Joe: 00:00

Alright. Welcome back to another episode of the Freedom Talks podcast, everybody. This is your host, Joe Ogden. And we're sitting down this morning with doctor Nina Olson, is our pelvic health specialist and one of our leaders here in our entire public health program here at Freedom. So special thank you to Nina for sitting down with us this morning.

Joe: 00:18

Nina, good morning.

Nina: 00:19

Good morning, Joe. How are you?

Joe: 00:20

I'm good. Good. And big podcast day. Nina just celebrated a birthday last week, so she turned 21 again. What a special opportunity.

Nina: 00:30

21 again.

Joe: 00:31

How was your birthday weekend, Nina?

Nina: 00:33

It was awesome. It was great. We had a wonderful weekend. It was beautiful out. Spent some time outside.

Nina: 00:38

My husband and I played golf. It was great.

Joe: 00:41

And Nina went above and beyond. And I have to bring this up because Friday, our manager Scott and I talked about this. Nina gave me a hard time. And if you know Nina, she doesn't give anybody a hard time. So when she starts picking on other people, it's a big thing.

Joe: 00:56

Nina brought in a birthday treat before her birthday because she took the day off on her birthday.

Nina: 01:01

I sure did. I planned ahead. I brought those kids to the store at 09:00 at night, left the dog, the puppy in the car. I risked him chewing up my seat belt, and I picked up some treats and brought them over.

Joe: 01:13

And not just one. You know, brought in did you bring in four Kringles or three?

Nina: 01:17

Three. Three Kringles. Mhmm.

Joe: 01:19

That's why that that's probably why you were manager at one point too. That was probably a part of your screening process. Right.

Nina: 01:24

Well, back in the day, Pete, used to work here, who now lives in Iowa, our birthdays are a day apart. And we used to cook out. We would have a whole celebration.

Joe: 01:32

Yeah. You guys used to do a big thing. We did

Nina: 01:34

a big thing. We would always do pizza or burgers and brats.

Joe: 01:38

So I think I saw on Facebook, was it Friday was Pete's birthday?

Nina: 01:41

Yes. It's Oh, no. Was

Joe: 01:42

Saturday. Saturday?

Nina: 01:42

Yeah. Mhmm.

Joe: 01:45

So May is our pelvic health month. Expect specifically women's health month. In February, I believe, we did male pelvic health. And now in May, we're gonna do female pelvic health even though there is a lot of overlap, there is a ton of differences and obviously Nina is our senior leader I would say when it comes to the pelvic health space and this is her baby, no pun intended. Nina, let's let's just kind of start with, you know, I know we've talked about it to death through our marketing and just other podcasts, but let's kind of just give a general overview of women's health and what are some symptoms, some are presentations that females might come in with.

Nina: 02:25

Right. Okay. Well, good question. Question. So what exactly does women's health cover?

Nina: 02:31

So my specialty is pelvic health. So with pelvic health, first and foremost is incontinence. So that's usually what brings people in, is that we're leaking urine or leaking stool when we don't want to be leaking. And that is a symptom that is probably most prevalent in the patients that we're seeing. So patients are being referred in for incontinence.

Nina: 02:53

They're being referred in for pelvic pain. So whether it relates to some sort of traumatic birth or some scar tissue from birthing children or just muscles that are too active, those could all be pain producing. It could also be some trauma to the tailbone or a fall on the pelvis. That would be a reason why somebody would be coming in with pelvic pain. We also see that there is an issue with what's called pelvic organ prolapse.

Nina: 03:25

So that's really going to be kind of what we're focusing on here today, is a recent class that I took on pelvic organ prolapse. But what that is, is it's where your internal organs are falling down into the vaginal canal, and what that feels like is a sense of pressure, or like you're sitting on a ball, or a feeling of heaviness coming down into the pelvic floor that could either be your bladder, your uterus, or part of your colon that's pushing into the vaginal canal and sometimes even coming out of the vaginal canal. So it can be quite uncomfortable. So that is another reason why are coming in for pelvic floor dysfunction. We also see women in the childbearing time, so if they're pregnant or trying to become pregnant or after pregnancy, These are quite often patients that are coming in for pelvic floor dysfunction, or even hip and back pain as they relate to all the changes that our bodies go through in that time.

