Skip to content

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

Jane Cannan: The Pain Revolution Ride: Training for Tassie

I have written another previous blog about one of my lovely, smart, compassionate pelvic health physios – Jane Cannan – who got herself a gig on the #painrevolutionride around Tasmania with Lorimer Moseley and David Butler this coming March, 2019. I am so pleased for Jane because this is a highly sought-after ride to spread the word through regional Australia about how best to manage persistant pain. It’s a hard ride and is especially amazing because Jane is certainly the athlete – but a runner not a cyclist. But she is showing that she has hidden talents as a cyclist because she is ‘killing’ the training. She slips into work each week looking like SHE is doing LitenEasy (not me) and looking stronger and fitter every day. She has written this blog and kindly allowed me to post it as well. I love it because she reminds us about the training required to teach the brain how to not go into the usual fear-driven response when pain is felt with a movement and also how innately strong and resilient the spine and our bodies really are.

Jane’s blog follows:

I recently read a quote by Wayne Gretzky that said “you miss100% of the shots you don’t take”. I’m reminded of it this morning after coming home from another ride in preparation for the Pain Revolution Rural Outreach Tour which is only just over 7 weeks away. Since applying for this Tasmanian adventure in September 2018 I have ridden over 4150km to prepare for the 8 day, 700km ride from Devonport to Hobart.

Hello, I said 4150km, in 4 months!! This is NOT normal behaviour for me. I absolutely loved this morning’s session because it was hard – it asked me to give more than I knew I had and 10 hours beforehand I was horribly afraid of showing up for it and needed a friend’s encouragement to be brave. More than the physical gains I’ve made, the most meaningful change has been in how I cope with fear; an achievement that I have learnt doesn’t happen through hope or good intention alone, and coincidentally, neither does recovering from persistent pain.

One of the goals of the Pain Revolution is to prepare people to rethink what their pain means and in doing so give them the opportunity to try and take the shot. The shot they have probably taken unsuccessfully for quite some time. That activity or movement that has caused them an increase in pain and reinforced the belief that they are fragile, broken, limited and should never expect to be free. This feeling is crushing to a person’s sense of self and is responsible for killing many a joy.

Wayne Gretzky was an ice hockey player and coach, but I watched a game once and couldn’t understand it, so I’m sure he won’t mind if I think about his quote in terms of basketball instead. 

Picture a basketballer about to take a shot that will determine whether his team wins or loses a game. Now we know he has no choice but to take the shot, it’s very unlikely that he will shake his head, plant the ball on the ground and walk off the court. What does he do to give himself the best chance of success? He calms his breathing, relaxes his shoulders, softens his grip on the ball, quietens himself and blocks out the environmental noise. The same applies when moving differently for the first time in a long time.

If bending to pick up something off the floor has resulted in pain over and over again, it makes sense that in preparation for the task a person may hold their breath, tense their shoulders, over-tighten every one of their abdominal and back muscles and grit their teeth, possibly without even realising it. You could take a person with no back pain history, teach them to move this way and have a pretty good chance of making the activity hurt or at least feel dreadfully uncomfortable. This is pain science in practise. We are choosing to use intelligent internal cues that come from accurate knowledge to manipulate physical performance. You could use it for good, or to increase someone’s chances of failure. I choose for good.

Whether it’s in preparing for high stakes sporting moments or turning up for a training session or performing that movement that gives you grief, I urge you to stop, check in with your body and see if you can manufacture the state that will increase your chance of making the shot.

If you want to know more, or to follow the Tassie ride check out the website https://www.painrevolution.org/ and facebook page. A little more about me and my pain story can be found in the link to my fundraising page below. All donations are most gratefully received.

https://painrevolution2019.everydayhero.com/au/jane

Thanks Jane and I hope many of my readers will take on board your wise words about fear and pain, about the amazing ability of breathing and relaxing to change pain intensity and to develop the body’s inbuilt belief system to adapt to this new and evidence-based knowledge that your body is innately strong and robust not weak and fragile.

Jane needs to raise a certain amount of money towards pain research as part of the #painrevolutionride so if you feel inclined give a few dollars towards this worthy cause she would be very grateful. All monies raised goes to pain research. 

Great work Jane xx

LRSM: The new acronym for post-op gynaecological and colorectal repair surgery management

Blog Number 300: Well done me!

Today’s blog is Number 300. I started my blog back in 2011 inspired by my son who was in first year architecture and had to do a blog as a part of his uni course. It’s hard to believe today, that I didn’t even know what a blog was back in 2011, considering they are so much a part of our lives these days.

My blog is not only a way to catalogue pelvic floor dysfunction (PFD) resources for my patients and maybe anyone else who may wish to read it, but it has become a personal diary in lots of ways allowing me to remember memorable (overseas) holidays and get on a high horse about things that seem a little unjust or unfair.

Thank you to anyone who has taken the time (in this day of 20 second scrolling) to actually pause and read my blogs and also thanks to anyone who shares them or adds the link to their own website. I love the ability we have these days to share information and whilst the internet has some negative aspects, it is such a wonderful opportunity to talk about things like prolapse, pessaries, incontinence, pelvic pain and sexual dysfunction in a world-wide fashion. My blog is evidence-based but it is written in such a way that non-health professionals can read it and hopefully understand it.

I wanted Blog Number 300 to be significant because I think getting to my 300th blog is pretty amazing even if I do say so myself. But enough of my self-congratulations. And on with the blog……

Health care is riddled with acronyms. Basically just about every medical condition has an acronym, which makes it very hard as you get older to try to remember what they all mean. And I am sure there are some people who are making new ones up just to confuse us oldies. Some may use acronyms as a ploy to sound important to the patients. Some acronyms are scary… like Deep Infiltrating Endometriosis – yes DIE really??? and many researchers try to get clever with their trial names and they actually become memorable and easier to remember like the POPPY Trial Pelvic Organ Prolapse PhysiotherapY ( Results: One-to-one pelvic floor muscle training for prolapse by a physiotherapist is effective for improvement of prolapse symptoms)(1).

Today’s blog was inspired by two acronyms I saw in a recent post on Facebook and it took me a while to work them out – AVWP and PVWP. Anterior vaginal wall prolapse and posterior vaginal wall prolapse. Now I have read many (a million) articles on prolapse and have never come across those before and I am provocatively writing this so someone (maybe manyones) will call me out and say ‘Hey, that is now the correct new terminology Sue’! (I did google the International Continence Society Terminology page and didn’t see it). 

But today a patient returning for a 6 month post-op repair surgery check up inspired my new acronym and I think this is going to catch on <winking>.

LRSM. And what does it stand for? 

L for LISTEN

R for RESPECT

S for STOP

and M for MODIFY

My patient said a little phrase that just triggered these words. It really isn’t that catchy, but I like the sentiments and it gives me chance to integrate the words into this post-op post.

We pelvic health physios teach you to listen to the messages your body gives you and respond appropriately to those messages. So if you feel pelvic floor descent when you cough and sneeze, you need to counteract that descent by turning your pelvic floor on – I call it ‘bracing’ in my books but it is known as ‘the knack’. (2) If you get a bowel urge then don’t defer, make sure you try to find a toilet to evacuate your bowels using the correct position. If you are feeling pain (your pelvic floor muscles may be spasming and producing that pelvic pain), so remember to relax your tummy, pelvic floor muscles and inner thigh muscles and do some belly breathing.

The next word is respect!

