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

#Stayathome #FFS #sorrynotsorryforswearywords: #newCoronalife

The message should be clear!

#stayathome!!

But it’s not clear.

It’s contorted.

If you had a wedding planned – tell the guests to come in the #activewear and you can have double the number (10 not 5). Just tell them there’ll be some burpees thrown in – possibly more effective after the sculling of the Prosecco- to comply with the instruction that apparently boot camp attendees are exempt somehow from #spreadingthevirus (#not – this is a nonsense and beggars belief)??

Could I suggest that you look at the following information which is looking at the raw data.

“The success or failure of Australia’s coronavirus fight relies to a remarkable degree on just one thing, new modelling has found. And that thing is whether individual Australians now follow official advice -and just stay home. The data comes from a complex model of how COVID-19 could spread in Australia, which finds: Coronavirus will continue to spread virtually unchecked unless at least 8 in10 Australians stay home as much as possible. If that slips even slightly-to seven in 10 people-the fight to ‘flatten the curve’ will be lost. ” (1)

This article above, together with the fact that India (a nation of 1.3 billion people) has gone into a 3 week lockdown, has led me to make the extraordinarily difficult decision to see our last face-to-face patients today (25th March, 2020) and go 100% Telehealth for the next 3 weeks at a minimum. After a sleepless night – and disappointment that we weren’t ordered to go into lockdown by our PM last night- I made the call myself.
I would have done this much earlier, but I have 10 staff (whom I love and I am very concerned about their financial position) to consider. But the brave decision by India and the state of Australia’s ever-increasing curve made it crystal clear for me at the crack of dawn.

We will be available for Telehealth consults and have online bookings. We will soon be live-streaming exercise classes for a nominal fee. Check out our website (soon) for details.

Another thing: If it is recommended that we wash our hands for 20 seconds, then if your physio has recommended you do pelvic floor exercises (or that you relax your pelvic floor and belly breathe regularly through the day if you have a pain condition) then marry those two things together (hand washing and pelvic floor mindfulness we will call it) and when we ‘come out the other side’ your pelvic floor will not have suffered for the #lockdown!

And finally: For all of those couples who are contemplating (freaking out) 24/7 ‘internment’ with their partners (and children) please note that Bob and I will be offering Telehealth counselling about how to survive and come out of #lockdown still together. As you may or may not be aware we have worked and lived together 24/7 for the last 18 years of our 44 year relationship. We have much wisdom and knowledge to share and for an exhorbitant fee (to cover 10 staff on reduced wages) we will get you through this nightmare!

And #stayhealthy , #stayhappy and #stayathome

Restoring trust in your pelvic health #newCoronalife

Most of what I do every day relies on restoring trust to our patients’ bodies.

Trust that their bladder will hold and not let them down at the back door or in the (extremely) long queue at the checkout (these crazy COVID19 days).

Trust that they can hold their gas when they get into a crowded lift on the way up to their hotel room.

Trust that as another period approaches their pelvic floor muscles won’t revert back to their usual overprotective ways that causes pain and magnifies anxiety.

Trust that the newly fitted pessary will hold their prolapse up.

Trust in our bodies is important because it promotes stability and confidence, happiness and joyfulness with life. It enhances freedom to move and exercise, to have pain-free sex and to concentrate on the fun things in life. But what happens when you have a spanner thrown in the works by something like the novel coronavirus called COVID19?

You hear increasingly worrying news about illness rates in other countries and then you realise we are about a week behind those countries. A little bit of anxiety creeps into your thinking. You see a social media post about a shortage of toilet paper and then you remember a story your mother told you about the job given to her by her father during the Great Depression (cutting the newspaper into squares and popping a small hole in the corner for some string to tie it together- yes this is a real story). A bit more panic sets in, which further accelerates your anxiety. Then you head to Coles, Woolies, Aldi and IGA and there is no toilet paper to be found anywhere.

Definitely not my toilet

You have faecal urgency and have been known to have accidents so the fear is real for this patient. This fear generates more cortisol and adrenaline, which in turn causes the bowel to be very reactive and makes the urgency even worse.

Before we know it there is a full scale calamity unfolding both in the whole world and in this lady’s life. Her body is letting her down and she no longer trusts it to behave safely.

Trust extends further in our lives. We need trust in the mechanisms that keep our society running smoothly. We need trust in all levels of government. We need trust that the health system will be able to withstand the pressure of the tsunami of patients if COVID19 takes off. We need trust that the financial system is robust and can bounce back after this is all over.

Most importantly we need trust that basically humans will behave in a humane and kind way.

But what can you do?

Individually try and use this strange time to your advantage. Over the years everyone at different times has felt the pressure of too much work, too much socialising, too much lecture preparation, too much Committee-ing and no absolutely no down-time. Not a minute. And certainly if you take a minute – you are usually plagued with guilt that you should be doing something, anything on your To Do List.  so why not write a bucket list of #jobstodoinlockdown

Here is my #Coronalifebucketlist:

  • Tidy desk (I did this today and I am very pleased with the before and after).

Achieved prior to #lockdown #impressive

  • Delete the 21,989 emails in my inbox (you think I am exaggerating……..I promise you I am not. I am definitely an email hoarder)
  • While on my computer – try and learn how to save a Powerpoint without saving it 40 times thereby completely choking the storage on my computer. Then delete all unnecessary Powerpoints. (Similarly with Word documents)
  • Tidy up my many ‘desks’ that I have ‘home offices’ set up at.
  • Delete the photos from my Iphone that I do not need on there (I have even more trouble deleting photos from my iPhone, than emails).

