The Women’s Health Podcast

On this podcast, we chat to Amanda Thebe, fitness professional and author of the book Menopocalypse: How I Learned to Thrive During Menopause and How You Can Too!

Amanda has over twenty years of experience in the fitness industry. She is a popular guest on podcasts and online summits, and her health and fitness tips have been featured in media outlets like Shape, Prevention, Healthline, and Global News. She lives in Houston, Texas.

In this episode we talked about:

• Amanda’s recent experience with COVID-19 and how it knocked her for six for a few months. The post-viral syndrome left Amanda with a lot of fatigue and she struggled with daily activities for a long time, but is thankfully now on the mend!
• her story about when she first started experiencing symptoms of menopause (ie migraines, vertigo and depressions) and how it took two years and several health practitioners to find the answers she was looking for
• how surprised she was to find out that she was perimenopausal at the age of 42 and how so few people were talking about the subject! This led Amanda on a journey of discovery - she dived deep into the literature to learn more about menopause so that she could help herself and others. This led to her writing a book on it!
• the frustration that Amanda felt when she couldn’t find the answers to what was going on. She felt so much despair and thought that she was going to be feeling like that forever.
• how little medical professionals get trained on the topic of menopause -including the management. But this seems to be changing in the UK with new guidelines and mandatory training
• some of the common symptoms that women experience through the perimenopausal period (that no-one talks about!), such as vaginal dryness, urinary incontinence and sexual dysfunction.
• what happens to oestrogen and progesterone during the perimenopausal period. Amanda also talks about leptin and ghrelin and how these hormones can impact our hunger and satiety cues.
• some of the physiological and psychological changes that occur through the perimenopausal period and how we can become more susceptible to things like cardiovascular disease, Alzheimers disease and osteoporosis
• the controversy around hormone therapy, how the medication has changed over time and how incredible helpful it is for so many women
• how physical and emotional stress can impact on symptoms during perimenopause - and some things that you can do to reduce these!
• why women tend to put on weight around menopause and how there is often a change in body shape around this time.
• how perimenopause can be a tough time for many women as they are often not only working and raising children, but also looking after elderly parents too. She discusses how useful it can be for women to spend some time exploring their values (see website below) and learn to make values-based decisions. And say no!

Resources
Menopocalypse book! (BUY HERE: https://www.fitnchips.com/books/)
Oestrogen matters - Dr Blooming and Dr Tavris
XX Brain book - Dr Lisa Mosconi
www.viacharacter.org
www.valuescentre.com

You can find Amanda at
fitnchips.com
[email protected]

In this episode we have a fantastic conversation with Dr Julie Granger all about adolescent health and well being.

You may remember Julie from our previous episode (#20 "Do you have a hormonal teenager?")

Julie educates and mentors physical therapists and health professionals to eliminate the awkwardness that comes with helping teens — to instead confidently and expertly guide them and their families toward healthy lives in adolescence and adulthood. She also helps entrepreneurial physical therapists and health professionals who are feeling stuck, confused, or overwhelmed about how to start or grow a practice to tap into their intuition and discover a personalized life and business plan that’s both inspiring and reflects what they truly love in life.

In this podcast, we talk about
- how teens often slip through the cracks as they don't fit into either the adult or paediatric models of care
- how some teenage boys can bottle up their emotions and minimise their injuries - and how we can open up dialogue with them
- the importance of allowing children to experience the consequences of their decisions in the process of transitioning to independent adults
- why some injuries and pains are more common at different age points (think: bony changes)
- why it is essential for health professionals working with teens to know the growth charts and to have good links with radiologists that understand growth plates
- some tips for communicating with parents of teens
- how to help navigate the rehabilitation timeline with teens (when a week feels like a year!)
- how to set up your working environment to make it more "teen friendly"

You can learn more about Dr Granger here:
Facebook: @drjuliegranger
Instagram: @drjuliegranger
Twitter: @drjuliegranger

If you would like to join her FB group and learn more about working with this population head to

https://www.facebook.com/groups/healthproshealthyteens 

And for those who want to deep dive and become the go-to expert in working with teens, then definitely check out her online course (commencing November 16th):
http://bit.ly/healthprosforhealthyteens (using this code will help support our podcast by giving us a small commission).

In this episode, we finally manage to grab Dr Jo Milios back on the podcast. We spoke to Jo for over an hour this time last year...and sadly the technology let us down. Yes...it all got wiped.