Respect the state of your pelvic floor – Has there been trauma to the muscles meaning the strength is compromised such as with Levator Avulsion (and not because you are not doing pelvic floor exercises);

 

Respect the research statistics on risk of failure of your surgery – with gynae repair surgery in general there is up to a 30% failure rate (3,4) and if the patient has partial or complete avulsion it potentially may be as high as 80% (5);

Respect the surgery that the surgeon has done and the advice she or he has given you;

Respect the money you have spent on the operation and the cost of the time you may have had off work.

The next word is stop!!

Stop and think, assess, remember your guidelines and the advice from your surgeon, pelvic health physiotherapist and in my book Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery;

And finally modify your behaviours. Sometimes its just small adjustments – learn to exhale on effort – don’t hold your breath; paced and graduated return to exercise; do more repetitions of a lighter weight; alter the position – adjustment of position can significantly alter pressures down the vagina; but make sure your physio has helped you understand the state of your pelvic floor strength and descent so you modify accordingly but don’t stop exercising completely.

So there you have it! LRSM! 

L for LISTEN

R for RESPECT

S for STOP

and M for MODIFY.

Remember it, implement it and pass it on.

Do you think it will take off? Or just confuse the hell out of another ageing physio or two?

And here’s hoping I (and my brain) have it in me to do another hundred blogs and get to 400.

If you want to follow my blog the word Follow should be on the screen somewhere – click on follow and enter your email address and the blog will automatically pop into your email box.

(1) Hagan S et al (2014) Individualised pelvic floor muscle trainig in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. The Lancet, Volume 383, Issue 9919, 796-806

(2) Miller J, Ashton-Miller J, & DeLancey J(1998). A Pelvic Muscle Precontraction Can Reduce Cough-Related Urine Loss in Selected Women with Mild SUI. Journal Of The American Geriatrics Society, 46(7), 870-874. http://dx.doi.org/10.1111/j.1532-5415.1998.tb02721.x.

(3) Brubaker, L., Maher, C., Jacquetin, B., Rajamaheswari, N., von Theobald, P., & Norton, P. (2010). Surgery for pelvic organ prolapse. Female Pelvic Medicine & Reconstructive Surgery, 16(1), 9-19. 10.1097/SPV.0b013e3181ce959c

(4) Wu, J. M., Matthews, C. A., Conover, M. M., Pate, V., & Jonsson Funk, M. (2014). Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstetrics & Gynecology, 123(6), 1201-1206. 10.1097/AOG.0000000000000286

(5) Dietz, H. P., Chantarasorn, V. and Shek, K. L. (2010), Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol, 36: 76–80. doi:10.1002/uog.7678

London: The final travel blog 2018 trip

Hello Islington

We flew into London which was swathed in a greyness which I have heard has barely lifted over the past 6 weeks. We whinge a bit about our endless sunshine but I know most Londoners crave a blue sky and the need to squint their eyes when they go outside and relish any sign that it is going to be a sunny day. We trained it to Islington- Highbury and walked to our London digs. It was an AirBnb in Islington close to where our children are living. After the decadence of the aDLER Hotel in Innsbruck, our London flat was a shock to the system. It was a bit mouldy, a bit ordinary and had a saggy double bed – but it was close to family and that was all that mattered. We walked into Clerkenwell to meet the kids at a London pub and it was lovely to see them looking so well.

First London night at The Eagle, Clerkenwell 

The main reason for coming to London in the colder (wetter) months was to see the London Christmas lights and they didn’t disappoint! Down most streets and on most buildings were sparkling lights and Christmas trees – London takes Christmas very seriously.

      

London ‘does’ their Chrissy lights well…..very well!

The other significant reason for a November trip was to celebrate our 40th wedding anniversary. 40 years – it rolls off the tongue so easily and to be honest it really seems like yesterday that we were standing in the backyard of my brother’s new Ascot home ( which he and his wife had generously made available for our wedding and reception) taking our vows.

Sweet young things 40 years ago   

 40 years later

But for it to pass so quickly – it must have been a hoot and to produce three beautiful children, it must have been a blessing.

Our wonderful kids gave us a voucher for the beautiful Palomar Restaurant in Soho and also two tickets to Les Miserables on Covent Garden. This is our favourite live show and this production was very special. Thank you very much xx

Spectacular eggplant dish and yummy dessert from Palomar Restaurant

 

     

Off to Les Mis!

Over the course of our stay, we did lots of walking around London – The Regents Canal Walk, around Bath to watch Soph play netball, to Buckingham Palace for old times sake, past 10 Downing Street and then had lunch at the pub opposite (Bob got his pork pie there). We ‘did’ the Natural History Museum, went to the top of the Shard (again another great birthday present for Bob from the kids) and saw St Paul’s lit up at night.

     

Regents Canal walk

   

St Pauls at night from the Millenium Bridge and at the top of the Shard

We went to Maltby Markets and had some of the most delicious market food ever and walked down one side of the Thames across the Millenium Bridge and up the other side of the river. Every day in London was easily 25000 steps!

    

Maltby Markets – Delish!

One of the special trips we had planned to do was to make a day trip to Folkestone on the train so we could walk from Folkestone to Dover. It’s part of an architectural walk called ChalkUp 21and seriously we were so lucky to get to do it. It had rained every day in Dover since the start of our trip (I studied the weather app every day) and after 17 days on our second last day in the UK, it was predicted to be fine and gloriously sunny – which it was – but it started out at 4 degrees but warmed up slightly as the day progressed. As you can see the not only was the weather spectacular but the scenery was also.

We started the walk at the Battle of Britain Memorial at Folkestone and then walked along the ChalkUp21 path. It isn’t very clearly marked so take care (you’ll hear why in a moment).

 

The Battle of Britain Memorial, Folkestone

The problem with being the only sunny day in 3 weeks of rain is the path was very, very muddy and ever so slippery so it was a slow and slightly hazardous walk.

   

Real mud but they washed up well after the trip!

We managed to take the wrong path thinking the path went down to the ocean and we would walk along the edge of the water. But sadly the walk goes along the top of the cliffs and we had to climb right back up to the top. It was the first time that I actually wondered how I was going to do that because the climb down was so difficult. But the climb up was dead easy compared to the slipping and sliding of the descent.

The White Cliffs of Dover – If we hadn’t taken the wrong path we wouldn’t have seen this view. A bit daunting to climb back up to the top again!

Personally I think the Seven Sisters walk we did last year was much more scenic, but I felt a great sense of achievement completing this walk and making it to the Dover Train Station and sitting down for a scone and hot chocolate. But I am a little regretful now that I sent Bob to check out the start and finish line for the (offical) English Channel Swim because I didn’t think I could take another step to go and look at it. It was a very long walk that we had finished and my feet were killing me. 

The best part of the trip was knowing that Mike had secured his own accommodation in London. He arranged it on our second last night and that in itself is quite a feat as demand for accommodation is fierce. We celebrated at his local to say goodbye.

The funniest thing about this trip was by the time we had to depart London, I had grown quite attached to our little mouldy, saggy apartment and was sad to say goodbye to it, but there will be another trip – that’s what happens when your kids “Do London”!

London last night at Mike’s new local pub, de Beauvoir Arms 

That is the last of the travel blogs for the moment. I had to write it today because a patient asked me a question about the trip and I struggled to remember what we had done that was special. And while there is lots more that we did in London, these are some highlights and will give us lots of lovely memory prompts in the future. I apologise for the self-indulgence and boring you with all my personal blogs but it is my diary (sort of). At least I’ll never lose it and know exactly where to find it!

