process (and it can be very glorious) there is often not a lot said about birth injuries prior to the birth that can happen to a woman with a vaginal delivery and which can ultimately be devastating to the future well-being of a woman.

Image demonstrating levator avulsion taken from the new edition of Pelvic Floor Essentials 2018 

But should we not fully inform women about the current status of their pelvic floor muscles? Shouldn’t we give them an opportunity to receive the information, process it, maybe grieve a bit and then move forward with a plan to maximise their potential of every skerrick of muscle they have left? Enable them to move forward with a plan to support their vaginal walls with a pessary to potentially protect against prolapse (if it will work) and a plan to get them exercising again in a manner that is relevant to their pelvic floor strength and other anatomical changes that have occurred with their vaginal delivery?

 

I believe that informing women about any birth injury they have is their right.

It is incomprehensible that we should keep the woman in the dark about their changed pelvic floor status. But we have to be there to give them encouragement, motivation and a positive plan of moving forward based on evidence not just dramatically tell them about the damage/changes and leave them dangling and unsupported emotionally, psychologically and physically.

I recently received an article by Alexandre Fornari & Cristiane Carboni which reviewed all the articles referencing pelvic floor physiotherapy as a modality for the treatment of pelvic floor dysfunctions. The aim of this study was to identify and characterize the most frequently cited articles on pelvic floor physiotherapy published in the last 30 years. Between 1983 and 2013 (30 years) there were 1,285 articles published (among them there were 12 randomized clinical trials (RCTs) and 4 reviews). The most common topics among the classic articles were behaviour therapy, pelvic floor muscle training (PFMT), biofeedback-assisted PFMT, and neuromuscular electrical stimulation.

In 2017, the same authors conducted a new search for papers on pelvic floor physiotherapy using the same methods to compare them with the 2013 data and they found 1,745 papers containing the term pelvic floor physiotherapy, indicating an increase of around 35% in 4 years. The authors concluded that ‘pelvic floor physiotherapy is an emergent sub-specialty where scientific knowledge is evolving fast. This is seen not only in numbers, as demonstrated by our quantitative results, but also in quality, as seen in the high-level evidence presented by the classic studies analyzed in our research’.

When I revised and updated both editions of my books Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Surgery and Pelvic Floor Essentials I wanted to include as much evidence in the books about rehabilitation of the bladder, bowel and pelvic floor as I could, while still making them readable and easily understood by the target audience – which is the lay person in the community. I wanted to translate seemingly complex concepts into easily understood strategies that the woman could begin to implement- particularly if she is a regional area without access to a pelvic health physiotherapist. But if you can access a pelvic health physio, always do so for that individualised, personal assessment and treatment.

If you have concerns about your pelvic floor (or your bladder or bowel function or pelvic pain) then find yourself a pelvic floor physio to mentor you and to assist you to obtain a fantastic recovery from your birth experience in the short-term, medium term and long-term.

A blog about VACTERL: introducing Anja Christoffersen

I recently received an email inviting me to a new book launch for a book called Behind the Smile: An inspirational journey from disability to ability by Anja Christoffersen. The following summary of the book is from the cover of Anja’s book.

Anja Christoffersen learned early on that you can never judge a book by its cover. Born with a congenital disability that deformed her digestive, skeletal, reproductive, circulatory, urinary and respiratory systems; she had her first surgery at five hours old. Despite a grim diagnosis, from the outside you would be unable to tell she was any different.

You would never have known that at birth, the medical fraternity warned that she would never live a normal life. Once Anja grew to an age where she could understand her medical differences, she made the decision that she did not want an ordinary life anyway – she wanted an extraordinary one. As soon as Anja realised happiness is a choice, she made the decision she would be happy despite her circumstances. From surgical theatres to chasing her dreams led her to a career as an international fashion model.

Anja from a young age seemed to chase a dream of not letting her significant disability ruin her life. She says:

I didn’t realise my success was survival and experiencing it with a smile on my face. There was nothing more I had to accomplish in life than just be happy”- Behind the Smile, page xi

When I saw her book cover I was intrigued as it seemed incomprehensible to me that someone with that extent of dysfunction could end up wearing a beautiful white bridal outfit on a catwalk! Reading Anja’s contribution has certainly turned those thoughts on their head. Her words are inspirational and as says in her book she aspires to be, not just a model, but a wonderful role model for anyone with a disability.