So thankfully Jo does not hate us and she kindly agreed to come back on the podcast!

Dr Jo Milios is a physiotherapist based in Perth, Western Australia. She is passionate about helping men with urinary incontinence, Peyronie's disease and pelvic pain.

Here are some of the topics that we discussed in the podcast
- Jo's journey in physiotherapy and how she came to be working in men's health through a connection with her brother who is a urologist
- how Jo became so passionate in helping men after radical prostatectomy (RP) regain their continence and sexual function, culminating in her completing her PhD in 2019.
- the story of how she learnt about Peyronie's Disease through the experience of a young client and wanted to be able to help him. This led to her reaching out to international colleagues and trying therapeutic ultrasound to great effect
- Jo then added yet another project to her PhD, demonstrating the efficacy of ultrasound on Peyronie's disease
-she discusses the physiological changes that occur during prostate surgery and why there are changes in continence and sexual function.
- how penile length changes can occur after surgery and some of the things that can be done to help maintain length
- hard-flaccid syndrome - how some young men are suffering from too much vigorous self stimulation while watching porn. Can lead to hypersensitivity, pain, Peyronie's disease, depression/ anxiety etc
- how it can take 2 years for the nerves to recover after RP, so during that time we want to maintain length and function but take the pressure away from sexual function. Only 22% of men regain sexual function after two years and in men over 60 - only 4% will regain sexual function if don't do penile rehabilitation
-  ultrasound treatment for Peyronie's disease - how she performed her research study and some of the amazing results found. We may need to pull these machines out of the cupboard and dust them off!
- why it's important for men to check their penis regularly (eg in the shower) and feel for any changes such as lumps and bumps. 
- the importance of screening for erectile dysfunction (think: cardiovascular disease), urinary /bowel function and pelvic pain. We as health and fitness professionals need to be more proactive in this!
- the importance of screening the spine in clients with urinary symptoms and how treatment of the spine (eg through manual therapy and/or exercise) could help relieve symptoms esp in those who seem to have good PFM function

You can learn more from Jo by listening to her podcast with Melissa Hadley-Barrett
- https://thepenisproject.org/ 
https://thepenisproject.podbean.com/ 

In that podcast, Jo and Melissa talk to everyday men about their experiences post RP. 

You can also find Jo here:
www.menshealthphysiotherapy.com.au 
[email protected] 

****Apologies - this episode was released quickly on social media but Antony forgot to release it here. Enjoy!****

This is just a super quick episode to give you the heads up about Birth Trauma Awareness Week (6th-12th September 2020).

You can help by:
- donating money or buying a t-shirt 
- raising money while doing a 5km walk
- sharing your story
- signing the petition to help women around Australia get access to postnatal pelvic health physiotherapy care

Please see the links below for more information about how you can support this valuable cause.

https://www.redbubble.com/i/t-shirt/The-ABTA-Start-the-Conversation-White-by-TheABTA/54578433.YIZYC?asc=u 

https://www.birthtrauma.org.au/birth-trauma-awareness-week/ 

https://www.birthtrauma.org.au/change-org-campaign/ 

https://www.sbs.com.au/news/insight/prolapse-muscle-tears-and-trauma-why-women-need-better-support-post-birth?fbclid=IwAR10w6TxIMPN4hIRs9h_ZH3J0xeBQzYKX97t6T1fRLPdOgvRIrD3FYDPoFA 

In this interview, we talk to Dr Jane Foster, educator and creator of MYTERN - a program designed to help people change their language around emotion and regain control!

TERN = Take Emotional Responsibility Now.

As an educator, she was concerned about the false narratives that were, and still are, embedded in our culture, disrupting people's lives and even ending them. She wanted to create a simple, every day language that could be used by everyone to build new positive narratives, eradicating stigma and judgement, enabling people to regain control of their mental and emotional state. A language that could replace blame, judgement and retaliation with empathy, compassion and responsibility. The culture of having to be happy and positive all the time is unrealistic and almost impossible to maintain - especially now.