Traditions, Rituals and Onward to 2019

There’s a certain amount of comfort around traditions. They build expectations; they feel comfortable; and most importantly enable a culture to build and thrive. In Australia we have the Boxing Day Test, the Sydney Fireworks display broadcast on TV and our most favourite ones of watching Chevy Chase in the movie National Lampoon’s Christmas Vacation and another movie Love Actually on Christmas Eve. Our Aussie traditions around Christmas and New Year also inevitably involve the beach (as I have alluded to in previous blogs). And as we packed up the car this year it caused me to reflect on our Aussie tradition when going away to the beach of packing everything bar the kitchen sink.

This year was no different despite it only being us two in the unit. We squeeze everything around the grandies car seats in the car and the coffee machine goes as does the Xmas tree. Literally we were up to our eyeballs in things to make the unit a home away from home. And I love the build up, the repack when it doesn’t fit the first time and I love having the final groceries perched on my lap all the way up. (I didn’t always love it when the kids were small – it was somewhat of a drag. Because they couldn’t understand what was taking so long, there were endless questions and a bit of whingeing and of course there was often the need to either take 2 cars or a trailer). But now it’s exciting, it’s a relief to be on the way and wonderful when we arrive.

This tradition has been built over 40 years.

Another tradition that has developed for us is sharing New Year’s Eve with some dear friends of ours. We three couples have just spent our 27th New Year’s Eve together and we wouldn’t miss it (if at all possible) for quids. There is always good food, lots of laughs, board games (Charades) and this year we added in a giant walk to Alexandra Bay and the Sunshine Beach National Park.

   

We had a swim half way round and as we walked the circuit through the forested area we all relished the dappled light through the trees and marveled this year at the first ever sighting of a wallaby.

  

The highlight of NYE is always reading last year’s resolutions and seeing who achieved their goals and writing the next years resolutions. It has given us lots of laughs and a bit of competition to see who gets the best score with achieving their goals for the year and it has certainly kept us all accountable.

We have developed other traditions around setting up camp on the beach every day with the two beach umbrellas and beach chairs, scavenging for pippies to use as bait for fishing and having fish and chips and (if possible) a champagne on the beach one night.

Traditions are worth contemplating. They are like rituals. Like good habits.

And as this is my first blog for 2019 I thought I would go back to basics.

The biggest problem patients encounter with managing any urinary incontinence (UI) they have is long-term (life-time) adherence to their management strategies. The evidence tells us that women drop off with the regularity of these treatment strategies in quite a short time.

Such regular strategies include:

  • the discipline of maintaining regular pelvic floor exercises to bulk and strengthen their muscles;
  • using an E-stim machine to help you if you have particularly weak muscles or it also can be used to help an overactive bladder;
  • performing the knack before they cough and sneeze (and other increases in intra-abdominal pressure) meaning tightening muscles of the vagina and anus;
  • sticking to the good bladder habits (drinking an adequate amount of fluid mostly water, avoiding excessive caffeinated drinks if caffeine is a provoker for their bladder, keeping alcohol to a moderate amount); managing their bowels well (constipation makes urinary incontinence worse); using urge control strategies to go with an adequate volume in your bladder (350-500 mls for an adult under 70 years, it may be slightly less as you age); avoid going ‘just in case’
  • and if they are leaking urine wearing a proper incontinence pads as they have material in them to ensure good absorption of the urine compared with less adequate menstruation pads.  (The common brands are Tena or Poise brand pads).This allows you to keep exercising (such as walking daily, attending the gym for strength work etc). If women stop exercising on a regular basis they become generally de-conditioned (muscle strength including the pelvic floor, bone density, cardio vascular system) and research has shown that women see urinary incontinence as a barrier to exercise (38% with moderate leakage and 85% with severe incontinence stop exercising due to UI).(1) Therefore it is better to exercise with an appropriate pad (as long as you have had your exercise regime assessed by a pelvic health physiotherapist) than to stop exercising because you are leaking.

So if you have urinary incontinence start the New Year off with some discipline and a sense of resignation – that just like cleaning your teeth – your adherence to these strategies is forever. You wouldn’t say: “I’ll give it 6 months of cleaning my teeth twice a day and see how it goes with my dental hygiene. After that I’ll just do it sporadically.”

Horrifying thought!

Well why treat urinary incontinence the same way. Do everything you can with ritualising the treatment strategies so they become good habits and you will find your urinary incontinence improves.

Happy New Year and here’s to a happy and healthy 2019 from Bob and Sue. 

  1. Nygaard I, Girts T, Fultz N, Kinchen K, Pohl G, Sternfeld B. (2005) Is urinary incontinence a barrier to exercise in women? Obstetrics & Gynaecology Vol 106 (Issue 2) .

 

Have yourself a very Merry Christmas

Sunshine Beach, 2018

Christmas for me is the beach, family time, walks on the beach, fishing, reading on the beach, eating a little too much, falling asleep on the beach. You can see there’s a common theme here. And it isn’t the beach.

It’s that it’s all about me.

It’s a little selfish.

Now I could justify that I work hard all year and I deserve a good rest but then so do Dr Hannah Krause and Professor Judith Goh. And yet where are they for Christmas? In Uganda doing their amazing work – prolapse repair work, fistula repair work, training the doctors in Uganda how to improve their birthing skills, their operation skills, teaching the nurses how to improve their skills in caring for women.

Hannah and Judith in Uganda

These incredibly humble women don’t go chasing accolades for their work but recently Hannah had a lovely story covering hers and Judith’s work in the Weekend Magazine of the Courier Mail (Saturday 15th December, 2018) along with another group of generous doctors who travel to third world countries performing their incredible life-changing work all for nothing. These doctors all fund their own work – yes they actually pay with their own money to travel to these countries and they pay the local government to operate on the ladies to repair their fistulas and prolapse.

The article in the Weekend magazine 

Hannah and Judith also get help from HADA – which stands for Health and Development Aid Abroad. Below is a little bit about their work taken from the HADA website.

MEDICAL Training in Africa was approved as a project with HADA in 2011. Prior to this, it was mainly Drs Judith Goh and Hannah Krause who volunteered in developing countries, particularly in Africa, treating women with obstetric fistula and incontinence together with upskilling local health practitioners. Since that approval was given, and with the donations received, we have been able to expand our services and treat more women. Recently an invitation has been accepted to extend our service to Asian countries.

Socially ostracised

Utero-vaginal prolapse is a common problem in Australia and Africa. However, in Africa, the women are also socially isolated and often ostracized from family, in particular their husbands. It costs $215.00 to treat each woman with a prolapse. This includes travel to and from hospital, food and all hospital costs.

Engender Health, a USA organisation, ceased its funding for fistula women in 2013. With donations to Medical Training via HADA, we were able to raise funds to continue to treat these women. It costs $324 for each fistula woman. As a woman in rural Africa usually earns less than a dollar a day, the cost of surgery is beyond her means. Each time we visit Uganda for example, we do up to 40 prolapse surgeries and 70 fistula cases. We have been going over to Uganda at least twice a year.

What is it?

Obstetric fistula is the most common fistula worldwide. It is caused by prolonged, obstructed and neglected labour. The long labour results in a stillborn baby and severe maternal pelvic injury. An obstetric fistula results in abnormal communication between the vagina with the bladder and/or rectum. This means that women will leak urine and/or faeces uncontrollably into the vagina. These women, who are mostly young and in their first pregnancy, are usually ostracized by their husbands and families.

