It's prostatitis... or is it??

Hey Fellas! This one if for you! Prostatitis is one of those diagnoses that may be given to a man who is experiencing discomfort 'down there'. Men with this diagnosis have described their discomfort as pressure, burning throughout the saddle region, of 'like sitting on a golf ball'. Functional complaints range from decreased stream when urinating, urinary frequency or urgency, 'never feeling empty', as well as various forms of sexual discomfort and dysfunction.

Usually the diagnosis of prostatitis is made by a urologist. A very common course of care is a combination of antibiotics and Flomax. The antibiotics are to treat any infection that may be causing the inflammation. The Flomax is to relax the smooth muscles in the urinary tract to improve urine flow. When this works - it works!! Unfortunately when it doesn't work men are left wondering what they can do... or resign themselves to just dealing with their complaints on their own... or taking antibiotics again and again. The worst thing is when you're doing the things you're supposed to be doing and it doesn't help.

If you'd like to read more about prostatitis, you can check out this blog post.

If you'd rather, you can check out this short video.

[embed width="320" height="240"]https://youtu.be/eA_GYqAbFOo[/embed]

To my cab driver– I meant it, that doctor did not tell you the truth:

Dear sir,  

I appreciated your kindness in making sure I had my seatbelt on. And the humor about directions (you were right, it was the Northeast corner). Your conversation about weight loss and getting shorter as we age was fun (keep moving and Pilates is a fine choice if you like it).

But that thing just as you stopped at my place – we need to pull that apart, and I hope you do come to read this. For the rest of you, it went like this:

Cabbie: You’re a PT? Do you know anything about stiff muscles and trigger points? Because I’ve been told that I have this thing wrong in my neck that is Myofascial trigger point something or other and that it will take a lot of treatment to get better.

Me: I know a bit about that, what else did the person say?

Cabbie: Do you know ____________ ? She told me I need Saline solution injected into the trigger points and maybe cold laser. But it’s expensive and she said it would take a long time to help and I’m not sure.

Me: No. Don’t do that. There’s not good evidence for it, and there are better (more effective) ways to get you feeling normal – and most importantly, things you can do for your self so that you don’t need multiple visits for lots of money.

<I wrote the clinic information on the back of my receipt – I hope you do call!>

Cabbie: Can it really get better without injections? She said the trigger points are making it so the muscle is touching some nerves and that is bad.

Me: Please call me! I HOPE the muscle is touching those nerves, since they run through the muscles and are hardy things. I can help you, without injections and teach you how to take care of yourself.

He drove off, and I am sitting watching the sun set thinking how wrong and indefensible it is for health care practitioners to be selling such unfounded stories to people who should instead be helped honestly and kindly. Saline injections have no evidence to support their use. There’s compelling evidence that we should all toss the term Trigger Point (Travell and Simons did NOT do proper study and there’s a recent chapter about pelvic trigger points where the author clearly states that Simmons and her “extrapolated” the pelvic trigger points… ) See this and this and this.

I promised him that I could help him learn to take care of himself and that if he didn’t see positive change in 6 visits or LESS, that we would not keep going. It’s Easter. Let’s hope for a miracle and a shift in health care away from celebrating passive treatment and words designed to create passive (and fearful) patients – let’s aim for active change and self-empowerment. I’m all for gentle, kind manual therapy to unstick the stuck spots – and for teaching people how to do that for themselves. For cabbies (and everyone else).

Sandy

What to Look for When You're Looking for Help with Pelvic Pain

Pelvic Pain can be hard to deal with. The amazing amount of information (both good and bad, accurate and inaccurate) can be overwhelming. How do you wade through everything and find the help that is right from you? Here are a few suggestions that you may find helpful. Remember: If you feel scared or hopeless, you’ve just not yet found the right person to help you.

Medically Induced Healthcare Issues

Healthcare can do better....

This weekend I had the good fortune to attend a wonderful course, Comprehensive Management of Bowel Dysfunction. As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging. And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.

As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam. That’s right, even the rectal exam.

It got me thinking about what my patients go through on their quest for health. The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful. Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?

In our clinic, we’ve started referring to these as ‘medically induced conditions’.

We unfortunately see this often. Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments. Why does this continue to happen?? Is it necessary to ‘get worse before you get better’? Is it necessary to endure further testing? Here are some thoughts and questions for patients and clinicians to ponder. I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions. I hope it makes patients speak up if they’re being hurt.

1. If you poke anything hard enough, it’ll probably hurt. This goes double for poking into any orifice.
2. Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person. Especially if the person has already told you, ‘it hurts if this bit gets poked’.
3. Testing should be done to help rule out red flags, or to help direct the plan of care.
4. Patients should understand why they’re having a test, and understand how the results will impact their plan of care.
5. Clinicians should take the time to make the healthcare experience better. Make the patient comfortable. Take the time to explain what you’re doing. Take the time to answer the questions. Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
6. If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them. Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
7. If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.

I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions. There are a lot of us who also fancy ourselves to be wonderfully qualified: specializations, advanced degrees, conference and course attendance trying to acquire new knowledge, new skills, and new evidence to educate those patients. Professional development (heck, learning in general) should be life-long. However that knowledge should not replace common sense and good manners.