In this interview, Dr Foster talks about
- her PhD project where she sent one text message per day to university students over a ten week period. She had astonishingly positive results in the test group, including increased psychological well-being, life satisfaction and purpose. They also had decreased psychological distress levels and there were several students who said that the program prevented them from committing suicide.
- how MYTERN can be used in schools, homes and occupational settings.
- how the program revolves around metaphors such as roads- you can be on a red (rough road) or a green (smooth road) in terms of your emotions. They are not necessarily "bad" and "good" roads- and we don't want aim for always being on those smooth roads. The red roads can help us with our resilience, as we will always come up against challenges in life. The idea is to be in control - whether we are on the red or the smooth roads.
- how you can be out of control on red OR green roads. You can be on a green road and out of control - eg taking alcohol / drugs. You can also be in control on a red road - eg angry but responding in a calm way.
- how being out of control in MYTERN means that you are hurting yourself, hurting someone else or hurting something else.
- how the language can be simplified to - "are you on a red or green road? Are you in or out of control?"
- how the analogy of the steering wheel works - YOU are in control of the car (your emotions) and how you respond. Other people can not make you feel a certain way. "YOU made me feel this way" is giving the other person all the power. and making yourself a victim.
- MYTERN teaches you how to empty your glass - how little stresses build up over time and fill our glass. Minor stresses can help build health and resilience.
- how people of different ages can use the MYTERN model - from young children and adolescents to adults (even corporations)
- how sign language can be used to indicate when you're feeling out of control (extending the fingers, flexing the thumb across the palm)
- the acronyms of PETs and TEPs. 
- PETs are Personal Emotional Tools that help us regain control esp when we are on red roads. A PET could be going for a walk, taking some deep breaths, patting a pet, reading a book, cooking a nice meal, dancing etc. Adults will often choose alcohol, exercise or eating chocolate - which are fine in moderation, but in excess can become a TEP.
- TEPs are Triggers for Extra Precaution - ie the events/situations that cause someone to feel out of control. For example - parents are fighting, losing a computer game, bad drivers, feeling unwell or going to school/ work. Calling it a "TEP' rather than a "trigger" means that there is no judgement. It's a made up word so that there is no connotation associated with it. Understanding your own TEPs (and what PETs can help in that particular situation) gives you skills to help bring yourself back into control.
- how these tools can help lay down new neural pathways and some of the changes that Jane has seen over time within groups using the MYTERN model.
- the different packages available on the MYTERN website - eg therapist pack, teenager pack, family pack, adult pack. Each pack consists of short education videos and handouts (including maps and activities). The packs for individuals are only $AU19.99 and the therapist/family packs are $AU49.95. (Prices as of 21st July 2020). There are also a phone app (the emoji app) and the SMS messaging service.

You can find Dr Foster:

Email: [email protected] 
Website: https://mytern.com.au 
Facebook: https://www.facebook.com/myterncity/ 
Instagram: https://www.instagram.com/myterncity/ 
Twitter: https://twitter.com/myterncity 

Wow, this episode is a doozy!

We think EVERYONE should listen to this episode, whether you are a medical /fitness professional or general public....this information is so important.

After 23 years of misdiagnosis, Sallie embraced her struggles with endometriosis to forge a new pathway for all who suffer from the disease and its associated conditions. She is a practicing pelvic physical therapist specialising in endometriosis and subsequently occult hernia who has gone on to found The Endometriosis Summit - the largest patient and practitioner gathering for endometriosis in the United States with Dr Andrea Vidali and is a driving force behind iCareBetter, a new endometriosis education portal and video vetting system for endometriosis excisionists in North and South America. Sallie is currently weathering the USA's Covid life with her two poodles, and parents while doing telehealth to the endometriosis world.