The very grateful ladies after their surgery (the buckets are their ‘catheter bags’

The medical team

Since 2011, the team has expanded to included Drs Judith Goh, Hannah Krause, Miriam Lee, Neroli Ngenda, Barbara Hall and John Taylor. Nurse Jasinta Suric-Maguire has also assisted, as has Mr Darren Diserens. We have visited Democratic Republic of Congo twice, far western Uganda multiple times and Ghana twice. The team trained doctors and nurses in the management of obstetric fistula, pelvic organ dysfunction, cervical cancer screening and obstetric vacuum extraction. A formal pelvic flor workshop in Ghana took place in April this year. Nurses and doctors from three hospitals attended.

Dr Barb Hall and her husband Dr John Taylor also do some incredible fund-raising each year having a Soiree where many generous people give significant amounts to the cause. I’m talking hundreds of thousands of dollars over the years – simply mind-blowing.

Now all I can do every year is donate towards this incredible work. Two years ago my New Years Resolution was to forego any presents for the year and to ask anyone who wanted to give me a present for Mother’s Day or my 60th birthday to instead donate to HADA – Medical Training in Africa This is actually the link to the donation page and remember if you want to tell others about it – it’s Medical Training in Africa to give to Hannah and Judith’s work.

It was a wonderful year, I didn’t accumulate stuff which felt great and my family, friends and staff also got into the swing of things and accepted presents of donations to HADA and this ended up raising quite a lot of money over the year. My beautiful physio staff have continued the trend each year including this one all of them bought me a Xmas present of $160 towards HADA. This is the best. It felt great to receive it and can I implore that if you can do a little bit here and a little bit there with different charities – every little bit helps their work.

Now the last place to spread some Xmas cheer is to help Jane Cannan one of my physios who has gained the opportunity to join the #painrevolution ride with Lorimer Moseley and Dave Butler and the NOI team. All the money raised goes to Research for Persistent Pain via the Uni of South Australia research team.

Jane Cannan 

Jane has to pay money ($1800) to join the ride and has to also fund-raise another $3000 so if you want to have a positive feel-good Christmas (and maybe feel a tiny bit less self-indulgent) can I recommend a small donation to one or each of these worthy causes – I promise you that you will feel good and it will help you to Have a Very Merry Christmas!

Lots of love and here’s to good health and happiness for 2019

Sue and Bob and all my family xx

To donate to HADA here is the link

To donate to Jane’s #painrevolutionride here is the link 

ps #startmoving #keepmoving #staymoving #exerciseismedicine

Pessaries

 

We Pelvic Health Physios have a number of closed Facebook groups we belong to, where questions are asked and journal articles are disseminated about Women’s Health. This is great for us to network and learn from each other and if there are problematic patients who we are struggling with, we can throw the question out to the group and get some help. Recently there have been some more questions about pessaries.

Q: Any advice as to how to dispel the belief from some doctors – GPs, Obs and Gynaes and urogynaecologists -that pessaries are just for old ladies and not to be offered to young women to help them manage their prolapse?

Now this is an important issue to address and problem solve. Pessaries do come with some problems (eg. vaginal wall erosion, infection, the forgotten pessary, that a pessary just can’t stay in) but they can be life-transforming for a woman who is paralysed with terror about moving, let alone exercising, with her prolapse. Once we have fitted a pessary we give an extensive handout to the patient describing the precautions and problems that can occur; we ask the patient to sign that they understand they should get a new pessary every 12 months if they are wearing the pessary all the time; sign that they understand that they require a speculum check of the vagina from their GP or specialist doctor every 12 months to check for vaginal erosion; that they should be on vaginal oestrogen where possible to help plump up the tissues once menopausal and immediately remove the pessary if there is blood or smelly discharge or pain. The patients are taught self-management which is empowering for the patient. Then we say: “Go and exercise with gay abandon”.

Why wouldn’t there be a trend for doctors to encourage this wonderful, wonderful strategy?

Some gynaes have told us:‘It was glossed over in their training”.So it isn’t their go-to strategyAnd I can understand this. If you are training to be a surgeon it makes sense to concentrate on the complexities of surgery and that may fill virtually the whole training rather than the relatively less complex pessary fitting.

The belief was probably held by the trainer that pessaries were for old women (who were not sexually active and because of their age or other medical conditions were inoperable) so that information (some may say myth) was handed onto the next generation of doctors (surgeons).

It’s expensive to provide a pessary service. The cost of carrying the stock is huge. The purchase of the steriliser is a big outlay. Running the steriliser is expensive with a yearly service costing anything from $500 to $1500.

The biggest cost though is the time it takes to fit a pessary. It takes time because we have fitting kits and the patients get to go for a walk (with a fitting kit pessary in) to make sure the pessary doesn’t dislodge. My staff get to have 1 hour 15 minutes to do this – because we want to do it properly – and this is an impossible amount of time for a specialist to allocate I would imagine.

But we are in new times now- when surgical repairs are being researched more and those results (between 30-80% failure rate especially if there is levator avulsion / vaginal ballooning from a vaginal birth trauma) are being pondered; where a history of 10 years or more of vaginal mesh drama (many say catastrophe) has made the humble pessary start to make a comeback – after all pessaries have been around since the days of Hippocrates (you can read about it in this earlier blog I wrote)

I have been fitting pessaries since 2010 and keeping a register of them since 2011. I have had other staff who fit pessaries start working with me since 2015. We have recorded 470 patients in our register and so there maybe over 500 women who have had a pessary fitted (I had a year where I am not sure how many I fitted).

Some of those women have definitely gone on to have surgery.

Some of them will have stopped using their pessaries for different reasons.

But many of them have had their lives transformed.

There are now many other Pelvic Health Physios who are fitting pessaries – to female farmers in Dubbo, to weight lifters in Sydney, to runners in Perth -far and wide across the country. There are a lot of happy women thanks to their pessary.

Do they shout it from the rooftops?

Well some do, but most don’t. It’s like everything we Pelvic Health Physios do – it’s personal, private and most women keep their successes to themselves – which is entirely right. But sadly it means that the word is more difficult to get out to other women and many women are not knowing that a pessary is a valid, conservative option to try, in the plethora of conservative strategies that a Pelvic Health Physio can offer a woman who has prolapse (and other pelvic floor dysfunction), before surgery.

 

Dr Chris Barry   Dr Trish Neumann 

  

Taryn Hallum   Natalie McConochie 

The history of pessary fitting in Australia goes back to a lecture we had at the Continence Foundation of Australia’s National Conference in 2009 (I think) from a nurse practitioner from Canada who runs a pessary clinic in Canada and had done so successfully for 15 years. Dr Trish Neumann, a specialist Pelvic Health physio from Adelaide, was inspired to start a collaboration with Dr Chris Barry, a urogynaecologist in Adelaide, to come up with guidelines for pessary fitting by physiotherapists. There was months of hard work that was put in by that Committee (which also had another great Nurse Practitioner on it – Donna Coates) and soon the Pessary  Guidelines were born and Trish ran the first pessary workshop in 2010 which I attended. For the last 7 years, another great Pelvic Health Physio and Educator, Taryn Hallum (Women’s Health Training Institute) along with Natalie McConachie, has trained many more physios to fit pessaries.

