Putting All The Pieces Together

Welcome to Pelby biz podcast. I'm Dr. Kelly Alhui. I have grown and established brick and mortar practice in Northern Virginia called Ortho Pelvic Physical Therapy and also founded Pelvibiz, which is an online business consulting company that helps healthcare providers make more money and be healthy while doing it, especially in the pelvic health realm. And let's get into today's episode.

Today I'm going to talk about the holistic approach that we have to orthopelvic compared to other pelvic health practices. And there's a reason for it. Okay, so number one, I have made my logo. This was six, seven years ago, a puzzle piece with the pelvis in it. And the reason why is is because our logo literally says putting all the pieces of the puzzle together to help men and women get rid of bladder leakage, low back pain, hip pain and pain with intercourse to be able to do activities pain free. Okay. And it ties everything in our language, the logo, it's a puzzle. Peace. Not one person is the same. We know that. This is why for me, I'm not too big a fan of research. Yes, I think we should look at it a little bit, but really I don't rely on research to tell me really what to do that much because it always states at the end of the research, further testing is needed on a bigger sample size or with not this people or whatever else. Research can give us little hints, but I don't think it truly gives us the full picture because every human being is built differently. We all have different gut microbiome, biomes, we all have different personalities, we all have different stress levels, we all have different environments. So when you try to keep everyone in one box, to me, I never have been a fan of that. I've also had my own personal health issues, health issues for the last eight years. And I can truly say having my own experience with medical providers, they all want to put a label on you and they all want to classify you and put you in this box. And I have never found that to be helpful. And it's always been actually probably more harmful than helpful to put me in a box and say this is 100% the path we need to take because you have this diagnosis. So. So I don't believe people are defined by their diagnoses. And I really think we don't need a reactive approach. We need a proactive approach. And we've got to hit this from every single angle that we know about because these primary cares are not hitting it the orthodox are not hitting it, the gynecologists are not hitting it. And so we are the go to to be actually putting all the pieces of the puzzle together for our patients. I strongly believe this. I was mentored by Julie Sartin and by pelvic healing years and years ago in California. And she truly changed the game on this because she changed a lot of us. She's mentored a lot of us in the pelvic health world and she's brilliant. And the fact that we come out of school thinking manual muscle test is what we need to do. Range of motion special test. We need to look at the research and we only do what the research shows us. And I call bullshit on that. I don't think that's true at all. I believe that everyone is more than a research article. And it's actually, you've got to put all the pieces of the puzzle together because everything is connected. The insurance company wants us to chop a body part in half and only focus maybe just on that body part. And that's so not true either. The thing, it's a whole system. When we talk about the pelvic floor, there's muscles of the pelvic floor, there's over 20 something muscles of the pelvic floor. Then you have your belly, you have your diaphragm, you have your glottis, all that stuff is a pressure system. So why are we going to chop the pelvis in half and just focus on the pelvis? Makes no sense to me. And we know the gut microbiome massively plays a role in all the pelvic floor dysfunction. We know that to be true. So why are we not connecting the dots? And I find that many new grads coming out or many people getting into the pelvic health world are not understanding that we have got to look at it from a multifaceted approach. And we don't just have to be the musculoskeletal and nerve experts. We can actually be a human and help another human out because we understand in general health and wellness more so than our next door neighbor. We don't have to be the expert at it. And if we feel that we're not the expert at it, I have no problem referring out to my community. But we know more than we think we know. And I think it's time for us to truly put the pieces of the puzzle together so patients don't get frustrated and patients believe that they can actually get their problem solved and not be passed around to eight to 10 to 12 different doctors and still have no resolution. I think it's BS and clearly I'm passionate about this because I have been the patient behind on the other side of this friggin lens, okay? And it's really, really annoying. And this is why I have built orthopelvic to the be where it's at and to continue to be the number one pelvic health practice in my community. Because we have a multidisciplinary, a multifactorial approach and we're not just hitting it from the musculoskeletal and nerve aspect. So I'm going to tell you about what I believe, why I believe it, and truly how it has helped my practice. So we know that we have to hit this multi dimensional. So yes, if someone has leakage, there's probably some muscular skeletal problem for sure, but there's also some maybe upregulated nervous system problem. They also might have pelvic pain. Well, that also might be a pain science approach that we need to take to it. So if you just keep saying I need to lengthen, lengthen, lengthen the muscle, but you're not addressing, let's just say with pain, with intercourse, you're not addressing the partner is still trying to penetrate the female, let's just say, and they're having the same pain response. If you're not addressing the pain science aspect, that patient is not going to get better. No matter how much you stretch that the muscles out, it's just not going to work. So you have to hit it from a pain science perspective, creating a different route in the brain, saying, hey, I'm safe, I'm okay, I can do this activity and it won't be painful. You've got to hit it from that aspect. So that could look like bringing in Desert Harvest lidocaine cream. That could look like the partner and you playing a puzzle and you're connecting over that and you're not feeling, oh my God, my partner's gonna come near me and now it's gonna hurt. That could mean your partner just laying next to you and touching your inner thigh without you tensing your pelvic floor Again, I'm breaking the steps down so that we can get to the end result, which is basically not having pain with intercourse. Right. We also, in this case, I may need a sex psychologist on there. Maybe I grew up really religious and they always told me that sex was really bad and that's all I've known. Or sex is only for if you want to get pregnant and you're going to get pregnant every single time you have sex. Well, my brain has been conditioned to say, oh, sex is bad. This is not pleasurable, it's not for pleasure. You can't have pleasure out of this. I'm then not going to have pleasure out of intercourse. It's going to not be a thing. So I then have to recondition my brain. This takes time. So I may need to go see a sex therapist to understand besides penetrative sex, how are things going to be pleasurable for me to be able to have pain free