Joe: 04:31

So the course you took and this is something different countries I think it's super interesting in the physical therapy realm because I feel like a lot of the hands on stuff that is really good doesn't come from The US. And it seems like a lot of the it doesn't seem like it is. A lot of the pelvic stuff does not come from The US, where we're learning a ton about this, which I think is super interesting. Just with the we could get down a rabbit hole of just the health care in The US and just how it works. But your course you just took was from Australia, right?

Nina: 05:03

Australia, yeah. So it's through the Women's Health Training Associates, which is WHTA.

Joe: 05:10

And they're kind of the leaders in the pelvic

Nina: 05:12

I was, space, wouldn't you is really the leaders in research and really kind of paving the way for a lot of pelvic and health treatment. You know, The US is not far behind. We're certainly contributing to the But body of the leaders really seem to be the Australians. So Terren Halem is a physical therapist in Australia, and she has her company, WHTA, and she provides really excellent training courses and literature updates because there is so much research going on right now that it's hard to be on top of every aspect of all the things I just named that pelvic health and women's health is.

Joe: 05:54

We've talked about that a million times, I don't

Nina: 05:56

know Right.

Joe: 05:58

I don't know how some of the people are staying on top of it. Yeah. But there's not enough time in the day, in my opinion.

Nina: 06:02

Right. It's challenging. So that's why taking courses frequently is really what you have to minimally do to stay on top of what's going Yeah. And it's really nice when companies offer a lit review for you. It's just hard, also, to get your hands on some of these papers.

Nina: 06:20

You could see that there are papers that are being published, but then you have to purchase them for, you know, $30.40, $50 just to get the paper. Yeah. It's hard to subscribe to all of these different journals that these papers are in. It's quite expensive. So really just being on top of your continuing education is number one.

Nina: 06:42

You can get some great lit updates from that.

Joe: 06:44

And would you say now and I don't mean this to date you by any means. But you've been treating now have you been treating twenty years?

Nina: 06:51

Twenty years, yeah.

Joe: 06:52

Would you say right now in this post COVID era is probably the biggest push on literature that's coming out? Or has it kind of been this whole thing since you kind of started treating pelvic health?

Nina: 07:04

Yeah, it's been so certainly when I went through school at Marquette, we were working on evidence based treatment, for sure. Yeah. It's just now pelvic health has really taken off. It's becoming more mainstream. And so in turn, the literature is just exploding.

Nina: 07:28

So I think it's just evolving. It was starting when I was in school, and it's just exploding over the years, for sure.

Joe: 07:35

Yeah. And there's a lot more people doing it, obviously. There's a lot more out there.

Nina: 07:38

Yep, exactly right.

Joe: 07:40

Like when you first because you're certified through the APTA, Was Herman Wallace kind of the first pelvic course?

Nina: 07:50

Well, when I went through the training, the APTA offered much more as far as pelvic health than Herman and Wallison did.

Joe: 07:59

Okay.

Nina: 07:59

So I went through the APTA, which, if I'm comparing what they offer as far as a training program, APTA offers a three part course series. And then on top of that, you have to do a paper.

Joe: 08:15

Okay.

Nina: 08:16

So to complete their course as a pelvic therapist. So that's what I went through. Right now, Herman and Wallace, they offer, I think, three or four classes, and you can just kind of take those as you'd like. So I really enjoyed my training process and found it to be quite beneficial.

Joe: 08:34

So let's talk about kind of your new one that you just took, on top of the course, let's just talk about and Nina has two young kids that are very busy with sports and a puppy at home. He's Is he

Nina: 08:46

a year old? He's a year old. Gonna call him a puppy because he is crazy.

Joe: 08:50

We gotta wait till two.

Nina: 08:51

Yeah. That's so cute.

Joe: 08:52

Talk about just the setup of this course, because this is pretty unique on how they did it. Yeah. And just the timing and how it worked.