“I wanted to be more than just a model. I wanted to be a role model. I wanted to walk on the international catwalks on my own merits, not to have it gifted to me as the token disabled girl. I wanted to make it myself, so I could say that I did it. I wanted to inspire people with my condition and any rare disease or chronic illness that they could follow their dreams regardless of their diagnosis. I wanted to bring hope to the mothers of sick babies that they can get through it and flourish. I wanted to be the positive success story that empowers others to follow their joy and passion, no matter what it is, and no matter the odds that are against them” – Behind the Smile, page 111

Join Anja as she walks the catwalks of Australia and Europe with her hidden medical condition, overcomes challenges and discovers how to keep smiling – no matter what.

I contacted Anja on learning about her book launch and asked her if she could elaborate on her extraordinary life and she kindly sent me the following to help me to understand more about the life-impacts for her. It is a condition which has varying degrees of disability in the continence area and I hope through this blog the word will be spread to others who may have significant issues and that they and their parents may gain hope.

I was born with VACTERL Association in 1998. Barely anyone knows what that is now, so you can imagine the medical fraternity’s experience with it 20 years ago. Growing up, the best way to describe my condition to other 5-year-old’s was, “I was born without a bottom.” In reality, I was born with one main opening where my intestine, urethra and duplicated vaginas drained into.

Immediately, I had to have a colostomy and vesicostomy made so there was a way for anything I ate and drank to leave my body. At 7-months-old I had what is commonly referred to as “Pull Through Surgery” where I was cut from my clitoris to my buttocks to reconstruct everything, just so I could function ‘normally’.

Imperforate anus surgery

What that meant for me was a short-term anal dilatation, vaginal dilatation in my teens and incontinence for life. As none of my openings were natural, I did not have the typical nerve system, muscle complex, anal sphincter or rectum. Dilatation would battle scar tissue and I began rectal enemas to try to forge some routine with my bowels to prevent constant accidents.

Amongst this, I had many other issues associated with VACTERL, all except a limb abnormality. Blessing or a curse; I was graced with a hidden illness that was unknown and unseen to others, and commonly misunderstood by health professionals.

Despite challenge after challenge, and setback after setback, I landed an international modelling contract at the age of 17 and walked Amsterdam Fashion Week the day before my 18th birthday.

Since then, I have been getting involved in the VACTERL and Imperforate Anus community and have become a part of the Resource Development Team of the One in 5000 Foundation started to support those with Anorectal Malformation (ARM).

In July 2018 a few weeks after my 20th Birthday I had the opportunity to present and tell my story to a room of 400 people in the ARM community at the Pull Thru Network Conference in Phoenix, Arizona.

OMG what a story Anja! So inspirational for any young person entering their teens and wondering what their future holds if they have this condition or any other significant congenital disability. And to be so young and to take on roles in education and being an ambassador for VACTERL – such a public position to take. You are simply amazing!

Another common condition with VACTERL is Tracheo-Oesophageal Fistula (TOF). These are variations on TOF and a common complication of a TOF is chest infections which require regular respiratory physiotherapy.

I do think Anja’s book would be so useful as a compulsory read for any medical student to educate them about the heights that people with a disability can reach rather than dispensing gloom and doom to new parents who are facing the diagnosis of something as complex as VACTERL.

Self-belief seems easy when things are going your way, but when life presents challenge after challenge, and obstacle after obstacle, giving up or dismissing a positive story is easy. There were many times I could have given up on myself. The doctors gave up on me ever living a ‘normal life’ before I was even born. It would be celebrated if I could survive, let alone live.” – Behind the Smile, page 2

Luckily Anja had a wonderful, happy nature and obviously a family who fostered this self-belief attitude and this has led to a fulfilled life at such a young age.

“I was a very joyful and flamboyant child, and neither myself or my mother allowed my disability to hold me back in any way. I would always be so excited for different experiences, and despite needing to consider the logistics of how to manage my condition in different environments, it never dulled my enthusiasm.” – Behind the Smile, page 29

I recommend this book to you, your friends and any book clubs and look out for Anja’s Book Launch on Thursday October 11th in the Valley. Contact Anja if you are interested in attending on Ph 0418755691.