This is truly embarrassing

  • Clothes culling (some may call it #MarieKondo-ing but I’m going to run with #Coronakondo-ing). As each child has left I have spread my clothes amongst all the wardrobes in their bedrooms. In my #preCoronalife, when I was trying to be a good #climatechangewarrior I was embracing the #recyle #reuse #reduce and not buying any new clothes. So I couldn’t possibly contemplate throwing any clothes out just in case my size changed from my current-sized wardrobe, back to a previous weight (ranging from size 8 – such as my wedding dress to size 16 at the height of my #chocolateasastressreducer phase). But with some #lockdowntime on my hands possibly it’s time to let go of some oldies!
  • Clean out the children’s belongings (this is actually a test to see if they ever read my blogs – I couldn’t possibly ever let go of their numerous trophies, china dolls, cricket bats)
  • Read some (not pelvic floor related)books. I read a lot. I read journel articles, new pelvic floor-related books, pain and anxiety management books, Facebook stories, Twitter trending stories. Alot of reading. At Christmas time I read fiction and non-fiction (but non-pelvic floor related non-fiction) books and I love it. Give me a good book and I lose track of time and meal preparation and can knock a good book over in a day. But that happens but once a year – at Christmas time. I also have been known to buy a lot of books hoping I will read at other times of the year, so I have plenty of great books ready and waiting once all the chores above are ticked.
  • Get plenty of exercise. We will walk the streets while we are allowed to. We have a treadmill at work and a stationary bike at home which we will utilise if we get to the stage that Italy is at (please no). We are also in the process of setting up some exercise classes which we will be live streaming into your homes should you subscribe to keep everyone sane and healthy. We know that we need a tip-top immune system to not fall in a heap if we get Coronavirus. I too will love doing the classes my staff will be doing for us.

But seriously I am truly hoping I get no time to do these #Coronalifebucketlist things because I am hoping Jane, Martine, Megan, Amanda and myself will be absolutely flat out with appointments via our new treating medium called #Telehealth to restore everyones’ trust in their bodies.

What more perfect time to get control of your bladder, bowel, pelvic pain or prolapse, but when you are in #lockdown and can truly give time and attention to your body – to fine-tune it and problem-solve why it has been letting you down? We are so savvy with computers these days. We spend an inordinate amount of time on them – why shouldn’t we treat your pelvic floor dysfunction ‘virtually’?

For many years now we have been doing phone consults for regional patients who can’t make it back to Brisbane for their follow-ups. This will be better because we will have video capability. So much of what we do is education. We teach you about what is normal for your bladder, bowel, pelvic floor and what goes wrong. Or if it is a pain condition, we teach you what is persistent pain and how to treat it, and beat it. How to get back to living the fullest life you can.

Now many may ask about the important internal examination. There are lots of ways to teach you about the state of your pelvic floor. Of course it’s not ideal to not be able to examine you, but SO MUCH can be learned via good, thorough education and that is what we pride ourselves on at Sue Croft Physiotherapy. Much can be also taught to Mums and Dads to help their children who may have a pelvic health condition. Men’s health problems can be successfully treated with a #Telehealth consultation.

So if you would like a phone consultation or a video appointment with us ring one of my secretaries on (07) 3848 9601 or 0407659357 and book one in. Being able to book Telehealth (or phone) consults online yourself will also be available very soon.

Now finally, what about #trust in our public institutions? 

I think we trust our medical profession and our scientists. They are doing a stellar job.

Our teachers at the warfront with no possibility of social distancing and in the firing (spray) line of every sneeze and cough deserve a medal.

Our state leaders seem to be stepping up. South Australia have incredible testing procedures for COVID19. Tassie and NT are plain old shutting the borders. Victoria, WA and Queensland have consisitent messaging and their numbers appear to be stabilising. NSW? Well who doesn’t love a #Bonditan?

At a National level? The messaging is confusing, disjointed and at times I feel despair. I have 10 employees and if we are going into #lockdown – what is going to happen to us all? Boris Johnson (United Kingdom PM) has offered all citizens 80% of their pay if their employer can’t keep paying them when there is no income. Seriously, I would cry if we had that offer from our Government. The relief would be enormous for me and my staff.

But I am not waiting for such an offer. I am encouraging you all to embrace your #newCoronalife and attend to your pelvic health deficiencies via a #Telehealth appointment with one of my girls or myself. Let’s hope we talk soon. Stay healthy. Keep moving and exercising. Don’t despair. And most importantly, keep on the lookout for funny #Coronalifememes

 

Recognising that sexual intimacy is an important part of faith for women

International Women’s Day 2020 Post

All my physiotherapists at different times have been asked to contribute to my blog by writing an article on some aspect of pelvic floor dysfunction for me. Today is the turn of my newest staff member, Amanda Waldock. Amanda is settling in beautifully at my practice after coming back from the UK, where she worked in London in pelvic health. I recently bought quite a lot of books on different issues related to sexual intimacy and Christianity and I asked Amanda to have a quick read of the books and give a short summary of their subject matter. One of the recurring barriers for women are the conflicted thoughts they have regarding intimacy.

We have copies of the books at the rooms but if you like the sound of a particular book then they were easily secured from Amazon.

Here is Amanda’s first blog for me:

Sexual wellbeing is an essential part of a person’s overall wellbeing. However sexual difficulties are often not discussed and therefore go untreated. For women these include:

  • Painful intercourse – known as dyspareunia, vulvodynia or vaginismus with 1 in10 women suffering with painful sex
  • Lack of Libido – 4 in10 women have poor libido
  • Anorgasmia – 1 in 3 women find it difficult reaching orgasm

(See https://www.racgp.org.au/afp/2017/januaryfebruary/lets-talk-about-sex/ for more details)

Although the statistics are high for these conditions, we also know it takes women (and men) a long time to seek help about these concerns.

We pelvic health physiotherapists at Sue Croft Physiotherapy, believe that sexual wellbeing should be high on the agenda. We are able to see how sexual difficulties impact an individual, their partner and their relationship. It is a very important aspect of one’s quality of life and needs to be given more attention.

Although it is important to speak to a medical professional (such as GP, gynaecologist or pelvic health physiotherapist) about these conditions, sometimes having reading resources you can turn to in the comfort (and privacy) of your own home, and at your own pace, can be a helpful adjunct to seeing a trained professional.