Nina: 08:59

Right. Okay. So let's just like, you know, go back a minute in time. So before the pandemic, all courses were weekend based courses in person. So you would fly, and I've been out to DC, I've been, you know, all over for courses, and you sit in a room and you're totally immersed in the subject, you are totally dialed in, and then you leave the course usually Sunday evening, and then you come back home and you start work on Monday.

Nina: 09:27

Regimen, but I do think there were some really big benefits to that type of training. You, you know, had great camaraderie with the other therapists there. You could chitchat about different cases, you know, on your lunch break. Then we had the pandemic. And in an effort to still offer good quality courses, there was a big shift to offer these courses at home.

Nina: 09:50

So you would zoom into a course. Now, I think companies like Herman and Wallace have found it to be quite beneficial, maybe monetarily for them.

Joe: 10:00

Yeah.

Nina: 10:00

And certainly they have a bigger reach with that type of model. So now a lot of the courses are online. So you can take a course, and you can either be zoomed in where you're watching recordings, or you can be, you know, zoomed in where you are connected with the instructor. They just are different location. So we're starting to see maybe that swing back a little bit, whereas there are some in person options, which I think are excellent.

Nina: 10:30

This course, being that it was offered from Australia, we had a part in person, part live Zoom course. So the biggest challenge was the time difference.

Joe: 10:44

The time difference.

Nina: 10:44

Yeah. So we had a two part course. And the first course was on the weekend. And it started, I believe, at like 03:00 in the afternoon and went until midnight. So, you know, we were live zoomed in with the instructor in Australia.

Nina: 11:01

And I am a morning person through and through. I do not operate well after 09:00 at night. Am like So No, all at the club, this was a challenge for me, to stay awake and stay engaged until midnight. But we did it, and it was great. And then the instructor was able to come to Chicago, and we did the hands on treatment and training then.

Joe: 11:23

Oh, that's where the in person was?

Nina: 11:24

That's where the in person was. Yeah.

Joe: 11:26

I feel like that set up, at least for me, like finishing my last semester during COVID, and that's what we had to do. Uh-huh. These courses that offer okay. Here's all, like, the the book stuff.

Nina: 11:35

Mhmm.

Joe: 11:35

You can do that online. Mhmm. In my opinion, if you put in the effort, yes. There's gonna be more distractions at home. But if you can just set aside time to say, okay.

Joe: 11:42

I'm gonna go through the online stuff.

Nina: 11:44

Right.

Joe: 11:44

And then let's come in personal. Let's get through the the skills. I just think that's so much more efficient with time because there is so much dead time at courses Exactly.

Nina: 11:52

Right.

Joe: 11:53

And I think what you you know as well as I do with kids, it's like, you know, I've got this. I've this. I've got this.

Nina: 11:58

It's hard.

Joe: 11:59

Let me try and fit this in when I need.

Nina: 12:01

Exactly right. It's nice that they offer these hybrid models. Can get a much bigger reach.

Joe: 12:06

Yeah.

Nina: 12:06

And I think having the live version was really nice, because we could still do question and answers. When I've taken these courses that are not live, they're just recordings, I mean, of the big value of these courses, you can ask questions that are coming up in your mind, as you're thinking about this patient or that patient, and you have, you know, a leader in the field right in front of you. So this course was awesome that she provided that Q and A all throughout the course, and I got all my questions answered.

Joe: 12:35

So let's kind of talk about now, especially with you and what we do at Freedom, this course that you took, what more value, I guess that's a bad way to put it, but like what additional resources are now offering patients or even a new demographic of patients like, I can treat you better now than I Right. Could

Nina: 12:55

So really, this course was on pelvic organ prolapse. And it was bringing us up to date on what the research says, who pelvic physical therapy can help, and who it can't, okay? So with pelvic organ prolapse, we see often patients in the clinic for pelvic PT. And the thought is, if we have this group of muscles at the base of our pelvis, if we have strong stability in those muscles, they will help in holding up all of the internal organs that sit in the pelvis, so the bladder, the uterus, and the colon. So we know that it just makes sense, right?

