Stress Incontinence is NOT Normal!

Multitasking for many women = laughing, coughing, sneezing, and peeing all at the same time! 

Time for some education about this type of  multitasking, which is otherwise known as stress incontinence. Stress Urinary Incontinence is defined as involuntary loss of urine during effort or physical exertion (cough, sneeze, jump, etc). This is the most common type of leakage about which women complain, especially those who exercise frequently. Stress incontinence is not normal and can be indicative of larger problems.

There is another type of incontinence known as urge incontinence. Urge Urinary Incontinence is defined as involuntary loss of urine associated with urgency (you just can’t get there in time). The prevalence of urinary incontinence is estimated to be around 16% for women younger than 30 years, and 29% for women aged 30 to 60 years, with stress incontinence being most common. Some women suffer from a combination of both types, and this is called “mixed incontinence”.

When I look at the large percent of women who report incontinence I wonder, "Where are they all???" As the only local women’s health physical therapist I should have a list of women waiting to see me at my clinic, wanting to trade in their Pose pads for some more attractive underwear. Incontinence can be alleviated, if not eliminated altogether, with the right exercises and breathing mechanics.

Therefore, I ask all of you women reading this:
If you can identify with either type of incontinence, why are you not addressing the issue? Have you always thought this was normal? 

I am excited to bring this issue out of the water closet. This NOT normal, and it NOT what you should expect as you age. I am here to help you train your pelvic floor. I mean, really, do you even lift?

Attitude Shift

Here I am. One week post op. Yesterday was my worst day since this whole elective surgery thing began. I resemble all those patients who come to therapy post op week 1 or 2 complaining of increased pain and swelling, less motion, increased weakness, etc. As a PT I would ask, "Well, what have you been doing?” The patient always responds, “Nothing out of the ordinary.”

I can tell you right now -- that’s a lie. Because after about a week we (the patients) are tired of asking for help, tired of sitting on our butts, and tired of feeling gorked out on pain meds. So we stand a little (or a lot) longer, walk a little (or a lot) farther, and try to spread out our pain meds over a little (or a lot) more time. The result is more swelling, more pain, and less motion.

So today is the beginning of a new me. Less exercise, less impatience, more ice and elevation, and more positivity. Things I have learned about physical therapy from the patient side:

1. I like cold hands, 
2. I would rather bend my own knee versus having someone else do it, 
3. EStim feels great regardless of whether it’s helpful, and 
4. it’s really hard to relax a painful joint even when someone tells you repeatedly that “they’ve got it”.

My March Madness

My new BFF

I swear it is completely coincidental that I am home recuperating during the biggest basketball event of the year, March Madness, and I am oh so happy for it! Eating and drinking while sitting on the couch watching all the action (and brackets fall apart) is what everyone seems to be doing right now, so I fit right in. And what I realized today is that a total knee replacement isn’t your run of the mill knee surgery. I know. I'm a little slow. Or delusional. Or the drugs were just that good.

After 4 prior surgeries, I was planning on a few days of “terrible” followed by a quick progressive recovery. Um, yeah. Not so much. Each day does get a little better, but only just a little. Like 5% better. I’m bending my knee to 95 (vs 86) degrees, walking with a cane for short distances, and I can stand for about 10 minutes without significant swelling and pain. I look and feel about the same as 3 days ago. Well, maybe 5% better, if I put on some mascara. This reality is my nightmare. I. AM. BORED! I am just used to being on the go, go, go. There is a reason my favorite barista calls me Zoom Zoom!

Today was Day 2 of therapy and I made myself prone hang because most my patients dread it. The photo on the right is after about 3 minutes of “hanging” and you can see how much lower my foot is. There is some method to our madness. And yes, it hurt like H-E-double-hockey-sticks. I also started the recumbent bike and I was able to complete a revolution with some serious hip hiking (a.k.a., cheating). I am no super star. I am having a boring, uncomplicated, recovery that I am trying hard to embrace. That being said, I may want to reconsider that 5K I planned on doing next month. Sigh.

Early Post-Op Musings

Centipede or TKR incision?

Here I am, Day 2 post-op, and I am home fading in and out of consciousness as I write this. My hospital stay was uneventful, and I was discharged about 24 hours after I had surgery. My lovely scar is a little different than most total knee replacement (TKR, for short) scars as my surgeon followed my old ACL incision to ensure good healing. Remarkably (according to friends and family), I have been a compliant patient. I wake myself every 4 hours to take pain medication and, as a result, I have slept well and feel pretty good.