Dealing with sexual concerns can also be confronting and confusing with other factors such as religious, cultural and social beliefs being thrown into the mix.

For this reason, I have compiled a list of books we have in clinic at Sue Croft Physiotherapy along with a brief overview to help steer you in the right direction when looking for information on intimacy, sex, arousal and a whole lot more.

Christian Perspective

Hot, Holy and humorous by J. Parker

This book is a complete guide to Sex and Intimacy from a Christian perspective. Parker discusses everything from cultivating romance in your relationship, defining “Christian Sex”, tips for the physical side of things, but also refers to lower desire and other issues that may crop up. The focus of this book is on that fact that God designed humans to be sexual and that enjoying a sexually satisfying relationship is within his plan.

Bonus – Hot, Holy & Humorous is also a blog!

Parker has a blog full of resources as well! With over 850 blog posts ranging from the Bible’s perspective of sex to romancing your spouse and specific sexual techniques. The blog also answers readers specific questions and new blog posts are being added weekly.

Intimacy Revealed by J. Parker

This is a practise book for a year. 52 devotions, one for each week, which provide Bible passages, application, questions and a prayer that aim to shed light on God’s gift of marital sex. This book provides a scaffolding for you to think deeply about you and your partner’s sexual relationship and place this into the context of your life, and faith.

The Good Girl’s Guide to Great Sex by Sheila Wray Gregoire

A Christian place to turn to find answer to the most intimate and embarrassing questions. It aims to show people that sex isn’t just physical, but also an emotional and spiritual experience. Chapters include (but are not limited to) – How Good Girls Think about Sex, Lighting Fireworks and Learning to Make Love, Not Just Have Sex. This book is dotted with words from other women sharing their experiences.

Modern Scientific Approach

Come as You Are by Dr Emily Nagoski

This book takes the focus of the science of Sex and the surprising truths about what does work to maximize a woman’s sexual wellbeing. This book aims to teach you that although we are all made up of the same physical parts, no two people are the same. That we need to focus on “Turning on the ons and turning off the offs”, taking control of the context or environment and that unlike men, women’s desire is often more responsive rather than spontaneous.

The Come as You are Workbook by Dr Emily Nagoski

This is the companion to ‘Come as You Are’ which aims to bring together activities, prompts and thought-provoking examples to provide practical, evidence-based tools to enhance your personal sexual wellbeing. It is the perfect way to take the information learnt in ‘Come as You Are’ and expand on it to further understand yourself and your sex life.

Holistic/ Spiritual Approach

Women’s Anatomy of Arousal by Sheri Winston

This book is separated into three sections and talks about all things from spirituality, personal energy to chakras. The first focus on the history of female sexuality, how things have changed over time and how thing have gone wrong throughout time, specifically hiding and under-valuing female sexuality. The Section 2 focuses on the physical anatomy of a woman and pleasure, while Section 3 ties it all together providing practical tools to expand your sexuality.

Let us know if you have read any of the following and have any thoughts or if you have any suggestions for our bookcase.

Thanks Amanda for this summary. I know that many women will be pleased to see that there are some reading books available to them to help them expand their knowledge and gain comfort from the recognition of their faith.

 

Mon Repos Turtle Centre,near Bundaberg,Queensland

Twenty five years after our first attempt at seeing the turtles of Mon Repos we struck gold when we ventured to the brand new Turtle Centre at Mon Repos, Bundaberg. Our road trip this weekend was triggered by my son who has been closely involved with the design of this new iconic building by Kirk.

The new Turtle Centre at Mon Repos by Kirk (Architects)

Our first trip in 1994 to check out the turtles was an exciting trip in a hired camper trailer with all the kids (aged 8,5,2 years) having croup so badly that we actually took our humidifier and had it going all night! The midgies which were shocking also kept us on our toes and we didn’t come close to seeing a turtle laying or a hatchling hatching. There was nothing much formal organised to see the turtles- or if there was we didn’t find out about it (remember this was pre-google days).

Fast forward to 2020 and we had definitely prioritized seeing this new magnificent building. But we soon found out that seeing the turtles requires some forward-planning as there are limited numbers of tourists taken out on the sand each night and these book out months and months ahead. But we had a weekend looming with everyone free to go and so it was on. After searching websites and phoning to beg for seven spaces on the tour for the 8th, the lovely lady at Mon Repos Turtle Centre suggested we check out all the tour companies and see if they had any spare spots and sure enough Bundaberg Coaches came through with the goods. Seven spots for the Saturday night and better still, the ticket price included a pick-up from our accommodation to Mon Repos and return to the accommodation after the turtles sighting.

Some may say that driving to Bundaberg for an overnighter was too much, but we headed off for the four and a half hour drive at the crack of dawn on Saturday and arrived in good time and no discomfort- definitely achievable for a weekend. We stayed at Don Pancho Resort which weirdly was where (Bob believes) we stayed on another family holiday (but of which I have no recollection). It was very reasonable and very pleasant and most importantly you can stay there just for one night which made the whole trip very inexpensive. The young ones headed off to The Bundaberg Rum Distillery and the oldies and the babies headed for a session of beach and rockpool time. There were plenty of crabs and miniature fish to keep everyone entertained and then a big session at the great pool back at the Don Pancho.

Thousands of baby fish in the rockpools kept everyone excited

After an attempted (and failed) afternoon nap time the bus arrived for the pick up at 6.20pm and off to the centre we went. On the way we spotted some wallabies which added to the excitement. The all-important allocation of groups at the Turtle Centre desk revealed we had really scored by booking with a tour group because, despite purchasing the tickets only 6 days before, we were in Group 2 – the second group to go out and meant we didn’t have to wait until (potentially) 2am to see the turtles. There were around 300 people all patiently waiting for their turn to go down to the beach, carefully guided by a National Parks Ranger (we had Loz- she was great). There are lots of great audio-visual displays and plenty of things to keep the littlies entertained during the Big Wait.

