My name is Susannah Haarmann; I am your host! In this podcast you can expect expert interviews made for rehabilitation practitioners on topics related to business, pelvic health, breast cancer rehab and self-care. More and more providers are falling in love with these underserved niches and even delving into starting their own practices. Through teaching multiple continuing education courses internationally, I have met the most passionate and dedicated practitioners in the areas of pelvic health and breast cancer rehab. It’s important to me that we while I help people with business and professional development that we don’t lose sight of self-care. I believe rehabilitation practitioners are prepared in many ways to be the GO-TO practitioners for comprehensive, non-invasive, empowering care for people with pelvic health issues and breast cancer side effects. It is my mission to help you deliver the BEST care, promote our profession, and remove obstacles so that you can help more people with greater confidence.

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Thank you so much for listening! Next up...2021 Goals & Intentions with Lisa Holland & the History of Pelvic PT with Holly Herman!

Often, when people hear breast cancer rehab they think of lymphedema treatment, but there is so much more we can do! Comprehensive breast cancer care is about knowing how to prevent and treat ALL of the side effects of breast cancer. If patients have post-op issues such as seromas, lymphatic cording, shoulder dysfunction or core compromise…they need access to a rehab provider who can help! And sadly, there just are not enough of us. 

So many people are living with chronic pain after treatment, like post-mastectomy pain syndrome, chemotherapy-induced peripheral neuropathy, joint pain, and dyspareunia. Often, these are seen as unfortunate side effects from life-saving interventions, but it doesn’t mean that they are not preventable and treatable! 

As rehab practitioners, we have a unique perspective on systems integration. Few professions out there understand anatomy and can apply the bio-psycho-social model like we do! Imagine the ability of cancer patients to get early intervention at the time of diagnosis and improved continuity of care across all areas of rehab from acute care to outpatient services and home health. As our profession grows and continues to fill in healthcare gaps, oncology will be one of those areas that gains momentum as comprehensive cancer care expands.

-         Link to the FREE resource Safe Exercise Screening Tool for Breast Cancer Patients + Analysis & Next Steps

-         Link to the Do No Harm Breast Cancer Rehab Guide; it will tell you what modalities, exercises, manual therapies and more are contra-indicated or where you should take precautions after specific cancer treatments. 

Denise Stewart is an Australian Occupational Therapist who developed her own test for shoulder dysfunction in breast cancer patients called the Reach Out the Back Test. Shoulder dysfunction can occur in this population due to pectoral tightness, skin fibrosis, scar adhesions and cording. This test goes beyond straight plane movement in flexion and abduction to multi-planar movement which is how we live functionally. True functional movement can be harder to provide a quantitative measure for, but this test provides good qualitative findings on evaluation, and after treatment, to determine effectiveness of rehab interventions and help determine tissue restrictions.

If you would like to learn how to apply this test in your own rehab practice with breast cancer patients check out Denise's online Reach Out the Back course.

Also, register for the annual online Breast Cancer Rehabilitation Summit running February 15-21 2021. Don't miss this FREE summit! 

Are breast implants safe? In this episode we talk to Danielle Valoras, a physicians assistant specializing in psycho-neuro-endocrine immunology and an advocate for transparent conversations regarding the safety of breast implants. Danielle experience varied vague symptoms like fatigue, connective tissue issues, swelling, hair loss, brain fog and even depression-like symptoms. Eventually she was not able to use her left arm. Physical exertion lead to migraines. Multiple doctors and practitioners did not link these symptoms to her breast implants. She got an explant less than 2 years later and immediately could breathe more easily and use her left arm.

After the implant and surrounding capsule were removed a seroma formed. This seroma (fluid filled pocket) formed after the implant was removed, but interestingly, testing showed silicone within the seroma as well! This is important to consider due to the risk of Breast Implant Associated Anaplastic Large Cell Carcinoma (BIA-ALCL) which is a lymphoma associated with textured implants. Although there was a mass recall on textured implants, Danielle explains that any breast implant is a foreign body and no matter the type, silicone can shed from the shell of the implant into the capsule and surrounding fatty tissue.

Breast implant illness has been a diagnosis of exclusion up to this point meaning that the breast implant and surrounding capsule are removed (explanted) to determine if symptoms resolve. But recent testing via MRI has the capacity to determine physiological involvement of the implant by looking for silicone induced granulomas (SIGBIC - silicone induced granuloma of breast implant capsule). This is not yet a widely known diagnostic method and does require a polarized lighting microscope to detect the presence of silicone bleeding related to implants.

Danielle's experience with breast implant illness spun her career as a physician's assistant into advocacy. Her quest for answers and treatment options is crossing into the rehab world; she lights up talking about breath work to calm the nervous system, and manual therapy for lymphatic drainage and visceral mobilization.

As if breast implant illness isn't a controversial topic, we talk about other touchy subjects too, like radiation over expanders and implants, informed consent for breast reconstruction, and rehab services pre and post implant placement. This is an interesting conversation as we merge the worlds of breast implant illness with comprehensive care for breast cancer patients. If you are a medical or rehab provider who would like to know more about structure and function as it pertains to breast implants & reconstruction, check out the course Breast Cancer Rehabilitation; Comprehensive Evaluation & Treatment. I look forward to collaborating with Danielle in the future about how we can improve function for people with implants and quality of life for those who experience breast implant illness. 

For more information about the safety of implants please visit the resources page from the 2020 Breast Implant Health Summit. If you would like to get in touch with Danielle, you can find her on Instagram @navwell or on the Breast Implant Health Summit.  Get in the conversation by joining the Facebook group Pelvic Health & Breast Cancer Rehab Specialists. Informed care isn't easy, but it is necessary. Thanks for listening!

In this episode Dee Hartmann shares the value of incorporating pleasure into treatment for pelvic pain. Pain-free intercourse is an excellent long-term goal, but our patients usually want to experience pleasure during intimate moments with their partners and themselves. Moving the brain from a pain to pleasure-focused state requires a graded approach from attuning to pleasurable sensation in our environment to exploring safe and pleasurable touch with ourselves. Calming the brain, feeling embodied, and safe in communication to receive pleasurable touch are incredibly important for physical, emotional, and relational healing.

If you would like to learn more about integrating pleasure into your rehab practice, and want to provide your clients with a great resource, I highly recommend reading 'The Pleasure Prescription; A Surprising Approach to Healing Sexual Pain.'  It includes case studies, diagrams, and the latest scientific research. Each chapter ends with “prescriptions” designed to guide readers through the healing process.

Other resources mentioned in this podcast include:

• Vulvalove.com
• Pleasuremovement.com
• Genitalhealth.org

Thanks for tuning into the show and, please, leave a review!

March is endometriosis awareness month. Endometriosis is estimated to affect 1 in 9 women. It can cause physical issues such as pelvic pain and infertility, psychological pain, and functional limitations as well. The pathophysiology of this disease isn’t completely clear, but it’s important that women are diagnosed in an efficient manner and have access to skilled medical and rehab providers who can help them with proficient treatment. Truthfully, it takes a team of providers working together to treat the person comprehensively. 

Today we will be talking with Dr. Shrikhande of Pelvic Rehabilitation Medicine. Pelvic Rehabilitation Medicine provides an advanced model of care for treating pelvic pain conditions centered around treating the person and not just the symptoms. Their network of providers include overseeing physicians, surgeons, nutritionists, mental health, and rehab providers. 

Dr. Allyson Shrikhande, is a board certified Physical Medicine and Rehabilitation specialist and is the Chief Medical Officer of Pelvic Rehabilitation Medicine. She is also the Chair of the Medical Education Committee for the International Pelvic Pain Society. 

Links: 

• The ROSE Trial (Research OutSmarts Endometriosis study by Feinstein Institutes for Medical Research)
• ICareBetter.com (find an endometriosis expert)
• Retrain Your Brain (online course by Dr. Sckrivani)

On this episode, we talk to Dr. Jessica Reale about her journey as a pelvic health practitioner and transitioning from employee to private practice owner. Every person's circumstances and experience starting a business is different. If you are thinking about starting or expanding your own practice, I hope this episode gives you food for for thought and inspiration. 

Show notes:
:53 What has your pelvic health journey looked like so far?
2:45 What was one of your biggest considerations making the leap from employee to business owner?
6:00 How did you mitigate costs starting your practice?
8:40 What kind of business model did you decide to present to your patients?
12:15 What did it look like expanding your practice to include other clinicians?
16:00 What do you wish you had known prior to starting your private practice?

Dr. Jessica Reale is the founder of Southern Pelvic Health, LLC. She received her Doctor of Physical Therapy (DPT) at Duke University and is a Board-Certified Specialist (WCS) in pelvic health. She is also a faculty member of Herman and Wallace Pelvic Rehabilitation Institute.

In this episode, Dr. Kerian Duncan and I talk about how to define your intuition when it comes to handling your child's healing and trusting that intuition as a parent and patient.

We also talk about allowing intuition to enter patient care and how to access and strengthen your intuition through heart-based problem-solving.

Our guest, Dr. Kerian Duncan, PT, DPT, MSc has a  Master of Science in Neuroscience (MSc), and a Doctorate of Physical Therapy (DPT). Well versed in both neuroscience and developmental research and clinical practice, she believes that the best advocate for children are their parents when it comes to early childhood intervention.

She is also a trainee for the Utah Regional Leadership Education for Neurodevelopmental Disorders (URLEND) program. There she works to change the internal dynamics regarding the lack of support for children with special health care needs across the rural Rocky Mountain West.

Minute 8:25 - What is your biggest ‘Ah-HA’ moment becoming a sexual health counselor and educator you would like to impart on rehab professionals?

Minute 14:00 - How and why do you incorporate mindfulness and meditation into your practice?

Minute 19:15 - What are some of your favorite tools you like to prescribe to male pelvic clients at home?

• MANTA vibrating stroker
• ANEROS prostate massager
• Spike by Unbound

Minute 26:00 - What do you do if your patient gets an erection or has spontaneous ejaculation during treatment?

Minute 30:00 - What components of evaluation do you think are the most important to address on the first visit?

Minute 32:30 - What is the biopsychosocial approach and how does it apply to male pelvic pain?

Minute 36:50 - What advice do you have for creating a therapeutic environment for yourself and your client?

Minute 42:45 - What do you do if you feel uncomfortable working with a client of the opposite or same sex because you interpreted something they said or did as inappropriate?

Minute 54:30 - How specific do you get with your manual therapy treatments?

Jennifer MCGowan is a mother of 4 and owner of Regenerate Physiotherapy in Peachtree, Georgia.  In this selfcare in healthcare episode Jennifer talks to us about:

• How she learned to keep calm when things are hectic
• Prioritizing self-care and how being selfish can be positive
• Identifying thoughts that can lead to burnout
• The ebb and flow of balance and creating it in moments

Jennifer encourages to do what makes us feel good, not because of the outcome, but because it is an act of self-love.