Nina: 13:39

So it's kind of like, can we support from the bottom up? Well, the problem is, is that it doesn't always help everybody, okay? And what we're finding research is that really it has to do with how severe the prolapse is as to who pelvic organ or excuse me, pelvic PT will help, okay? And maybe there's another way that we can bring support to the organs beyond just strengthening. And so this course was training us on the use of pessaries.

Nina: 14:10

So a pessary is basically an orthotic that will help support your internal organs. It's a silicone device. There's lots of different types out there. The most common are rings or kind of like a cube shaped. And what those are is we are now, as pelvic therapists, trained on how to insert these devices to help hold the organ up inside, and then we can continue to strengthen the pelvic floor to support from the bottom up.

Nina: 14:42

So we know that with pelvic organ prolapse okay, here's my image that I'm gonna try to get you all to think about. If we have a ball, okay, a big, heavy ball hanging from the ceiling by TheraBand, okay? So big, stretchy band or rubber band holding on to this ball. And then you have Joe holding it up at the base, okay, with his hands. So he is standing underneath the ball, holding it up.

Nina: 15:13

Joe is the pelvic floor, so he's holding up the organ from below. And then above the TheraBand that's attached to the ball is actually your ligaments and fascia, which is your connective tissue. So when we have people who are able to keep their organs in, we know that we have good support where Joe is the pelvic floor. So Joe's doing his job. And we also have strong TheraBand, okay?

Nina: 15:44

So sometimes, though, that TheraBand has become so old and stretched, and, you know, the tensile strength of that TheraBand has kind of worn out. So even though Joe is doing all of his job and he's really strong at the base, we may need some more support from above. And that's where the pessary fits in. So the pessary is going to be helping what the TheraBand is doing to the ball, the support from the ceiling. So with this pessary treatment, we can really treat somebody who maybe has a little bit more severe prolapse, and get their muscles to help support them from below with just a little assistance or a little orthotic.

Nina: 16:36

And they can be quite helpful for people.

Joe: 16:40

So how many different options or not even options. Someone comes in. They're like, Okay, this is what you have. What is that process that you're doing to be like, Okay, these are the different options we have. This is how we fit you for it.

Nina: 16:55

Right.

Joe: 16:55

What is that process like?

Nina: 16:57

Yeah. So the first thing we need to do is really see. We'll take a look at the

Joe: 17:03

Because this is more in-depth than even I thought it was. This is even interesting for me.

Nina: 17:07

So when we see that somebody has pelvic organ prolapse, first of all, we want to find out what is the main symptom that's bothering them, okay? Is it creating pain? Is it creating leakage? Or do they feel like there's heaviness? When does that heaviness start?

Nina: 17:25

Is it first thing in the morning? Does it happen later on in the day? By answering those questions, we're already starting to kind of go through our head who would benefit from a stronger pelvic floor, okay? Then we'll examine the tissues. We'll see, okay, if you push like you're straining trying to have a bowel movement or trying to move a baby out of you, where are those organs?

Nina: 17:50

Are they coming out? How far are they coming out? And we can actually measure that. That will also help us determine who would benefit from pelvic therapy. Therapy.

Nina: 17:59

And And then then another another piece that's really big into this is how strong is the pelvic floor? Is it able to squeeze and lift? We'll have the patient stand up, do some movements. We'll see is the pelvic muscle turning on and supporting the tissues or not. And from there, if we find that there is an issue with their strength, we're going to do some pelvic floor strengthening.

Nina: 18:21

So with that, we're kind of going through a checklist and seeing how can we best help somebody based on how they're presenting. A couple big things, if you have pelvic organ prolapse, we want to make sure that the way that you're moving so if your main love is pickleball or tennis, we want to make sure that all of your muscles of your hips and your core and your pelvic floor are all working together to help support and lift your pelvic organs when you go to hit that ball, or when you go to cut to the left or jump to the right. So we can do an examination to make sure that that's happening. We also need to make sure that you are not constipated, okay? Because pelvic organ prolapse, if you're constipated and every day that you are trying to move your bowels, you're pushing, pushing, pushing.