Some Advice:

  • Definitely eat before you go, as the cafe only has drinks and the (inevitable, inedible) packaged pies and sausage rolls and limited baguettes.
  • You MUST take waterproof coats or ponchos if there is any threat of rain as you are not allowed to take umbrellas out onto the beach.
  • You MUST wear joggers on the beach to walk to see the turtle action and the walk could be 800-1000 metres in the PITCH DARK.
  • Really for this reason, you have to be fairly steady on your feet. You can’t see where you are going and the beach might be quite steep and with soft sand making it difficult to walk on.
  • No lights are allowed (including just the light of a mobile, mobile flashes with photos, torches or head lamps) as it may affect the natural process of the turtles that you have come to observe, whether it be turtles laying eggs or hatchlings making their way to the water after hatching from their eggs. But you will be given opportunities to take photos with lighting provided by the Rangers.
  • While there are plenty of tables and chairs for you to wait at, definitely take a good book to read and a thermos of tea/coffee and snacks to keep you awake if you don’t have young kids with you, as the cafe shuts at 8pm. It is a perfect time to catch up on some reading and the wait will be significant if you are not in Group 1 or 2. If you have young kids, they love the interactive room and as we were group 2 the ranger took us in to an auditorium, gave us a great talk and then some nice videos about turtles to look at after Group 1 went out to be taken to the beach. There is sand at the bottom of the auditorium with some giant turtle models that kept the 2 year olds entertained (when the beautiful video didn’t).

Our wait was around an hour and our ranger came and stopped the video and said there is action happening with a loggerhead turtle coming in to lay eggs. We headed out in the gentle drizzle (and very moody but slightly worrying distant lightning) and very carefully followed the ranger out on the boardwalks.

Did I say it is very dark? With intense cloud cover, rain and no lighting you have to hope the builder did a good job on laying the planks on the boardwalk. All the kids (and there were quite a few) were incredibly brave with none of them whinging about the dark. I think they were all filled with excitement about the upcoming reveal.

We walked along the beach and came to where the most incredibly beautiful (and enormous) loggerhead turtle was in the process of laying her eggs.

Oblivious to the large audience, she went about her business of laying 124 eggs!

She was unperturbed about her large audience and there was great excitement in our group when the ranger announced she was a brand new, previously untagged loggerhead. It was her very first time at Mon Repos. Loggerhead turtles usually start their reproductive years at age 30 and then lay eggs for around 40 years – and when they come back to nest they lay up to 6 clutches over a 12 week period. Each clutch of eggs is around 120 eggs and our girl laid 124 eggs! Unbelievable. It was so fantastic watching her and realizing she started her journey 30 years before as a hatchling and then came back to Mon Repos to complete the circle of life. We all felt very privileged to witness this beautiful experience. The rangers tagged her and that was something she didn’t particularly enjoy and she took off back to the ocean at a great rate of knots. But that tagging is vital to the researchers who work at Mon Repos in helping track the turtles and monitor their numbers.

But it got better. The researchers at Mon Repos know that they have a two hour window once the eggs are laid by the turtle to move the eggs to a nearby hatchery. This hatchery has sun protection and is closely monitored by rangers to ensure the eggs have the best chance to survive things like the hotter sand due to our increasingly hotter weather because of climate change.

The ranger carefully digs the eggs out after the turtle has returned to the water and then they get moved to the hatchery which is shaded

And you may ask – how did all those eggs make it to the hatchery?

Michael with the 3 eggs he moved

Yes all the people in the group got to move the eggs into the newly dug holes – another unbelievable experience which I didn’t know was coming. We all lined up and took our turn and because she laid 124 eggs some of us got a second go and I took 5 eggs to the hatchery. So moving.

After everything that had happened the group was on quite a high but it was about to get even better. We were making our way back to the boardwalk when we were all ordered to immediately stop because there in front of us were 8 little straggler hatchlings randomly walking down to the ocean.

 

A close-up of the hatchling 

I suddenly decided that night that when we retire it may be worth having some months up at Mon Repos volunteering to help the researchers across the turtle season. This is such a fantastic weekend trip. Don’t be put off by the drive up but maybe allow 2 or 3 nights as there is lots to do including just chilling looking at the beautiful water.

One of the lovely rangers at the Turtle Centre    Side View and the Outdoor Education Centre

 

 

Procrastination (the art of avoiding the must do tasks)

You may remember that when we had the Pain and Relaxation classes at the studio, I started to produce some Nuggets of information for our clients (the Nuggets name dutifully ripped of from the magnificent Lorimer Moseley and Dave Butler of Explain Pain fame). It started as short one page handouts about persistent pain management and then progressed to other concepts that are often closely tied in with pain such as anxiety and then morphed into anything we could think of. My physios were tasked with brainstorming ideas for these little knowledge bombs and then I would run with the word they conjured up or if they had a gap in their patient list, they would do some research and give me their ‘one pager’.

Yesterday I asked Jose, my secretary, to load them all up onto my computer, so I can have them close at my fingertips to draw on as I need.

Today so far, I have had breakky, looked at Facebook, cleaned my teeth, looked at Instagram, got dressed, scrolled through Twitter, got my computer out of it’s bag, turned on the tennis……… and then I suddenly remembered the Nugget about Procrastination. You see this weekend has been earmarked for a big sorting and solving weekend with a project I am working on (CFA National Conference on Incontinence 2020 or #NCOI20 – health professionals please earmark the 18th-21st November in Brisbane as we have some exciting speakers) and instead I found myself time-wasting BIG TIME. I find if I commit to a blog and write it, then I am often more productive for the rest of the day. I get my head-space cleared and focused and then can get on with the real work.

I also wrote it all those years ago because patients have been known to suffer #extremeprocrastination when facing up to their pelvic floor exercises or their pelvic stretch exercises or their belly breathing practise or any of the other strategies that their pelvic health physio may have given them and this time wasting or downright ignoring of their homework, acts as a barrier to their progress with their pelvic health issue.