Arivederci Studio194 SueCroftPhysioFitness

It has been a sad couple of weeks for me making some hard decisions- but that is life – it is full of hard decisions at times.

I have included below an email that I had to send to all our lovely clients at Studio 194 – the studio I created over 3 years ago to refer patients on for further rehabilitation after their initial assessment and treatment phase. So many times, the answer we get when we ask our patients at their initial consultation to write down 3 or 4 goals they hope to achieve from their consultation with us at Sue Croft Physiotherapy, is for advice regarding exercise which is suitable for THEIR pelvic floor. Many times they have significant prolapse with levator muscle damage that does mean some exercising may make their prolapse worse, particularly if they don’t have a pessary fitted. Sometimes they have pelvic pain which is exacerbated by excessive abdominal work and others have urinary incontinence and they are unsure about what to do to avoid this.

My little studio was my baby which ticked many boxes for those questions, but also in the process a small community was created and this has been the most difficult part about closing down. I know so many of the ladies personally and I know many have made connections and enjoyed the camaraderie of the classes. I know they have benefited from their attendance at Studio194 and I feel like a heel closing it. But you will see in the email below that I had to send all my clients, why it was inevitable that it had to close.

 

Hi to Studio194 clients,

It is with much sadness and regret that I am writing to let you know that I will be bringing our Gladstone Road Studio 194 PhysioFitness Pilates, Yoga and Dance classes to a close at the end of the year. It has been a heart-wrenching decision as I have loved developing the Studio over the past three and a half years and having the opportunity to progress our patients onto further exercise at the Studio. I have loved the ethos of the Studio and the community that has been established. It has been my little baby and I am terribly sad that I can no longer keep it open.
 

My physiotherapist Studio instructors – Jane, Martine, Megan and Alex – who all work with me at my Hampstead Road consulting rooms have also enjoyed the opportunity to help women apply the exercise advice they learn in the consulting rooms into the exercise environment at the Gladstone Road Studio.

  

My other instructors – Marzena (Yoga), Darci (Dance) and Alison (Barre) have all been enthusiastic proponents of their chosen speciality. They have adapted their teachings as necessary to incorporate cueing for the pelvic floor.

 

To have had a facility to send ladies who have significant prolapse, who have had repair surgery and all types of pelvic floor dysfunction and be able to exercise knowing that their pelvic floor will not be compromised has been such a blessing and one we will all miss.

My Hampstead Road consulting practice will continue unaffected of course.

And some good news is we will still be conducting ‘one-on-ones’ and some small group sessions at the consulting rooms in our downstairs gym area. The ‘Reformer’ will be relocated to the consulting rooms for ‘one-on-one’ and ‘two-on-one’ exercise sessions. These physiotherapy sessions will continue to attract a normal health insurance rebate.

It has always been difficult to make the Studio classes viable and we accepted that for the benefit it bought to our clients, but the final straw for us came when the Federal Government changed the rules which will disallow health insurers paying rebates for Pilates classes as of April 2019.

I wrote a blog about this a few weeks ago when I first learned of this dramatic legislation. The link follows:
https://suecroftphysiotherapistblog.com/2018/08/28/apparently-preventative-medicine-is-a-waste-of-money/

We believe this change will significantly impact on the class attendances. So, sadly it is time to close the Gladstone Road Studio and focus entirely on continuing our valuable work at my consulting rooms with our Pelvic Health (and musculo-skeletal) physios Jane, Martine, Megan, Alex and myself at 47 Hampstead Road Highgate Hill.

Some changes will happen before closure: Yoga with Marzena will be only on a Wednesday night from this week. The last Yoga class will be Wednesday 12/12/18; the Pain Relaxation classes with Martine will be held three weekly on Monday 15/10/18, Monday 5/11/18 and the last one will be Monday  26/11/18 all at 6.15pm. (We will be doing small group classes for pain management in the New Year at the Hampstead Rd Rooms.)

The last dance class is Wednesday 21st November – as Darci is travelling overseas from that date. Darci has also been helping with the Thursday PhysioFitness classes when Jane has had difficulty getting to the class – I take the class for the first 15 minutes mat work and then Darci does a 30 minute aerobic session (which is fun and great for your bone density, coordination and your memory/ brain). Jane will mostly be continuing this class until the end of the studio.