Nina: 19:20

You're pushing down on those pelvic organs, okay? So there's things that we can do in pelvic therapy to help you improve your bowel which will in turn make your pelvic organ prolapse a little less of a problem, or even prevent it from getting worse. Another thing that can be helpful is just looking to see if we need to help with some weight loss. So sometimes, you know, we see that these symptoms happen when somebody has recently gained weight, and having just more weight in our system will put more pressure on our pelvic organs, and we can help and assist with that as well. So those are kind of the big things.

Nina: 19:59

We need to make sure the pelvic floor muscles and really all of the hip and core are helping to stabilize from below. We need to make sure that our bowel habits are healthy and take a look to see if maybe weight loss could be helpful as well.

Joe: 20:17

So definitely, this is quite the in-depth kind of addition to what we're doing.

Nina: 20:22

Yeah, it is. I mean, this is kind of where it's at. It's more than just, can you squeeze the muscles and lift the muscles? We've got to make sure that when you are doing the things that you love or things that, you know, put pressure on the pelvic floor or on the pelvic organs, that you are managing the pressure well, okay? So you might hear the term pressure management often if you're doing your own research on pelvic organ prolapse.

Nina: 20:48

You know, if you just Google that, you may see, what can we do for that? Or what can pelvic PT do for that? You'll see pressure management come up. Well, that's really kind of everything I described, is making sure that we are our whole kinetic chain from our foot to our core is helping support those organs.

Joe: 21:09

So someone comes in and there may be question on whether they're a candidate or not. What is how do we know? Or how do you know?

Nina: 21:17

Right. So what we'll do is

Joe: 21:19

Or how does a patient know?

Nina: 21:19

How does the patient know? So if they have pelvic organ prolapse that is coming out of the vaginal opening, okay? So it's coming out past the opening.

Joe: 21:32

Now is that pretty obvious? Not to get like too into detail, but someone know, like, oh, the

Nina: 21:37

Usually people know. Okay. They can feel some discomfort there. Okay. And it may go in and out, you know?

Joe: 21:42

Okay.

Nina: 21:43

But if that's happening, they're most likely a candidate for a pessary helping them beyond just pelvic floor strengthening. Okay. Also, if I see somebody who comes in and they have this feeling of pelvic heaviness and pressure, and then I look to see how well their pelvic floor is working, and it's actually working fairly well, then I may think, well, maybe the problem's not with Joe holding up the ball. The problem might be more with the TheraBands that are suspending that organ, and we need to give it a little bit more help with the pessary, okay? So it's really kind of more of an exam case by case basis.

Nina: 22:24

So it can do with how severe it is, if it's coming out of the opening, or if I see that their symptoms are not matching up with their strength. So if they're a little stronger than I thought, then maybe we got to bring in a pessary to give it even more support because even the strength of the pelvic floor is not enough.

Joe: 22:43

Enough. Okay. And so let's say that you have the device. Is that the right term he is?

Nina: 22:50

Yes, device. Mhmm.

Joe: 22:51

How long is this process? Mhmm. Because obviously you don't want it I would assume you don't want it in forever.

Nina: 22:57

It really can be a forever

Joe: 22:59

Oh, it can. Okay.

Nina: 22:59

So it does need to come out to be cleaned. So depending on what type is used, there are some that really need to come out every day to be cleaned, you can wash them, you know, with soap and water, that type of thing. And there are some that really don't need to come out quite as often. Okay. It really depends on the type.

Nina: 23:16

It depends on the person. But it's something that will help support those organs indefinitely. So the way I look at it is, if you have pelvic organ prolapse, pelvic floor therapy may be helpful to you. Pelvic floor therapy plus a pessary might be the next step. And then the last step would be, in those most severe cases, surgery.

Nina: 23:41

So what it does is it allows us to have another option that if pelvic floor therapy is not enough, it's something else we can bring in without having to jump to surgery just yet.

Joe: 23:52

Just like any other body part, really.

Nina: 23:54

Yeah. Exactly.

Joe: 23:55

And that's what I mean. I'd be curious what you say to patients because obviously you've been doing the pelvic health much longer than I have. I always give kind of the example of the pelvic region is just like any other joint.