sex. So for someone that's having pain free sex, to put all the pieces of the puzzle together with, we create the team at orthopelvic. We pull in the sex psychologist we refer out for that. We, we are the muscular skeletal experts. So we treat that part and then potentially we pull in maybe a supplement or something else like the lidocaine cream or something else that's going to help us so that we create the help with the pain science approach as well. So we're hitting it now from three different facets and we're putting all the pieces of the puzzle together so that this patient's problem can, can truly get solved. I think that's massively important. There's a lot of talk about endometriosis and I see, I see is very rare. It's so misdiagnosed. We know that. But with endometriosis about the gut microbiome changing that there's over what, 83, I think billion little guys that are in your gut and your gut by the way, can change every four days depending on what you're eating or your stress levels. And we know that if we are changing the gut microbiome that it can impact how the pelvic floor response is which then can cause us to have an increase in symptoms. And like again for endometriosis, hitting it from a multifactorial approach, we're not just going to throw birth control at it. We're not just going to throw a pelvic health pt. We're not just going to put surgery at it. So there's many different ways you can treat it, but what's the best game plan for that patient? And us being the experts in this, in the field of this of endometriosis, we should be the ones guiding the treatment plan and saying, hey, I want you to go see this surgeon because they are the best in the area. From what I know and what I have interviewed with these people. I go and interview all the providers so that way I know clearly who is very knowledgeable on this stuff and who can help my patients out the most. I think that's important as well. When you have a holistic approach, interview them, go in there and get treatment from them. I mean, clearly if I don't have India, I'm not getting treatment from them. So I'll go and interview them, put them on live and interview them live. I really believe that's important. So again, being the ones, the primary care is not talking to them about exercise. Their primary care is not talking about stress reduction. And let me make this point too. I tell my team, we're not just musculoskeletal experts at what they teach you in school. We have many moms that come in, they're so overwhelmed, one session we're going to help that mom out, get unoverwhelmed, maybe create a schedule for her. No joke, I'm going to create a schedule for her. I'm going to have her be able to do different exercises, pain free, not exercise exercise where you're doing leg lifts exercises in the fact of just being able to move differently throughout her house or throughout her day, that then is going to impact her so that she doesn't have pain and she can focus on her kids. And we're going to teach her how to do that. I'm going to organize her day for her so that she doesn't feel overwhelmed. Her stress level goes up and then she has incontinence. Do you see how it all goes back together? Rather than me just focusing on the muscular skeletal system, let's Let me lengthen your muscle. Okay. And then now this person is still having issues because we haven't addressed the root cause, which is the nervous system being too heightened throughout the day. Because this mom is so overwhelmed, if I can address the overwhelm overall, the problem goes down. For instance, I had a patient, he is from a different background, different culture, and his parents put so much pressure on him. And because of that, if I don't address that underlying issue, that the parents are putting so much pressure that if he doesn't get straight A's in school that he's a failure. And the reason why he's having chronic pelvic pain is because the parents are putting so much stress on him that it's causing the chronic pelvic pain. So I don't care how much lengthening I do in the session and how many times it's been coming. If I don't get to the root of why it Matters of what his parents actually think about him, then I have not done my job. And if you feel it's not in your scope, then we need to put a psychologist on his team to help with that. Sometimes I feel like I can help these patients because I've been through a lot of therapy myself. And then sometimes I'm like, you know what? This is past me. I need to refer out. So are there ways that we can be the sounding board or listening board for our patients? Maybe that's all they need. And they're going to feel so much better. Maybe they just need basic nutrition advice. We can more than likely give basic nutrition advice if they need more or they need, like, blood work, whatever else. I'm pulling a naturopath in on the team. So then that way I can figure out their hormones, we can figure out what's going on with their gut, we could potentially add supplements. So now I'm hitting it not only from a pelvic health standpoint, but I'm also hitting it. The naturopath is giving me supplements and getting maybe like the Dutch test for hormones. And then together we're working on the hormones and we're working on increasing blood supply and lengthening the pelvic floor so that we can get this patient the results that they're looking for. So again, it's not just hitting it from one approach. It's really looking at the person, the uniqueness of the person, and creating a dynamic, basically a dynamic treatment plan for them that is actually going to get them the results is massively important. So I, you know, beg anyone that's coming out of school that's getting into pelvic health, please hit it from a multifaceted approach. And if you feel that you don't have the resources or tools for this, please elicit people in your community that are going to help these people. We also go as far as getting them completely back to their fitness level, because I was a personal trainer, I was a Pilates instructor, I was a yoga instructor. So because I have that background, I can speak that language and truly get them back to doing Pilates in a way that they've never even done Pilates before. So we just don't stop at, oh, you're out of pain. No, we want to get you back to actually your overall goal, your big activity that you want to do, that you feel confident in, and we're going to get you there. So really hitting the spectrum and the gamut on it. Talking about foods that we eat. We can do this and I really feel it's in our scope of practice to educate and prevent as much as we possibly can when it comes to stress, inflammation, the nerves, the musculoskeletal system, the digestive system, the psychological system, all of that we can truly, with basic knowledge, really impact the outcomes that our patients are wanting. So overall, the theme here is please don't hit it just from a muscular skeletal piece and do your range of motion and manual muscle test and all the special tests. To me, it's bs. You've got to listen to the person that's number one. They're going to tell you what to do to treat them of how it's going to make them feel, and then listen to them, create the team that they need and personalize to them to get the best outcomes that we're all wanting for our patients. So I think that's the biggest lesson today, is treat your patient holistically with a multifaceted approach. Bye, guys. Are you ready to live the life of your dreams?

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