This is truly spectacular. Thousands of women have been helped now as a result of this one lecture by Lesley Hanson.

Lesley Hanson

My point?

The physio in the Facebook group was asking how to talk to doctors about offering pessaries as an option for a woman with prolapse? How to educate the doctors that there are many physios who can fit pessaries?

My suggestion is share this far and wide.

Talk about pessaries on social media. We can talk about this stuff now. Vaginas, vulvas, prolapse, incontinence, constipation.

We are not in the Victorian times. Let’s stop being prim and proper about this. Disseminate information.

It. Changes. Women’s. Lives. 

 

Bilbao Precioso – more travel blogging.

Guggenheim Museum, Bilbao by day

The eerie colours and shadows by night of The Guggenheim Museum Bilbao

I have wanted to visit Bilbao for many years, ever since I first saw the first image of The Guggenheim Museum in Bilbao. I followed up this first image with some research into how Frank Gehry, the architect who designed the Guggenheim, came up with the design and I was hooked. I had to see this amazing building which emerged from first crumpling of some alfoil and some free-flowing sketches from this master architect.

The opportunity emerged with this trip and was made even better in the company of two architects – my husband and my son, who can genuinely gain some professional development by exploring the ins and outs of this magnificent building. And it is magnificent. And to think that is it’s 21 years old. How did that concept building which emerged from some crumpled alfoil possibly be designed, engineered and built into a functional, beautiful art museum? Whether you view it by day or by night, in sunshine or overcast weather, the shadows and detail of the building are exquisite.

   

Various views of The Guggenheim

Constructed of titanium‭, ‬limestone‭, ‬and glass‭, ‬the seemingly random curves of the exterior are designed to catch the light and react to the sun and the weather‭.  Fixing clips make a shallow central dent in each of the‭ .‬38mm titanium tiles‭, ‬making the surface appear to ripple in the changing light and giving an extraordinary iridescence to the overall composition‭. Because of their mathematical intricacy‭, ‬the twisting curves were designed using a 3-D design software called CATIA‭, ‬which allows for complex designs and calculations that would not have been possible a few years ago‭. ‬Essentially‭, ‬the software digitizes points on the edges‭, ‬surfaces‭, ‬and intersections of Gehry‮’‬s hand-built models to construct on-screen models that can then be manipulated in the manner of animated cartoons‭. ‬‬(1)

     

The internal views of the beautiful Guggenheim

Try and make add it to your bucket list because having just been to Bilbao, you could just ‘do’ Bilbao for its own culture and beauty without the incredible drawcard that The Guggenheim is.

When you fly into Bilbao you will see it is surrounded by mountains and on the day we went, unfortunately there were gale force winds blowing. As we started to descend it started to get very bumpy…….noticeably so……holding-onto-the-armrest bumpy. When we finally arrived we all looked at each other (strangers) and smiled with relief until the Captain came onto the intercom, rather unnecessarily and said: “Sorry for the rather turbulent landing, but that landing was just within the capability of this aircraft (WTAF did he just say???) Our smiles looked a little wan and green after that admission from the pilot!

When you touch down at Bilbao Airport (designed by another well-known architect Santiago Calatrava), you can get the obvious taxi but the Green Airport Bus is only 3 euros and it drops you very quickly into 4 stops through the town. The first drop off point is the Guggenheim and then the centre of the city and so on- so if organizing accommodation for Bilbao think about close proximity to the airport bus stops. Once you get into Bilbao track down a Tabachi shop (a tobacconist shop) or go to the main Metro station (Consortium of Biscayan Transport -CTB) and Metro Bilbao S.A. located in the historical neighbourhood of Casco Viejo and purchase a Barik card – which is the transport card that you can load with euros and use for up to 10 people (just swipe for each person). The card itself costs 3 euros and then you can load with 5,10,15 euros and use on every type of public transport – the buses (including the return bus ride back to the airport), the light rail, the underground, the funicular and the gondola on the Bilbao Suspension Bridge (or the Puente Colgante -Hanging Bridge) and they are all heavily discounted so well worth the outlay.

  

The view from the top via the Funicular and The Hanging Bridge

We stayed at an Airbnb halfway between the Guggenheim and the old town. It was a really nice unit which slept 5 – which was great for the family, but if I went again I would look for an apartment that overlooked the view of The Guggenheim and just sit at the window and stare at the building. Yes it was that special!

Bilbao has an incredible eating and socializing culture. Everyone sits at the bars (of which there are thousands it seems) and drinks Rijorca (the local red wine) and eats tapas -which are mostly toppings on sliced French bread. The food and wine is very cheap there and it is very pleasant sitting and absorbing the atmosphere, the socializing and the chatter. Children including very young babies in prams are up till very late, included in the outing and there is an incredible number of older men and women who are catching up at their favourite bar. The dreaded smoking is still a big feature and I fear will continue to be a significant health issue as a packet of 20 cigarettes are 4.5 euros (compared to our $30 per packet) so way too cheap for cost to be a deterrent like it is here. It is really the only thing about Bilbao that I didn’t like – apart from the fact that my beautiful new Mimco backpack- my 40th anniversary present as well as this trip- got stolen with all its contents. It was slick, completely unnoticed by the four of us at the table and all the people around us in the outdoor setting and happened in the daylight. So beware, hook any bag you have around your foot and keep your wits about you! Like anywhere that you travel. I won’t hold it against you Bilbao.

Hanging Bridge and Michael soaking up the sun

We went on a metro underground ride out to Algorta and walk to see the tall cliffs and the start of the surfing beaches overlooking the Bay of Biscay. The trees were being pruned by the local council gardeners and they have a very distinct look to them.

  

Long walk to see the tall cliffs overlooking the beaches at Algorta

We then came back on the bus to the old town and had another sit down in the square in the Old Town and tapas experience. Bilbao bars are not well serviced with vegetarian options sadly, but plenty for the meat and seafood eaters. The next day when all the family had finally arrived we went for our Guggenheim experience. The tickets are 13 euros each and that comes with an included audio firstly explaining the wonders of the building and then interpreting each of the exhibits which include Picasso, Leonardo De Vinci and many famous artists. You can go out and come back in for that day pass- just make sure you see an attendant to get a paper bracelet on to allow a re-entry. Personally after checking out quite a few of the artworks, I just sat and absorbed the building. You can honesty look at every aspect of the Guggenheim and there is nothing replicated. It is asymmetrical, with amazing soaring heights, glass, steel, titanium, special installations, special effects (such as fog and fire)…it is brilliant.

 

We next walked over the Zubizuri Bridge (meaning “white bridge” in Basque) which stretches across the Nervion River in Spain, connecting Campo Volantin’s right bank to the left bank of Uribitarte. This footbridge, designed by Santiago Calatrava, opened in 1997 and features a glass deck that lights up at night. Although the glass path can get slippery on a rainy day, many use the bridge to reach the nearby Guggenheim Museum. It is so slippery that it now has a carpet laid on top of it. And yes one of us did slip on the exposed glass to the far side of the bridge (Jimmy….). From a distance the bridge cuts a fine impression. We then caught the Funicular up to the high hill directly behind Bilbao and saw the city view. It was magical but very windy and a bit chilly so returned on the funicular and we headed back for some warming food and drink. With our Barik card the funicular ride was only 0.58 euro but if you didn’t have the card was 3 euros each way!

After seeing off two of our party who had to return to London for a netball game, we went for a walk to the Christmas markets which had opened that night – the 1st December.