All classes at the studio will cease as of Friday 14th December 2018. 

From now, in the lead up to the closure we have reduced the prices of Pilates, Yoga and Barre to a flat $18 and the dance classes are all now a flat $10 so there will be no need to sell the discounted packs as we want everyone to use up their class credits before the Studio closes. Please finalize all requests for health rebate tax invoices by close of business 14th December. There will be no refunds on any class credits.

I would love it if you can continue your support to the end and enjoy the last 3 months of Studio 194.

Warning: There will be tears! (from me anyway)

 

Thank you for all your support over the past years and I am so sorry that I couldn’t keep the studio going.

Sue Croft
Physiotherapist

I have had some lovely emails from clients who are also sad about this and I’ve had some angry ones who are upset that there is no insight from the political bureaucrats regarding the enormous value that regular exercise has for health outcomes – that they should be promoting exercise not diminishing its access.

I am pretty sure this piece of legislation slipped by unnoticed from many in the general public and come April 2019 there will be unhappiness. What I am looking forward to is a significant REDUCTION in the cost of my health insurance every year as the Government hoped would be a result of this legislation change.

World Physiotherapy Day- Get active, stay active for good mental health

Between Women’s Health Week and World Physiotherapy Day (September 8th) it is exhausting to keep up with all the spreading the word on these designated days/weeks.

But it is important especially when the theme for World Physiotherapy Day is Physiotherapy and Mental Health. 

Every day we Pelvic Health Physios see plenty of stressed out, anxious women who are coming to terms with their pelvic health issue/ diagnosis. Part of the difficulty with these pelvic health problems is you can’t unburden yourself to just anybody about your newly understood problem. There is shame; there is the fear you are the only thirty-something with these issues; and there is your own revulsion that your life has taken this shocking turn for the worst. The bottling up of these stories continues to place a strain on the mental health of women.

Women are so used to sharing EVERYTHING that is worrying them with their girlfriends, their sisters and mothers. But who can divulge to your mother/sister/husband/friends…even GPs about your faecal urgency that is causing your anxiety to sky rocket or your prolapse that makes you feel extremely unfeminine or your pelvic pain that is causing you to refuse any intimacy post-vaginal delivery? It’s never easy- but the knowledge that the stats are high for many women having pelvic floor dysfunction tells us you are certainly not alone and in these days of social media thankfully the word is getting out. However in my 27 years of just treating pelvic floor dysfunction alone I have seen the messaging change – from barely being able to get a line in an article about urinary incontinence to there now being multiple Facebook groups for every pelvic floor condition there is and lots and lots of conversations in the media for women to access. This is mostly a good thing.

But the down side of this is that so many women who actually don’t have prolapse are convinced they do and there is a certain level of catastrophising about pelvic floor dysfunction.

There are many odd sensations in the nether regions after you have a baby. Drag and ache, bumps and bulges. Sometimes you are right with your diagnosis from Dr Google and sometimes you are not. There can be normal post-natal swelling which is not a prolapse. Also whilst it’s good in theory to understand about your anatomy- looking with a mirror after childbirth can definitely escalate anxiety.

Schedule a 6 week post-natal check-up with a pelvic health physiotherapist who can tell you what is what but also remember prolapse can actually change through the day- it can start off with everything sitting inside the vagina early in the morning and as you have a heavy day on your feet with toddlers and babies and shopping and housework and washing the dog – things can drop by the afternoon. It is always handy for the GP to do an examination in standing to see what you are feeling rather than just in lying where everything is reduced.

You can see there is a common theme from the photos inserted in this blog -that keeping active is important for your mental health. We physiotherapists know and many women know that exercise is wonderful for improving your head-space. And yet so many women believe they can’t do anything after they have had a baby. Even if you have prolapse you can usually exercise with a pessary in – so get along to your pelvic health physio and start the conversation.

What can I do?

When can I do it?

Facilitate my rehab!

Be my pelvic health mentor!