So after you have read this blog, put down your phone and get out your notes and handouts and revisit the Essentials of good pelvic health. Anything in the section below not in italics has been added by myself.

Procrastination

(Sourced directly from https://www.psychologytoday.com/basics/procrastination. Written by Psychology Today)

Everyone procrastinates sometimes, but 20 percent of people chronically avoid difficult tasks and deliberately look for distractions which are unfortunately increasingly available with phones and computers. Procrastination is related to self-control with “I don’t feel like it” taking precedence over goals. This then leads to negative emotions that deter future effort.

Procrastinators may say they perform better under pressure, but often than not, that’s their way of justifying putting things off. It is possible to overcome procrastination but requires effort. Perfectionists are often procrastinators; it is psychologically more acceptable to never tackle a task than to face the possibility of failure.

Time Pressure and a “Scarcity” Mindset

Too many demands on your time can lead to a ‘scarcity mindset’ in which you are chronically busy. Often exercise and healthy eating suffer, your house is disorganized and you neglect relationships.

Take Control of Your Time

Being more intentional with managing your time can help with greater life satisfaction, you feel less overloaded and have less day-to-day tension.

Below are some useful things you can do to take control of your time:

  1. Set priorities: Take time for goal setting. Prioritize and record them. Examine relationships, work, finances, health and particularly work-life balance. Planning your time and commitments accordingly.
  2.  Be realistic about what you can accomplish It is better to achieve the goals you set, than to feel that you’ve failed, so start with lower expectations and then build as you get better at time management. Take your initial estimate of how long it will take you to get a task done and then increase it by at least 25 percent to begin with. See how well this works and adjust it up or down as needed. This is particularly important when looking at the solutions your pelvic health physio has suggested to you. There may be multiple (often overwhelming) ideas she/he has provided to you and so just choose one or two to focus on and perfect them and then move to the next one. You have the rest of your life to solve these issues that you have lived with for years (often).
  3. Limit interruptions: Limiting how often you get interrupted is key to getting things done. Stop notifications, texts or emails from showing up on your screen or pinging – a trick my children taught me is to turn the phone onto aeroplane mode. Instead allocate some time every hour or two hours to look at them; close the door of your office; work when the kids are asleep during the day or once they’ve gone to bed at night- generally remove distractions. Remember to also get up and change position and move regularly
  4. Learn to say no: Setting boundaries with others is an important part of managing your time and limiting excessive stress. This is easier said than done, but often is the problem.  
  5. Stop procrastinating: Work out what may be causing you to procrastinate. Is the task boring? Automate boring tasks, add music, make lists and tick them off (I love doing this – sometimes when I have made a list and then do a task that wasn’t even on the list, I add it to give myself the satisfaction of having another tick on the page (insert open eye aghast emoji, add smiley face emoji – I need to find out how to get emoji’s on my computer as I obviously rely on them big time!)
  6. Do you not know what to do? Research, ask for help. Are you easily being distracted? Minimize distractions (see above)
  7. If you don’t think you can do a good job, evaluate whether this belief is true. The belief that you can’t succeed may be just a symptom of lack of confidence. Imposter syndrome is rife in many people these days. Imposter syndrome is defined as the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills. You can be so judged these days – not just in the public sphere of the internet – but also by where your political beliefs lie; where you were educated; what your body shape is like; your social justice values that you feel strongly about and so on. As I get older, I am letting go of my profound imposter syndrome and just hoping that I make the most of my next period of life – old age. I have lots of life-experience from treating and talking to literally thousands and thousands of patients and I am determined to just use this incredible thing we humans have created called the internet to: pass on information (hopefully all evidence based); to comment on inequality and injustice; to spread some laughter because there’s some very funny stuff on the internet; but most importantly not listen to my inner doubts or other chemical reactions called thoughts (and particularly thought viruses).

Now to get on with the Scientific Programme!

PS. Governments and citizens alike are procrastinating on #climatechange

 

Bisacodyl suppositories are not glycerol suppositories

Glycerol suppositories and Bisacodyl suppositories

This is a short blog to alert people about the hazards of walking onto a pharmacy and getting a substitute suppository when the brand recommended is out of stock. I had a patient who had significant bowel emptying dysfunction and who was straining quite a lot report that she had gone to the pharmacy to purchase the suppository that can be helpful to achieve better evacuation without straining. She reported that the pharmacist did not have any glycerol suppositories in stock – the commonly recommended ones that colorectal surgeons suggest. The pharmacist suggested Bisacodyl suppositories instead.

She used one of the Bisacodyl and reported distressing symptoms that then made her very uncomfortable- burning all around the perineum and constant ongoing bowel urges all day, with a feeling that she could’t control her bowels if the urge hit.

One of the things I ask my physios to do is to be aware of what some of the things we talk about actually feel like. All of them who have done pessary courses have tried a pessary so they understand what patients may feel (they may not need them but they still get to trial it). Of course, as I tell all my patients, I use a pessary for my prolapse and due to my own pelvic floor dysfunction, experience the day-to-day delights of childbirth. I have always tried any product that I may suggest to my patients will be helpful so I understand the ramifications of it.

So when this patient reported these unpleasant symptoms – I thought it essential I test it out….she wasn’t lying. It was extremely unpleasant with the generalized burning and the ongoing constant urges through the day.

Glycerol suppositories are NOT Bisacodyl suppositories.

Deeds not words

Aussie Bushfires, 2019/2020

There are many people directly involved or affected with this current Australian fire catastrophe. Some are very busy fighting the fires, organizing the firefighters, coordinating the helicopters and planes, saving lives, tending to the sick and burnt, feeding the hungry and rallying the troops. But there are now around 25 million people living in Australia, plenty of whom are not directly involved or affected by the fires – some with the smarts in science, the weather, the climate, economic nous, organisational skills, business entrepreneurs and so on.

If my house had burned down in an event which had never, ever been seen before, would I want to wait a respectful period of time before a think tank was established to sort this mess out? A gathering of brilliant minds to come up with many ideas to combat this catastrophe?