Nina: 24:05

Mhmm.

Joe: 24:06

It moves, contracts, relaxes. You have to have some interaction with it. The only difference is it's inside your body. I mean, of like the jaw, I say that to patients with jaw pain as well, it's just like in their joint, it's just inside your mouth. It's just, you just can't see it.

Joe: 24:22

So a lot of the stuff we do is just a little more internal, little more intimate, so to

Nina: 24:27

I always give the example all the time of when somebody says, Okay, you're working with a personal trainer. And they say, let's do some arm strengthening. We can stand right there and watch you do the exercises, and I can tell you if you're doing it well or not, if you're using the right muscles or not. This is a group of muscles that you it's a by nature, a little more invasive to see how well they're working Because I can't tell by looking at you if you're doing it correctly or not.

Joe: 24:54

I think that's the important part too is and I've learned this too is, one, don't assume anything.

Nina: 25:00

Mhmm.

Joe: 25:01

You have to get in there and just make sure. Right. Your hands will tell you what's going on.

Nina: 25:06

That is right.

Joe: 25:07

Which you just got to get over.

Nina: 25:09

Yeah. Right. You know, and some patients prefer not to have an internal assessment. And that is okay. You know, there are various reasons why it's an invasive exam.

Nina: 25:23

Yeah. And we can do some other things. We can use external palpation. We have real time ultrasound in our clinic where we can get an idea of how well the pelvic muscles are working.

Joe: 25:34

Is that all figured out, It

Nina: 25:35

is. It's working beautifully. Yeah. We had a little issue with it, but we got her up and running thanks to my care genius.

Joe: 25:42

You put a lot of work in making sure that was Yeah.

Nina: 25:44

Yeah. Technology.

Joe: 25:46

I'm also I have very rarely seen Nina frustrated in the clinic. The ultrasound was one Right. One little thing

Nina: 25:52

that just

Joe: 25:53

got under her skin a little bit.

Nina: 25:55

Yeah. But now that we got it working perfectly, it's great. I can really see if the pelvic muscles are lifting the organs by putting a little ultrasound gel and this ultrasound machine on your belly. I can see what the bladder's doing when I have you do a contraction, and that can give me a really good idea on how effective the contractions are.

Joe: 26:16

Well, this stuff sounds I mean, obviously from a PT perspective and nerdy perspective, this seems like it's really cool. But I do think this is a really good avenue for patients to also have a benefit from

Nina: 26:27

in

Joe: 26:28

our pelvic space here at Freedom, which I feel like the nice part to again, you've been here longer than I have, but it seems like if we're not doing something, the company is very open to supporting that in any capacity that they need to make sure that you can provide the best care that you think is

Nina: 26:44

Oh, you bet. That's why I've been here for twenty years, is that they support your interests, and they want to provide a really good quality product to the patient. Yeah. And they're willing to support that. Offering pessaries here at Freedom is something that is will be up and running here in the very short, near future.

Nina: 27:04

And I am so excited about it because it will be another way that we can help these patients that just want a little relief from the symptoms that they're feeling to allow them to do the things that they love.

Joe: 27:14

Love it. Love it. Thank you, Nina, for sitting down this morning. We put this podcast in quick before both seeing patients. Nina's much busier than I am.

Joe: 27:23

So it's always nice when she's able to sit down. If anyone's having any pelvic health symptoms, one, I always say it's not normal to have those, it's okay to go and seek out help. We have therapists that are in essentially all of our locations. For sure Fox Point, Grafton, we can make it work in Brookfield but we are still working on hiring someone there. And then Mukwonago has it as well, They I

Nina: 27:49

have pregnancy treatment, which Abigail is

Joe: 27:52

Oh, that's right. That's right.

Nina: 27:53

Excellent at that.

Joe: 27:54

So if anyone is having symptoms, please come and see us. We'd love to help you. Nina, thank you.

Nina: 27:58

Thank you, Joe. Thanks for listening.

Joe: 28:01

Have a great day everybody and we'll see everybody in the next couple weeks on the next episode.