In this interview we discuss:
- what endometriosis is and how common it is (one in ten women!!).
- how those lesions make their own oestrogen (and progesterone) and nerve/blood supply.
- why hysterectomies don't cure endometriosis
- the history of diagnosis of endometriosis and some of the theories that have existed over time
- how in endometriosis, the tissue can extend as far as the lungs and pericardium. The only organ in the body that hasn't been shown to have endo is the spleen!
- how birth control can modulate the period but not the disease
- how you can get endo in the skin - typically iatrogenic such as being dragged by a surgical scalpel
- how diagnosis is made. Typically imaging is not helpful. Gold standard = laparoscopy.
- Staging of the disease is not well correlated with pain experienced
- the common symptoms associated with endo - including cramps, painful periods, IBS-like symptoms, pain with deep penetration, back pain, leg pain, tailbone pain, rib pain, leaking for no reason, increased urinary frequency, issues with fertility, nose bleeds with periods, neck pain and reflux, symptoms at ovulation (bowel problems worse with periods and ovulation)
- how girls/women are often taught to be warriors and put up with pain. The message is often that period pain is normal and needs to be put up with.
- some of the changes that are happening around the world to educate high school girls about periods (see resources below)
- that symptoms may be there early in life such as inflammatory issues in the gut, but not diagnosed until older age when having fertility issues.
- how early menstruation is associated with higher risk of endometriosis
- teens don't always need to rush in for surgery. Birth control can modulate symptoms in some people. It does not treat the disease.
- some of the conversations to be had around providing contraceptive pills in children.
- how endometriosis itself can impact ovarian reserve
- the receptor site sensitivity for progesterone can be down-regulated in some women with endo. Some docs will throw more progesterone into the system, which may not do anything. So different pills need to be considered
- how the type of surgery is important - ablation just burns off the top, you need excision surgery to remove the roots
- the current limitations in the medical system - in terms of education of doctors and gynaecologists.
- how health and fitness professionals can help women with endo - by being aware of the different symptoms that can be related to endo and screen further. How exercise can help improve mobility around the scar. Try and meet your clients where they are at and tap into the activities that they enjoy.
- some of the questions that you can ask if you suspect a client has endometriosis
- how every woman deserves treatment and some of the gaslighting that still goes on within the medical system
- how as physiotherapists we can support our clients with endometriosis - through connecting with our clients and teaching them that they will need to advocate for themselves. Educate re: central nervous system sensitisation and teach the client tips to help them regulate this such as meditation/ breathing exercises and some cardiovascular exercise.
- the Endometriosis Summit - usually every March. This year was over 700 people! In October there will be an Endometriosis Reproductive Immunology conference online.
- how iCareBetter is putting together a list of excisionists and doing blinded studies on the surgeons

Resources:
https://www.theendometriosissummit.com/ 
https://www.endowhat.org/ 
https://nzendo.org.nz/education-in-schools/ 

You can find Sallie here:
Facebook: https://www.facebook.com/sallie.sarrel 
Website: https://salliesarrel.com 
Email: [email protected] 

In this interview, we talk to Inemesit Graham, fitness professional (and all-round incredible woman!) based in Yellowknife, Canada.

This was a fantastic conversation that touched on so many topics, including:

- her experiences moving to the UK from Nigeria and growing up in a predominantly white neighbourhood
- her journey as a child having surgery for abdominal hernia and the trauma associated with that experience
- how after her second child she struggled with body image issues related to her abdominal profile. She thought she was overweight and went on a weight loss journey and eventually discovered that she had diastasis recti.
- her experience living with DRA and hernia and how she felt strengthening her body and learning to love it as it is was so important
-how she started posting her workouts online and was told she was being negligent so she went and did qualifications to be certified as a fitness professional
- how her whole life she has lived outside of other people's expectations. As a Nigerian it was expected that she study law or medicine, but she studied politics indeed and moved to Canada.
- how she rarely sees people who look like her - at school, in magazines, in Canada. There was a period of time where she didn't want to be black, so she actively sought out black people to follow and listen to so that she could learn to love who she is.
- covert versus overt racism and how important black representation is in the health and fitness industries as well as in tv/magazines.
- how important it is to expose ourselves to different voices - how we need to be intentional in cultivating our social media feeds, so that we aren't just hearing one voice.
- the importance of the Black Lives Matter movement. We have one world view and we have to listen to other people's life experiences. Ours is not the only story out there. Some people may not see racism but that does not mean it doesn't exist. How acknowledgement of other people's experience takes nothing from us, but could make the world of difference to that person.
- her thoughts on the phrase "I don't see colour." She discussed how difficult it is to find makeup that suits her skin tone or to see women like her in advertisements. "When you don't see colour, people of colour become invisible in your society."
- how #alllivesmatter is often posted out as a retort to #blacklivesmatter and that acknowledging that black people are 2.5x more likely to be killed by police is important. It diminishes the plight of black people to post this hashtag in a reactionary way.

If you want to learn more about Inemesit or work with her, you can find her

Email: [email protected] 
Facebook: www.Facebook.com/MummyFitness 
Twitter: www.twitter.com/inemesitg 
Instagram: www.instagram.com/mummy_fitness 

In this interview we talk to Amy Dawes, founder of the Australasian Birth Trauma Association (ABTA).
ABTA is a national charity committed to reducing the instance and impact of birth-related trauma whilst supporting affected women, families and health professionals.