No way.

I would want…no expect…that there would be an emergency declared (this IS an emergency – if you are worried about calling it a #climateemergency then just call it any old emergency but this is what an emergency looks like)!

Respectfully, there is not a second to be wasted. The first fires started on 4th September, 2019 in Queensland with 50 fires in various regions throughout my state. The iconic Binna Burra Lodge was decimated. One of Australia’s longest-established nature-based resorts, Binna Burra Mountain Lodge was founded in 1933 by Arthur Groom and Romeo Lahey. These two pioneering conservationists shared a vision to create a place where people could stay and experience the beauty of the Lamington National Park rainforest. (1)

That is not a typo. Binna Burra was destroyed by a bushfire and it is in a rainforest.

We damn well need to get our sh*t together and get a plan. As many people have said, this is like a war. And it should be treated as such.

We need army generals with good planning skills to organize this bunch of nerdy, smart people who have NO VESTED INTERESTS. And there must be no politicians allowed. They unfortunately proven themselves over 10 years to be incapable of rising above the politics and think of Australia’s long term future. We don’t need politicians. Shane Fitzsimmons has shown himself to be a real leader, but we need him to stay where he is.

But I bet there are many many ‘Shane Fitzsimmons’ out there. Clever, calm leaders who can work this mess out. And there can’t be any financial constraints on this battle- there wouldn’t be if it was war- the generals would say: ‘We need this’ and the politicians would say: ‘Here you go’.

We need health professionals to advise about how to prevent a catastrophic overloading on our already stretched health services. How to get around the calamitous air quality? What will our future be like if we are forced to stop exercising outside because the putrid air is dangerous to inhale? How will our children enjoy their childhood if they are locked inside – never allowed to breathe the air outside, run and skip and play with gay abandon.

What do you think the people who have been affected so horrifically by these fires would think about this idea? I believe they would be relieved, heartened, grateful, excited that something was finally happening and did I say relieved? Very relieved….

Did you know there is actually a Fire Centre in the Uni of Tasmania? The Director is David Bowman (a fire scientist).

Professor David Bowman

He says that climate change and weather driven processes have to be confronted. We have to stop allowing politicians attempting to distract us from where the real action is- the fact is the bush is drying out and the weather is hotter and there’s danger ahead and we have to get on top of it. And it is driven by humans.  Trying to frame these recent fires as criminality is just plain wrong- pathological lighting of fires is very small percentage of fires. Lightning strikes and lightning from within the fires themselves cause the majority of fires.

Why do I keep writing out of my scope? Why do I keep bleating on about this issue? ** Because it affects us all and is life-changing!

Will this little boy ever be the same? The day he drove the boat with his family in it away from the cataclysmic fires at Mallacoota will be etched on his brain forever. He’s about three years older than my grandson. What a nightmare for him.

PHOTO: Allison Marion took this photo of her son Finn as they joined the exodus from Mallacoota

If this isn’t an emergency…… well I don’t know what is. The army evacuating Mallacoota residents, January 2020

What should we want as citizens of Australia?

Real action by our Government. Set up a think tank and fund it with our surplus. We are losing BILLIONS AND BILLIONS of dollars ($$$) in tourist dollars, let alone the dreadful damage to houses, infrastructure and our citizens’ lives by not addressing the elephant in the room #climatechange

We want deeds not words.

And when do we want it? NOW!

(Embrace the future. Let go of the past. It’s ok to change tack. There needs to be immediate establishment of renewable energy industries in coal towns and regions. Give every coal worker a job in renewables. No jobs will be lost. Leave the coal in the ground. And it will be healthier work for the current coal workers. And establish another think tank to sort out the water crisis. And this is another definite politician-free zone. There is something rotten in the water management area of Australia.)

(1) https://www.binnaburralodge.com.au/about/

** And because I want a record for my grandchildren that I cared about their future and I spoke up.

A Merry Christmas and Happy New Year blog in not so merry or happy times

Bush fires Australia 2019   Exhausted volunteer fire fighters 

Everyone knows this has been a terrible spring and summer in Australia for drought and bushfires and to be honest it almost feels disrespectful to those suffering in fire regions to be having fun and relaxing at the beach with the family (like I am) when fire is raging all around the country and people are suffering. The pictures tell the story and I just can’t imagine what it’s like for these families who have had their past erased and their futures plunged into uncertainty by these catastrophic and unprecedented fires.

We all know what it means to be an Australian in tough times – the ANZAC spirit is often quoted – qualities which include endurance, courage, ingenuity, good humour, mateship, being resilient under extreme pressure and having a ‘she’ll be right mate‘ attitude. But sometimes I feel our politicians take advantage of these qualities and quite frankly, these amazingly brave firefighters and just ‘ordinary’ citizens who live in these regions suffering under extremely dangerous and overwhelming conditions, need a break.

The army was called in immediately after unprecedented floods in Brisbane in 2011. I remember saying to my mum who lived on the northside: “Yeronga is literally like a war zone“.

 

The army was immediately ‘deployed’ to all the flood zones

I felt distressed at the damage in my suburb, but relieved and almost guilty at the same time as our house was unaffected by water inundation. The only discomfort we had was we had no power for 5 or 6 days. It was in fact a special family time when we played board games around the camping light and binge-watched a TV series each night on the computer until it died and then we’d recharge it the next day as we had power at my rooms at Highgate Hill. There was only one round-about way into Yeronga and you had to plan your routes if traveling to family members who lived out of the ‘war zone’.

Our shops at the end of our street 2011

There was mud and enormous piles of rubbish built out of the memories and lives of our neighbours; there were helicopters circling overhead; and army trucks and soldiers everywhere pitching in with the ‘mud army’ (other Brisbane residents unaffected by the floods who came out of the woodwork to help their fellow citizens) to get people’s lives back in order.

The famous Brisbane mud army that rose to the challenge the floods created

The council were incredible – getting trucks to remove the rubbish from the streets to a local park area and then magically taken away and then within a week, some order felt like it was restored.