Speaking of mental health for women here is a link to a great article about the mental load that women invariably carry once they become a mother. It is a long post (and a little unfriendly for reading when we are used to things that are fast and iPhone-friendly with reading) but I encourage you all to persevere to the end. It’s the “You should’ve asked” repeating at the end of each little cartoon that really resonates while you are reading it. This is what is exhausting for women. Not just doing the tasks but thinking about what needs to be done, when and by whom (which often ends up being by the woman because it’s just easier than coordinating another to do it) but then the answer comes back when they may crack “But you should’ve asked”.

And finally the mental health of mothers takes a downward plunge if the mental health of their children is not good. This link to an interview on the Today show has the full interview of Hugh van Cuylenburg from the Resilience project with some thoughts on building resilience in children and adolescents.

I encourage you to listen to the whole interview but if you don’t have time, a synopsis follows. Hugh talks about how to develop three key pillars that will help you and your kids develop resilience, which may lead to mental health improvements and you become happier. Hugh stated that recent research that studied 300,000 kids over last 3 years showed statistics that around 40% of high school kids and 24% of primary school kids have a mental health issue with anxiety being the primary one. Anxiety is a condition where obsessive, negative, worrying thoughts can’t switch off.

He commented that he recently heard someone say that with social media and iPhones “We have never been so connected and yet never so lonely”. And it is the omnipresent technology that can be so overwhelming for developing brains. Hugh reminded us that the 2018 adolescent and child brain will receive the same amount of information in a week that we older folk were exposed to in a year. Now that is mind-blowing.

Hugh tells us about how he got interested in resilience training. He was studying teaching in Australia and got access to a classroom when volunteering for a few weeks in India. In this village, there was no running water, no electricity- but these people were so unbelievably happy and so full of joy. One particular child slept on a dirt floor- he was happy, he was full of joy. Hugh couldn’t stop thinking about his own sister who was three years younger than him who was very unhappy, anxious and diagnosed with anorexia. She was desperately unwell and at a dangerously low body weight.

He wondered “How is this possible? This little boy is sleeping on a dirt floor with no running water, no electricity and yet he was so happy and yet his sister was so unhappy. What does this kid do, what do this community do every day that make them so happy?” He observed and watched them for years and he learnt about these 3 pillars- their key to life: Gratitude, Empathy and Mindfulness. He came back to Australia, went to uni and did post-grad studies to provide sound evidence that these strategies will help build resilience and found in fact there is over 30 years of research behind these strategies that if implemented our mental health improves and you become happier.

Pillar 1: Gratitude the ability to pay attention to what you’ve got and not to worry about what you don’t have (we have so much in Australia but we are not very good at paying attention to what we’ve got- we are always wanting for more and searching for a better life without really appreciating what we have got).

Pillar 2: Empathy put yourself in someone else’s shoes. This little boy – who had nothing, who sleeps on a dirt floor- was always exuding kindness and he loved giving compliments to people. Hugh pointed out that we often think nice things about people, but we never say them. He recommended thinking beyond yourself and the happier you are then the more likely you are to be kind to people. There is also strong neuroscience evidence that if you are kind to people your brain releases ocytocine – a feel-good hormone.

Mindfulness is about the ability to be calm and to be present. Mindfulness is not meditating but being in the present moment. Anxiety is the biggest problem- we are on edge and only present for 15% of our day. Screens are our biggest distraction. It is detrimental to children to feel you are not engaged fully with them. The answer is -get off your phone, be there for your kids, leave your device in the car.

To finish this blog I wanted to include more links from the wonderful articles and links that Jean Hailes for Women’s Health created for Women’s Health Week. Mostly this is so I can quickly access them for my patients because there is a wealth of information on the site but I commend them to you.

Here is the link to Day 3 of the Jean Hailes Women’s Health Week.

Here is the link to Day 4 of the Jean Hailes Women’s Health Week.

Here is the link to Day 5 of the Jean Hailes Women’s Health Week.

I hope you find lots of worthwhile information in this special blog celebrating World Physiotherapy Day and to all my Physiotherapy colleagues have a great day, great weekend and a great working year with your patients.

#startmoving #staymoving #bekind #bepresent #begrateful #bemindful #beempathetic

Women’s Health Week Day 2

I get to look at this lady every day in my treatment room

Day 2 of Women’s Health Week is devoted to Happy Hormones – here is the link to Jean Hailes’ articles about hormones.  I thought my contribution would be to post some info about when local oestrogen may be advantageous to improved pelvic floor function.