    

The crowds were extreme. It seemed like literally every citizen and their children were out promenading and showing the kids the Christmas lights and then heading to the main food street for food Colon de Larreategui Calea. It was almost impossible to make your way through the crowds but we found sanctuary in a restaurant – the Old Shanghai which seems odd in Bilbao, but it was indoors, less busy and the food was delicious.

On our final day in Bilbao the sun was shining and we discovered the Hanging Bridge and then the Gran Hotel Puente Colgante where there was a bar, a verandah in the sun with a DJ playing some cool music and beautiful food (salt and pepper calamari and tapas) very warming and enjoyable. Again across this four days the average number of steps was 25000 per day – it is so damn easy to get your steps up! (Despite this, as I am writing this now that I have been back in Australia for a week – the sad news is despite 25000 steps EVERY day it appears I have put on 3 kilos. Everyone to a person I have told this has said it must be muscle. But it does show calorie intake outweighs exercise).

The final travel blog will be about our two stays in London – one before our visit to Bilbao and one after.

(1) https://www.archdaily.com/422470/ad-classics-the-guggenheim-museum-bilbao-frank-gehry

Ageism in health care

Pair of oldies (over 60s) at Guggenheim Museum Bilbao

Australia’s population is ageing. There is an explosion of people aged over 60 about to present itself to the health care system of Australia. The general consensus if you ask the much older population (my mother, her friends and relatives) is that the health care system doesn’t really have a solution for the problems (pain in joints, difficulty walking etc) that come in the older years. I attended the Explain Pain 3 (EP3) course with Prof Lorimer Moseley, Assoc Prof David Butler and Prof Peter O’Sullivan in Melbourne in early November and Dave’s lecture on the use of metaphors in educating around pain science was fantastic. Using metaphors when teaching patients pain science allows the educational point to ‘stick’ with the patient and makes learning and understanding easier.

Oldies are Goldies is one of the metaphors he used to combat the problem of ageism in health care regarding persistent pain where many health professionals write off pain and different ailments older people suffer with as being a natural part of ageing, when there is plenty of evidence to say that much can be done for persistent pain (AND urinary incontinence and other pelvic floor dysfunction, see later) regardless of the age of the patient. Instead of the usual negative metaphors such as Getting old ain’t for sissies, Oldies are Goldies has a connotation that there’s something to look forward to in the golden years – retired from work, opportunities to travel and spend valuable time with the grandchildren and share wisdom gained with younger friends and family. If you want to learn more about these fabulous metaphors that Dave and Lorimer utilize so effectively in their pain education, I recommend you read any of the Explain Pain books available at the NOI Group website. 

There are different books for different target audiences. The Protectometer is a book written specifically for the general public – the patients in pain- and Explain Pain (2013) and Explain Pain Supercharged (2017) are both targeting health professionals.

As Dave pointed out, we are all living longer – 60 is the new 40, 80 is the new 60…?

This is usually a good thing but ageism is in the air. Ageism is a negative perception of getting older and older people. It’s a really big DIM (Danger In Me) as opposed to a SIM (Safety In Me)and it needs to be challenged. Young and old people can be ageist, older people can be ageist about themselves. This constantly feeds negative messages to the over-vigilant brain. Health professionals and sometimes government departments and companies can be ageist. Let’s challenge it, first by obliterating some myths about pain and ageing.

Myths about pain and ageing

Myth 1: Pain is inevitable with ageing

This is not true but most people including some health professionals think it is. Sure, there may be a few more illnesses and surgical procedures, but people over sixty have no more migraines, no more back pain, no more neck pain than younger people have. In fact, the oldies may have less pain.

Myth 2: If you have pain now, then you will have worse pain later

This is not true either. Pain comes and goes in older people just like it does in younger people. Even though x-rays and scans may show things such as narrowing of joint spaces, this has no relation to increased pain. These are age changes and more age does not equal more pain.

Myth 3: Toughing it out makes it easier to tolerate

Some of us oldies think ‘I can grin and bear it!’ This might be true for a while, but we know that it doesn’t make anything easier in the long run and being stoic can lead to depression, which in turn increases pain more in oldies than it does in younger people. You don’t have to ‘grin and bear it’, ‘suck it up’ or accept it as part of ageing – seek help from an up-to-date health professional, just as you would if you were younger. (1)

But what about pelvic floor dysfunction? Surely there is no hope for people with bladder, bowel and pelvic floor health issues?

The following is taken from my books: Pelvic Floor Essentials (2018) and Pelvic Floor Recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery(2018).(2)

As we age there are obvious changes that occur to muscles, collagen and the nervous system which can significantly affect bladder, bowel and pelvic floor function. Significantly though, we can hasten or exaggerate these changes, not only through bad habits, but also through inactivity and weight gain. Older people should do some form of physical exercise regardless of age, weight, health problems or abilities and be encouraged to develop habitual physical activity behaviours.(3) While there are substantial physiological changes that do occur with ageing, one of the critical things to remember the old saying:

If you don’t use it, you will lose it”.

We have already seen that if you do not maintain regular training of your pelvic floor throughout your life there will be a 5% to 10% loss of muscle strength per week which is worse in older age groups compared to younger age groups.(4) The more sedentary you are, the more likely you are to hasten the problems that come after the age of 60 – when the ageing process really kicks in!

If you are suffering incontinence (leakage of urine or faeces), it is also important to use proper incontinence pads especially when exercising as they have material in them to ensure good absorption of the urine compared with less adequate menstruation pads. Research has shown that women see urinary incontinence as a barrier to exercise (38% with moderate leakage and 85% with severe incontinence stop exercising due to UI).(5) Therefore it is better to exercise with an appropriate pad (as long as you have had your exercise regime assessed by a pelvic health physiotherapist) than to stop exercising because you are leaking. Also, if you try a device to help reduce leakage such as a pessary or Contiform®, remember to ask your doctor about using local supplemental oestrogen. If you cannot use an oestrogen-based product (due to previous oestrogen-dependent breast cancer), try a vaginal moisturizer twice a week or a medical lubricant to help insert the devices.

As we age, fat is often deposited around the middle waist area. This increases intra-abdominal pressure, especially when exercising. Evidence tells us that if you are overweight, losing 5% to 10% of body weight can significantly help to reduce incontinence episodes and decrease risk of worsening prolapse.(6)  Finding a variety of exercises to do such as walking, dancing, cycling, swimming, Tai Chi, bowls, golf, resistance training plus many more is a prescription for a healthy life.

Dementia is another serious disease process which comes with ageing and has a detrimental effect on continence. There are many types of brain impairment that come under the broad category of dementia but almost all of them result in loss of continence control for both bladder and bowel. This sadly often results in nursing home admission. Some recent research into continence and nursing home admission has demonstrated the staggering statistics that at 6 months after admission, 28% of nursing home residents developed urinary and faecal incontinence (dual incontinence); at 1 year 42% did so; and at 2 years, 61% had dual incontinence. Significant predictors for the length of time to developing dual incontinence were already having urinary incontinence, greater functional or cognitive deficits, more co-morbidities, older age and lesser quality of nursing home care.(7)

An important management strategy can be to institute timed voiding – either nursing staff prompting the client at 2 hours to go to the toilet or by the client using a watch that vibrates to alert them to go to the toilet every two hours to help stay dry. Other neurological conditions such as Parkinson’s Disease or stroke can mean the woman can suffer with slowness of their gait, leading to functional incontinence – where they are just too slow to get to the toilet. The impact of this will be exacerbated by any urinary or faecal urgency. See Chapters 4 and 6 of Pelvic Floor Essentials for management strategies.