Today was my first day of physical therapy and my favorite part was Corey’s cold hands. Seriously! The cold felt great on my knee and leg. My motion was -4 to 86 degrees, and my leg is quite swollen and very heavy (I am unable to lift it). Soreness around my lower thigh where the tourniquet was is the most bothersome and I take muscle relaxers to alleviate this pain.

Overall I am pleasantly surprised with my first few days. Now I just need to find a job that I can safely perform under the influence of Percocet. Any suggestions?

A New Beginning

"Every ending has a new beginning.”

This is how I feel as I say goodbye to a knee that served me well for 50 years. After my ACL surgery in 1981, she has seen me through 7 marathons, a least a hundred half-marathons, countless 5Ks, and 3 half-Ironman races. She's logged a lot of miles, but all good things (or shall we say worn out things) must come to an end. Today, I am now sporting a brand new Wright EVOLUTION Medial-Pivot knee system.

For my first new knee blog post, I would like to recount how I spent the last 24 hours saying goodbye to my old knee. Our day began together with a 25-mile bike ride on hilly terrain – a nice reminder of how weak you are. We rewarded our hilly efforts by enjoying a bloody mary and brunch with dear friends. Afterward, we headed home to walk the dogs one final time and of course stand and iron clothes for 2 hours (because this is when you really like to swell). After a luxurious Hibicleans scrub and a peanut butter dark chocolate truffle, we hit the sack one last time together. As always you allowed me a great night of sleep.

Why must I say goodbye is what many may ask. In all honesty she just isn’t carrying her weight anymore. My left knee is tired of doing all the work, and my body (and mind) is meant for more than short walks and bike rides. I want to run (a little), squat below 90 degrees, and assume Child’s Pose in yoga without pain. Sayonara right knee – see you on the other side (do all knees go to heaven?).

Learning is Our Choice

“The capacity to learn is a gift; The ability to learn is a skill; The willingness to learn is a choice.” - Brian Herbert 

If you have been in our Wilton Clinic lately, you will notice that I am often gone or working with some of our other therapists. For the past 15 months, I have been enrolled in a fellowship program with Evidence in Motion (EIM). So many of you ask….what does this mean? First of all, EIM is an educational institution with the primary function of providing top-notch postgraduate education programs for physical therapists. Their program is a blend of online and hands-on training by faculty who are clinicians, professors, and researchers in the field of physical therapy.

A Fellow in physical therapy is considered an expert practitioner skilled in the evidence-based practice of orthopedic manual physical therapy. Fellowship graduates are also primed for leadership in teaching manual physical therapy and are active participants and contributors to clinical research. The program is 24-36 months long and requires weekend courses in addition to many hours spent with a Fellow Mentor, a physical therapist who is currently a Fellow. I am considered a FiT -- a Fellow in Training. This past year, I traveled to Des Moines University to gain hours and worked near Norman, Oklahoma.

Corey learns by experiencing

In addition to furthering my education, three of our physical therapists are enrolled in EIM’s Residency program. Corey Dieser, Wilton Clinic, and Rene Teel-Mulka, Blue Grass Clinic, have been in this program for 8 and 3 months, respectively. Joshua Crow, Wilton Clinic, will be enrolling soon. A residency program is also a combination of online courses, weekend intensive hands-on courses, and clinical practice hours. These therapists will also be receiving the highest caliber of training with the goal of becoming distinguished leaders in evidence-based orthopedic, sports, and manual physical therapy practice. Pretty impressive!

Therapy with a little help from my friends

As you can see, all of the therapists at EIPT are passionate about what we do. We continually strive to be better for you, our patients. Learning is our choice, and we are doing it well here at EIPT to help you live fully and move freely.

Employee Spotlight: Josh Crow

Josh sports his new #TeamEIPT schwag.

Time to meet our newest Physical Therapist, Josh Crow, who joined Team EIPT about 1 month ago. We are so happy to have him as part of our team. Welcome, Josh!

1. How and when did you start working with Team EIPT?
I have been working at EIPT for 1 month now, started the 1st of February. Beth Dessner posted a opening for a Therapist in her Wilton Clinic and I responded that I was interested.

2. Describe your typical day at Team EIPT.
Typical day so far is spent treating a good variety of patients. Learning more about the local language and customs, and the learning new documenting system.

3. What is your favorite part of working with Team EIPT?
I really enjoy the relaxed, positive atmosphere at the clinic and the great therapists I work with and learn from.

4. In what ways do you strive to provide a great experience for Team EIPT clients/patients? 
I strive to make therapy as positive experience as possible while address all the patient's needs and goals for therapy.

5. How do you spend your time away from Team EIPT? 
Time away from EIPT is spent with amateur carpentry and home maintenance, reading periodicals of the day and novels about simpler times, card games involving statistics and tactical whit, multimedia drawing, and playing HALO.