Local vaginal oestrogen can be helpful through different life-stages for women. One of those stages can be whenever you are breast feeding.

 

Breastfeeding may suppress your monthly menstrual cycle due to high levels of prolactin (a breastfeeding hormone) competing with oestrogen and progesterone production. As time progresses following the birth, the atrophic vaginal tissues can not only impact on prolapse and incontinence, but also may cause dryness and subsequent pain with intercourse. You cease the local oestrogen as soon as you stop breastfeeding.

Another stage is when you become peri-menopausal and post menopausal. It is useful for plumping up the urethral and vaginal tissues which helps with continence control and with comfort in the vagina with penetration during intercourse. Any changes in the ability of the smooth muscle sphincter mechanisms to provide good urethral closing pressure will contribute significantly to stress incontinence and insidious leakage. The urethral sphincter mechanism also deteriorates with ageing due to decreased vascularity and will benefit from oestrogen supplements locally to help after menopause with maintaining urethral closing pressure. Discuss the use of local oestrogen cream or tablets (inserted into the vagina) with your general practitioner or specialist if you are having continence issues or painful sex.

About nine months ago I received a newsletter from HealthEd with an overview on Vaginal Atrophy and Sexual Function. This highlighted the changes suggested by RANZCOG in the method of application of Ovestin, one of the types of local oestrogen.  If you have been prescribed local oestrogen please take note of the Take Home Messages below. After personally changing from Vagifem to Ovestin a couple of years ago, I became aware of the silly design in the applicator supplied with Ovestin. So I was very pleased to read these guidelines which encourage dispensing a small amount of Ovestin cream on your finger – halve one of the doses every second night as this means you lose less and you can avoid using the applicator (which is impossible to clean) and use a finger to apply. Squeeze the cream on your finger, insert low in the vagina – away from the cervix and be sure its on anterior wall and less deep– the half dose also means you don’t lose as much and this will be easier for any arthritic-fingered patients who were worried they couldn’t reach deep enough.
DR JOHN EDEN MB BS MD FRCOG FRANZCOG CREI wrote the following information. Dr John Eden is a certificated reproductive endocrinologist and gynaecologist. He is a Conjoint Associate Professor at The University of New South Wales in Sydney. He is a visiting medical officer at the Royal Hospital for Women, Sydney, Australia where he is Director of the Sydney Menopause Centre and the Barbara Gross Research Unit.
Take Home Messages
  • There is considerable data to support the use of topical oestrogens in urogenital atrophy.
  • Topical oestrogens should not be deposited deep in the vagina, but rather in the anterior portion, in order to minimise uterine exposure and to maximise the effect on the vulva, urethra and clitoral areas.
  • Oestrogen creams may be best used by abandoning the applicator all together and placed on a finger instead. This is then inserted inside the anterior vagina; some cream should also be smeared onto the vulval skin.
  • Patients who have had breast cancer should use nonhormonal moisturisers first and topical oestrogen as a last-resort.
  • Vulval dryness may respond to soap-free washes, using plain moisturisers on the vulva and intravaginal moisturiser products. Natural oils (such as coconut oil or olive oil) can be effective lubricants.
Post-menopause local oestrogen also helps the vaginal tissues with lubrication and thickening to tolerate any sort of supportive pessary (e.g. a ring, cube, Gelhorn or others) to help maintain any prolapse.

Mona Lisa Touch Therapy laser treatment

Since 2013, a non-surgical, non-hormonal alternative to vaginal atrophy has been available in Australia and around the world. This is a laser treatment (Mona Lisa Touch Therapy) which stimulates the body’s regenerative processes to create more healthy and hydrated cells and to improve the vascularity of the vaginal mucosa. I have written a previous blog on the Mona Lisa. It costs around $2000 in Australia for the 3 treatments necessary  and is not covered at all by Medicare at the moment. This may be a useful option if the patient has vaginal atrophy and has had an oestrogen-dependent cancer and is advised not to use local oestrogen. Discuss this with your specialist or doctor.

I hope these titbits help you start some conversations with your medical practitioners.

 

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