Some of the changes that occur with the ageing process

  • A decline in muscle mass, although continuing to exercise regularly throughout your whole life can minimize this.
  • Less elastin in the collagen which results in less strength, plasticity and elasticity of the fascia.
  • Average loss of 2% per year from age 15 to 80 years in the total number of striated muscle fibres in the wall of the urethra leading to decrease in urethral closing pressure.(8)
  • Stiffer smooth muscle (which is found in the bladder and internal anal sphincter).
  • Urodynamic studies show advancing age is associated with a reduced bladder capacity, an increase in uninhibited contractions, decreased urinary flow rate, reduced urethral closing pressure (particularly in women), and increased post-void residual urine volume.(9)
  • Decreased number of motor neurons.
  • Decreased conduction velocity of the nerves.
  • Higher excitability threshold of the nerve therefore making it harder for the muscle to get going.

So as I am looking out the window of my Bilbao apartment and watch the massive crowds, particularly many older men and women walking up and down the pathways (promenading), I say to all our Aussie 60 year olds – keep walking (promenading), keep socializing and keep learning (using your brain) to make the charge towards the Queen’s telegram much more fun and comfortable!

 

  1. Taken directly from the brilliant Explain Pain Supercharged Butler and Moseley, 2017 Page 214
  2. Croft, S (2018) Pelvic Floor Essentials, Pelvic Floor recovery: Physiotherapy for Gynaecological and Colorectal Repair Surgery
  3. Taylor D (2014). Physical activity is medicine for older adults. Postgraduate Medical Journal, 90(1059), 26–32. http://doi.org/10.1136/postgradmedj-2012-131366
  4. Morkved S, & Bo K(2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: A systematic review. British Journal of Sports Medicine, 48(4), 299-310. 10.1136/bjsports-2012-091758.
  5. Nygaard I, Girts T, Fultz N, Kinchen K, Pohl G, Sternfeld B. (2005) Is urinary incontinence a barrier to exercise in women? Obstetrics & Gynaecology Vol 106 (Issue 2) .
  6. Wing RR, Creasman JM, West DS, et al. (2010) Improving urinary incontinence in overweight and obese women through modest weight loss. Obstet Gynecol; 116(2 Pt 1):284–92 .
  7. Bliss D, Gurvich O, Eberly L, Harms S. (2018)Time to and predictors of dual incontinence in older nursing home admissions. Neurourology and Urodynamics. 37:229–236. https://doi.org/10.1002/nau.23279 .
  8. Bo K, Berghmans B, Van Kampen M, Morkved S. (2007) Evidence-Based Physical Therapy for the Pelvic Floor. Bridging Science and Clinical Practice. Churchill Livingstone Elsevier.
  9. Siroky, M. B. (2004). The aging bladder. Reviews in Urology, 6 Suppl 1(Suppl 1), S3-S7.

 

 

 

 

Venice to Innsbruck

Why Innsbruck? Well I had it in my head that I wanted to travel through some snowy alps in winter so when we looked at Venice and London and train trips and biggish airports, Innsbruck seemed to fit the picture. Whilst it didn’t really end up being lots of surround-view snow-capped mountains, it ended up being quite a picturesque train ride (and the train rides are always so comfortable and easy) and Innsbruck itself was a very pretty destination.

The fast train from Venice to Innsbruck 

This fare was very reasonable. Trains in Italy (and I realise now, Austria) are much cheaper than travelling on trains in Switzerland (they can be prohibitive – but it is cheaper if you book second class in Switzerland and they are still quite roomy seats).

First snow-capped mountains from the train from Venice to Innsbruck

There are lots of amazing engineering feats on this trip with giant suspended roadways everywhere. Europe really does have their infrastructure well organised.

Some of the amazing engineering feats on the trip to Innsbruck

We chose the aDLER Hotel (their branding, their way of writing it) because of its close proximity to the train station carting luggage and the panoramic view from every room – and it didn’t disappoint on both counts. It was a fantastic hotel and I would definitely return to Innsbruck and have another stay there again (but longer this time).

That was our complimentary welcome drink in the bar with the panoramic view in the background. We settled in the room after another reflection on how amazing the view was and then headed out to walk Innsbruck. I know I say it a lot, but truly it is so easy to get your steps up in Europe/UK. The transport system is so well set up and the expectation is there for everyone to get around by walking, cycling, bus, light rail/trams, train or even water or aerial gondolas. This trip has been extraordinary for step accumulation – I am now averaging 25000 steps every day and falling into bed completely exhausted and sleeping like a log every night. I also know the troops (Alexandra, Megan, Martine, Jane, Jose, Roxie, Suse and Ally) are all holding the fort back at work which definitely does help with promoting good sleep also.

The weather (averaging 4 to 8 degrees centigrade) is also much more conducive to walking everywhere also. With our heat wave in Queensland, Australia which I have heard about from those still at home and the dreadful bushfires which have come with it – the intensity of the sun really saps your energy to walk too far and you have to lather up with the sunscreen before poking your nose out the door. Mind you it is actually difficult to warm up when it is as cold as it is over here. We are walking very briskly, long distances and it is still very cold once you have reached your destination and dive into the intensely heated venue. I have invested in yet another essential cold weather apparatus – the neck warmer. I bought it in Bath yesterday and it is my most favourite acquisition over here. It literally blocks out that whistling wind and you heard it here: a warm neck is a happy traveller (my saying, I’m patenting it).

Back to Innsbruck and they really have Christmas Markets nailed – there are plenty of twinkling lights, real Christmas trees, Singing Santas, gluwein everywhere and beautiful Christmas presents and trinkets for sale. I know my grandies would love it here but the thought of rugging them up to combat the cold is very off-putting.

  

  

Wonderful Christmas markets in Innsbruck

One of the other reasons for heading to Innsbruck was to see the Zaha Hadid Architect designed gondola and railway funicular service. For nearly a century, a funicular system offered passage around the hills of Innsbruck. In 2007, the system was retired and replaced with something so architecturally stunning that it became a tourist destination in its own right. The journey is what matters on the Hungerburgbahn, and it happens in futuristic style. Travelers from around the world come not just to travel between four stations – Congress, Löwenhaus, Alpenzoo and Hungerburg – but to marvel at the sheer wildness of the design. Designed by the late Zaha Hadid and built in 2007, the system replaced the previous funicular service in operation between 1906 and 2005. In a country renown for its architectural daring, this new collection of structures seemingly hails from another galaxy. With biomorphic undulations and futuristic curves, they celebrate the gorgeous landscape – while ferrying you over it. Each train carries just 130 people, and the ride lasts less than ten minutes; the physical scale is small, but the artistic vision connects with a great tradition of architectural innovation throughout Austria. (1)

The tragic part about coming to Innsbruck to see the work of Zaha was the fact that it was closed for maintenance and was due to re-open the day we left Innsbruck. Oh well a reason to come back!

The futuristic design of the first entry to the railway tunnel by Zaha Hadid in 2007

We packed up our bags and jetted across the Alps to London to catch up with our children and some WH colleagues – we knew we had arrived in the UK as a dense grey sky greeted us at Dover.