Amy discussed:
- her birth experience and diagnosis of pelvic organ prolapse 16 months later. She talked about how this diagnosis affected her psychologically and impacted on her quality of life. She became scared of doing any movement or exercise and felt that she would make things worse.
- how, with some assistance of a pelvic health physiotherapist and connecting with other women who had returned to exercise after prolapse diagnosis, Amy started to feel more confident in her body
- how she connected with Elizabeth Skinner, psychologist, who mentioned the need for a birth trauma association here in Australia...and how the ABTA was formed (and a special shoutout to Christine Percy and Christine Pistone!).
- the goals of the ABTA and how they support women through Peer to Peer mentoring.
- that birth trauma can be physical, psychological or both.
- the need for more comprehensive antenatal education, so women are aware of the potential risks associated with birth, without scaring the heck out of them. "Why didn't anyone tell me that this could happen?"
- the fact that health care providers can also suffer trauma associated with supporting women in birth and that they don't always receive the help that they need.
- how important it is to have care in birth that is supportive, nurturing and empowering.
- how birth can trigger past trauma, which women may need psychological help for
- how we can help support the ABTA and spread the word of these services to the community

The ABTA relies on donations, so if you would like to help please reach out to the ABTA via the links below. Please share this information with anyone who you think might benefit!

Website: https://www.birthtrauma.org.au/ 
Email: [email protected] 
Facebook: https://www.facebook.com/birthtrauma.org.au/ 
Twitter: @AusBirthTrauma 

In this episode we talk to Vicki Webber - CrossFit Competitor and Box owner.

Vicki shares with us
- how she fell in love with CrossFit and went from being someone who never really did much lifting to being an international competitor
- her pregnancy and birth experiences... and how different number four has been in comparison to the first three!
- her recent postnatal experience including difficulties with bladder control and heaviness in the perineum
- her experiences returning to CrossFit in the postnatal period
- how she has found that changing the way that she moves (with guidance from her physiotherapist) has helped her symptoms of heaviness in the perineum.
- her experience as a coach of the changes in post pregnancy information that is provided to pregnant and postnatal women
- how her coaching has changed since having recent symptoms of pelvic floor dysfunction

We hope to chat to Vicko again in the future to see how she is getting on in her journey.

You can learn more about Vicki here:

https://www.steelcoastcrossfit.com/  
https://www.facebook.com/vicki.webber.75 
https://www.instagram.com/vwebbs2011 
[email protected] 

In this interview, Marika and Antony talk to Professor Peter O'Sullivan.

Peter is a clinical researcher at Curtin University and specialist physiotherapist at Bodylogic Physiotherapy, Perth WA. With his team, he has published over 250 peer review articles on MSK pain and its management, His passion is empowering people disabled with pain to get back to living again.

In this interview, we discuss
- how COVID-19 is resulting in more anxiety and how this is showing up in clinics
- helping people in pain via Telehealth
- Pete's journey as a physiotherapist and in particular his thoughts around pain and how they have evolved over the years. (He even goes back to his experiences as a child and how family shaped his responses to pain). He talks about how frustrated he was with the biomechanical model of pain in his early years and how his personality as a rule breaker probably helped him to think outside the box and develop new ideas (alongside his colleagues).
- things that you can do in order to keep growing professionally and how to create positive clinical environments
- the pros and cons of doing patient demonstrations in front of live audiences
- the Biopsychosocial Model - how the "Bio" is really important and not to be ignored. We also discussed where manual therapy and touch can fit into it (and when it is maybe not appropriate!).
- Cognitive Functional Therapy (CFT) - the model that Pete and others created and how it is not about "talking to people" and a lot is based on building relationships and trust, as well as performing behavioural experiments.
- minimum requirements for physiotherapists in order to implement CFT - incl a discussion on how for some people learning CFT is relatively easy whereas for others it takes a long time or it's just not a good fit.
- bottom line - patient-centred care is where we should start. All models will be criticised/critiqued and will evolve over time, but if we put the person in the middle of their journey (and put our egos aside), we'll be doing a decent job of it.

You can learn more about Pete at
https://bodylogic.physio/ 
[email protected]