The houses at the end of our street suffered badly- people’s lives exposed wet and muddy on the footpath

I have read where some poor people have endured both floods and bushfires and they have commented that whilst they have lived through devastating floods, these bushfires were much worse, as everything has been completely erased, including the surrounding environment and the animal life that lived there. Worse still they were terrified they could be caught in the fire and burned alive. It was bad enough reading reports of the bushfire residents hearing screaming wildlife as the fires ravaged the landscape.

These survivors of these bushfires must be traumatized.

They have to be suffering psychologically as well as emotionally and financially.

How fortified would they feel if the army arrived to help?

How strengthened would their resolve be if every day on the news they saw their elected representatives travelling the country dishing up food to weary firefighters, shaking their hands and thanking them for their amazing bravery.

But wait- how could they see that? They probably don’t have power due to the fires. They don’t have TVs or living rooms anymore. They don’t have lounge chairs or platters to put their cheeses on.

God how desolate must they feel?

How relieved would they feel if they had a promise from their government that significant financial help will be provided. Personally, I am happy to give up our budget surplus to help these people through these disasters. I’ve taken a poll – all my family agree. They would understand that this is a necessary burden to our economy to give these people some hope for their future. If their villages are rebuilt and they are compensated, this will be a boost to the local economy and the national economy.

These bushfires are wrecking Australia’s bottom line and our brand. They are trashing our reputation as a tourist destination. Getting on top of them quickly and restoring faith in the ability of our leaders to lead is paramount.

It isn’t enough to say Aussies are strong folk. They’ll pick themselves up and get on with life. Whole villages have been decimated. Schools, shops, maybe even physio practices have disappeared off the face of the earth. I can’t imagine what it must be like.

There has been much criticism of the behaviour of our Prime Minister. I expect many Australians are disappointed and many others, directly affected by the fires, are feeling abandoned and others are angry. I think those affected by the fires wish he could walk in their shoes – feel their sense of loss, fear, anxiety and abandonment.

But I think he is conflicted. He has got himself trapped in a corner with nowhere to go because he has made so many strong comments about coal, climate change and the surplus and he has contested opinions about climate change to deal with within his own party about climate change and it’s impact on our environment.

Backed into a corner with nowhere to go

But it is never too late. Don’t feel trapped. It’s OK to change your tone and your opinion in the middle of an argument. People respect you for listening to the science and looking at the evidence that there is much money to be earned in alternatives to coal. It’s OK to leave the coal in the ground and forget about it – forever!

And the fact is – there is no need anymore to actually say: ‘I believe in climate change’.

It’s like saying I now believe the Earth is not flat!  Believe it or not there was actually a time when the belief was that the Earth was indeed flat. Our children may not have heard that fact – the fact being that there was a time when the inhabitants of Earth thought it was flat. It sounds ridiculous now doesn’t it?

And this is what will be said in years to come about climate change. Since the seventies, scientists and vested interests in coal production have known about the effect of carbon emissions on the warming of the climate. The link below is to an excellent short video from Dr Karl that I commend to you to listen to.

Dr Karl – Do you believe in climate change?

I have always believed there are some things that should be exempt from government decision-making. And the impact and effect of climate change on the Australian natural environment and the potential future extinction of so many native animals, insects and amazing natural wonders like the Great Barrier Reef, should definitely make the list.

It should be left to an expert panel of climate scientists, farmers, economists, innovators, business leaders, researchers and experienced negotiators and mediators. It must be represented equally in gender. Get the brain storming going. Lock the doors until they sort it out.

The plan must have strong parameters:

The coal towns must be promised that every job in coal will be replaced with viable work in renewables and other industries which will be created. (We don’t even know what these things will be – they are still trapped in the innovative, clever brains of our scientists waiting for research funding from the government).

The farmers have to be consulted and listened to. They are at the coalface of climate change.

First nations peoples must be involved. Their skills in managing the Australian bush must be utilized. They know the land and the bush.

Why not utilize the manpower left abandoned on Manus Island. I am sure they would relish the opportunity to show that they can be useful members of our Australian community.

Let’s think out of the box. Let’s go off tangent. Let’s declare any vested interests and leave those people out of the decision-making.

And why you might ask is a pelvic health physio writing this blog?

Because I am a health professional who sees the burden of our changing climate on our health and fears for the effect of the smoke and pollutants on the respiratory system of those with asthma, bronchiectasis, chronic hayfever and other similar conditions. All that coughing and sneezing -it is a serious problem for pelvic floors believe me! I worry about a time when we may not be able to exercise outdoors anymore and the deleterious effect on our health – compromised cardio-vascular system, diminished brain health and bone density to name a few.

I am a grandmother who wonders what the future will bring for my children and grandchildren. What will be the extent of species extinction?

I am a citizen of the world and we are a part of the global community, not isolated and disrespectful of other countries and communities.

Because I write a blog and therefore I can.

But I hope it will open a dialogue, not shut down conversation or cause discontent. We must take this scary ‘new normal’ seriously.

Most importantly, I want to know when I am 90 and look back at what I have thought about or how I have acted on this climate emergency in 2019, that I didn’t choose to not ruffle feathers or upset friends, relatives or the public by saying nothing. I will know that I have tried to make a difference beyond my own individual choices such as plastic use, choosing to reuse, recycle or reduce and other ways to reduce our carbon footprint.

#climatechangeisreal

#theearthisnotflat

#believethescience

Merry Christmas and a Happy New Year and may our new decade bring us new direction and strong effective governance.

Here’s a great pelvic floor friendly exercise: Walking netball? Yes really!

Ladies playing Walking Netball 

Recently I had a patient who, when I asked about her exercise that she is currently doing or would like to do, told me about Walking Netball!?!  Now we are a netball family and in all my years sitting around netball courts, I have never heard about it. I actually couldn’t imagine such a thing and then if there were such a thing, how would it really work? This patient wrote a little paragraph about it and then to my surprise (or is it that Facebook and Instagram have a wifi link to my brain waves -see Years and Years on SBS – a great, but rather worrying show with Emma Thompson about our future) walking netball posts started to appear in my feed…..

Here is a image of the amount of activity someone on Instagram posted the very next day that her Fitbit recorded while she was playing walking netball. Looks like a lot of moving.

Here is my patient’s paragraph.

My friend Sue had been asking me to join Walking Netball.  When younger (much) I played basketball and thought that the Walking Netball would be a bit tame. Well, I was ‘hooked’ from my first game.  Actually I was exhausted, but soon built up fitness.

Special rules apply – NO RUNNING – NO JUMPING – NO DEFENDING UP CLOSE.  If off balance, bounce the ball or take a step. Be aware of players with a disability and help newcomers. The objective is to provide exercise while being aware of creating a safe environment.

I felt welcome from the first game and soon was part of a great group of ladies.

Thanks for sending this in JS and I hope my pelvic health colleagues will remember this when offering pelvic floor friendly sports and activities to their patients who have significant pelvic floor compromise and need to modify their exercise. When I checked out Netball Queensland about walking netball, this was on the site and seemed appropriate to lots of things in life.

“The hardest part about Walking Netball is being brave enough to walk through the door, but once you do, you will be welcomed by lots of smiles and a bunch of new friends. I encourage people of all ages to come and try Walking Netball.”  Rhonda Newton, Walking Netball Coordinator, Netball Qld 

Some links:

Netball Qld Walking Netball

Netball NSW Walking Netball

 

A patient story – a holistic approach to managing urinary frequency, urgency and urge incontinence (also known as the Overactive Bladder)

Treating Overactive Bladder problems involves many strategies – I liken it to the many slices in a big apple pie.

I recently saw a patient who was at her wits’ end with her urge urinary incontinence – one of the symptoms of a condition called the Overactive Bladder (OAB). The other symptoms are urinary frequency, urgency and nocturia. She had tried physiotherapy and medication and came reluctantly to see me because her urogynaecologist had insisted she come. When patients come to see me and they say they have had physio, I always make them sit through the education again, because the most important part of what pelvic health physios do each day is educate the patient in an easy-to-understand way about the pathophysiology of their condition.

I find that often patients ‘hear’ the education the first time from their therapist and they sometimes are not quite ‘listening‘- it sounds like a lot of words that involve them making changes to long-held behaviours and beliefs and so they inadvertently switch off. So it isn’t that the first physio isn’t doing the right thing – it could be that the patient wasn’t ready to hear it. The second time around, with some emphasis on the importance of self-empowerment, patients are often more receptive and ready to ‘run’ with their treatment programme.

So here is T’s patient story. Thank you for your thoughts T – everyone learns from patient stories.

As you know, I had already been dealing with this incontinence for three years before my first consultation. I had tried several medications as well as physiotherapy, but could not seem to get on top of it.  I saw no light at the end of the tunnel. After our first treatment session, I decided I needed a more pro-active attitude and I had a clearer vision of what I needed to do myself to help fix this problem and I understood more about this condition which helped me plan a path ahead.

I started with the exercises you gave me (** see below) and went back on the Betmiga 25mg at night. By taking the medication at night I started getting a better nights sleep for one thing, as I was getting up several times a night. I had previously been given Endep for night-time, but found I was too tired the next day to do anything. 

I then started walking because I had more energy, so I was walking four kilometres a day. That meant I started losing weight and pretty soon six kilos dropped off over 3 months!  

During this process I looked at what food and drinks were triggers for my condition. I was amazed to discover things like a vitamin C tablet would cause me want to visit the toilet more. I gave up coffee and tea, and even the decaf. I stopped eating anything with caffeine in it, especially chocolate. I also never touch alcohol or carbonated drinks, as they are huge triggers for me as well as any citrus fruits drinks.

I started drinking more water and concocted my own version of a healthy drink each morning to start the day with.  The more I drank the less I actually felt that urge not the opposite, so I no longer had those trips to the toilet that produced 50mls! 

I also use my TENS machine every day.

Image from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730708/

I still wear a liner when I leave the house but no longer need thick pads. When I’m just at home I don’t wear anything which is amazing. Another side effect of all this is my bowel works more regularly and I’m never constipated anymore! 

I know I’ll always have to do the work and keep to my list of ‘can’t haves” but it’s worth it to have a lifestyle free from stress and worry about my bladder condition.

I now can see how by taking control myself and attacking the problem from several angles my life has changed so much since my first visit.

Thanks T. A nice inspirational summary for other women (and men) suffering with overactive bladder (OAB) symptoms. You can see why patients can be reluctant to fully embrace a programme because -as for T- there can be a lot of ‘nice’ things in life that may be provoking the bladder.

(**) The exercises I gave T were urge deferral using urge control strategies, pelvic floor exercises including relaxing the PF and abdominal muscles and the breathing exercises to help her stay calm for when the urge suddenly arrived.

T also had been offered another treatment by her specialist and asked me about the research results on success with this treatment (stimulating the posterior tibial nerve with a needle). She wanted to know this because it was quite a commitment (number of visits to the specialist rooms) and quite expensive ($200 per treatment but it is reimbursed quite handsomely by Medicare. A TENS unit costs around $70-$100 plus the visit to the physio but then you continue at home with the treatment yourself).

When I looked at the research for T, the needle stimulation of the posterior tibial nerve results were similar to the application of the external sticky electrode with the TENS machine. Studies suggest applying the TENS electrodes over the posterior tibial nerve (this technique is called TTNS) daily for 20-30 minutes and this has a positive impact within 4-6 weeks on bladder holding capacity. TTNS has minimal side effects and it is safe for the large majority of people to implement.

If you have these issues and are feeling despondent with your OAB then get your notes out from your physio and revise them or you can purchase my book for $20 plus postage as a little Xmas present for yourself. Think of all the extra savings you may have from not requiring such thick pads anymore!

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