The alps from our plane 

(1) Taken directly from https://www.austria.info/us/austria/stunning-and-surprising-art-architecture/traverse-innsbruck-in-style

Venice Biennale 2018

Look away now if you do not want to see some travel blogging.

The Grand Canal, Venice

As you may be aware my blog is also my diary for trips we take because it is so easy to forget memorable moments as you get older (well it is for me anyway) and I often do some homuncular refreshment and re-read an old blog from years ago when I feel I am need of a mental reboot. So the next few blogs will be about our current trip. We usually head off in the warmer, drier months, but I was very keen to see the lights and Christmas decos in London so delayed the trip until the end of the year.

Our first stop this trip is Venice – it always amazes me that the big A380 passenger jets can deliver us into Venice. This year we were on the wrong side of the plane to see Venice as we were landing, but on our side we were pleasantly surprised to see the snow-capped Italian Alps. Bellissimo! We have come to Venice quite a few times over the years because every two years they have the Biennale Architettura which goes from May to the end of November and with Bob being an architect we go for his Professional Development. It’s a tough gig but he has to do it to keep his PD hours up! The other reason for this trip at this particular time is we have been married for 40 years in a couple of days and I reckon we both deserve a reward for that achievement.

To get from the airport to the main part of Venice you can take a water taxi at 100 euros for two or for 15 euros each catch a Alilaguna, the water buses from the airport to Venice – the boats that are the equivalent of the Brisbane City Council bus – up the Grand Canal and delivered us to pretty close to our destination. (You can have a couple of nice meals in Venice for the 70 euros saved). This year we realised there are actually 3 water bus lines that you can catch – every other time we have come, we literally just jumped on the first boat that arrived and ended up taking the longest route that took well over an hour! So make sure you check where your hotel is and choose the shortest one – which for us this time was the Orange line to Guglie. The excitement of visiting Venice never leaves me and as I write this blog on our train trip through the Alps to our next destination Innsbruck, I feel a little sad to say goodbye to Venice again.

San Simeone Piccolo Church

Oh but I love this landmark in Venice. That striking copper dome roof (La Cupola, which with ageing has achieved a beautiful patina -this beautiful green colour) of San Simeone Piccolo Church greets you when you arrive at Venice Train station or slip past it as you catch the vaporetto. Our hotel for this stay was The Carlton Hotel on the Grand Canal – seeing it was such a short stay I was determined to stay on the canal and as it was the quiet season for Venice, we got a remarkably good price (which we booked directly through the hotel). Our hotel was right next door to the church. Standing at the window or on the tiny balcony in our room, the frenetic pace of the boat life on the Venice canals was there for us to enjoy day and night. The temperature was a marked change also for us for Venice. It has always been super hot 30degrees C every trip we have had before but this time it was 4 degreesC most of the time. An immediate purchase of a woollen scarf and woollen beanie from a street vendor happened about two hours after walking through the streets of Venice as sunset is at 4pm and the chill factor is significant. Note to self and Aussie winter travellers – don’t bother with our acrylic or cotton scarves – they are a waste of time in the real cold.

New woollen beanie (plus pom-pom) and scarf 

Be aware to pack some earplugs also if you stay at any hotel on the canal as there is significant canal noise at night (boats of all kinds including emergency services such as ambulances, police and fire) which for me is part of the fun of Venice.

The best part about coming to Venice in the off-season is the streets are literally devoid of tourists. We could actually walk the streets of Venice and stop and admire the architecture without causing a (pedestrian) pile up behind us. And there was hardly any smoking happening – such a stark difference to every other visit. Often people can’t understand why we love Venice so much – what with the vast crowds and the smoking issue, but truly I am spellbound every time I come here and it is starting to feel like a second home. It is spectacular and around every corner there is a view that every artist would love to paint.

The second day was free of cloud and a bright warm sun warmed us up on the hike to the site of the Biennale – the Giardini – right down the other end of Venice. As we walked toward the Giardini, we saw for the first time the Acqua Alta – the rising tide of Venice flooding St Mark’s Square. The heights of flooding are rising every year and there is a genuine concern that one day Venice will be no more. The elevated platforms which get brought out by the invisible workmen to allow the tourists in Venice to continue to walk around were erected as the centre of the square was flooded.

 

Stark evidence of how Acqua Alta impacts on life in Venice

There is no filter on that photo-that is the true colour of the water

As we were lining up to buy the entry tickets, I became aware of the first of many large groups of students we were to encounter that day. They stood out because each of them was carrying a large Pilates ball. They were architecture students from Spain and we followed them into the Spanish Pavilion to see what they were up to. It must have been “bring your own seat” as they were all just sitting on them listening intently to a panel of architects discussing architecture in Spain.

Spanish architecture students with their Pilates balls

Everywhere we went throughout the Biennale, there were groups of school children listening intently to their teachers who were guiding them through the pavilions. The ages ranged from 6-7 years to University students. I reflected on how amazing it must be to have the opportunity to educate children from a young age on the value of good building design, of opportunities to introduce environmental design to minimize the footprint of a building on our earth and to teach them to look out for the beauty in a building.

Everywhere we turned there were groups of school children of all ages being exposed to the concept of good design

Living in Venice would colour your opinion I am sure. The design concept each country had to work with was ‘free space’. I have to say I was a little disappointed with the Australian entry this year – I do wonder if this is funded at all by the Federal Government because the entry looked like it was starved for money.

We had lunch and then walked to the Arsenale to see the second part of the Biennale. The scale of the buildings housing this section is huge and I marvel each time I come here at the capability of the Venetians in the 1400s to build these giant structures.

One of the displays had some big comfy bean bag lounges so we plonked our weary bodies on them and watched a (terrifying) video on global warming showing the extent of melting ice in Greenland -hit the link to see a shortened version of this ice melting event. I do often despair at our country’s inability to recognize that Climate Policy should be a dire concern for everybody. The extent of climate change we see in the news every day- the drought in Australia with huge dust storms and bush fire season hitting earlier and earlier every year; the savage fires in California; this ice melting event; the worsening flooding in Venice….. I sometimes wonder if it would be better served by taking climate policy away from the politicians and see if it could be decided by a partnership between scientists and business – let the grown-ups decide what we should do not the self-indulgent politicians. They have had their chance and stuffed it up for 10 maybe 20 years. They too would benefit from travelling the world and actually LIVE global warming. This is what is so good about the Architecture Biennale – you see the displays of many countries and get to understand the issues affecting their built environment.

The last stop on our well-planned day was the Peggy Guggenheim museum but as we made our way towards the venue the crowds suddenly began to swell and there suddenly thousands of people heading the same way we were. We found out that 21st November is a very special day on the Venetian calendar – Madonna Della Salute Day .Our plans to go through the museum were thwarted by the fact that on this special day all local Venetians get into the Peggy Guggenheim museum for free so it was very crowded. So we headed out and went to investigate the church associated with the Madonna Della Salute Day. Then the crowds really exploded- you could only go with the flow- you couldn’t say “I’m getting out of this” – there was only one way to go and that was with the throng.

 

These crowds were slightly terrifying – you couldn’t turn around and get away from it

Once we made it through, it felt satisfying that we had rubbed shoulders with the true Venetians – not the usual crowds in Venice that are the tens of thousands of tourists off the cruise ships. We made it safely back to the hotel and at the end of the day 25000 steps had been done. It is so easy to clock up your steps when you are travelling overseas.

The train is heading north towards Innsbruck our next destination…..

%d bloggers like this: