kim_vopni (00:01.841)
i susan welcome thank you so much for taking time to chat with me and my listeners
susan_guidi (00:08.26)
oh my gosh i am so excited i am a huge fan of yours ever since you popped up on my radar on instagram i've just been obsessed with your
kim_vopni (00:20.641)
oh thank you so much
susan_guidi (00:21.08)
i am a huge fan and then i bought your book so don't look i highly recommend it especially if you work in your gun or female health care obstetrics cynacology it's great and i didn't realize tuscarino wrote your forward tranoscorino i had every book e clean that she published so
kim_vopni (00:24.721)
no thank you
kim_vopni (00:40.501)
she's a good friend of mine
kim_vopni (00:46.821)
it's funny around the time that she was writing her books i that's how i was sort of first introduced to her in the fitness world and became a huge fan and followed her journey for a long time and then we many years later we both present at a fitness conference in toronto every year and so as a result of us being presenters not together but in the presenter community we got connected and she learned about my work and we've become really really good friends
yeah tosca is amazing she i i still admire i've mired her the whole time and i just think that the way she lives life is something to be admired and aspired to
susan_guidi (01:27.0)
yeah she was were ahead of her time i think you know
kim_vopni (01:30.401)
yeah for sure so let's talk about you and your story i know we have a couple of common common connections as well such as tracy share but i'm really interested in how you how you got into doing what what you do and how you got into doing that and an
susan_guidi (01:46.82)
so i'll tell you a little bit about that i started doing ultra sound at the beginning of time i'm like a thousand years old and just rehabilitywork you know holding up but i really technically did start doing ultra sound when ultrasan was in its infancy i had the ultimate blessing of being able to go to johns hopkins for my training at a time where hopkins was mecca i literally
kim_vopni (01:52.381)
okay also ahead of your time then
kim_vopni (02:16.021)
hm
susan_guidi (02:16.72)
say that i worked with the gods of ultra sound when the ultra sound community was there were six seven people some of the best out of canada actually some i had huge crushes on peter cooper burgh if you're still out there and ted lions both of them made your people from canada who were doing amazing early work and i think over time i had a real love for women
i just realized that women sort of got the short end of the stick and when i started in obstetrical not even to mention kinochalogical ultra sound i don't even know if you're old enough to know this but we did static ultra sound so there was no real time ability to see organs move or heart speed or babies move we literally had to create the image i then had an oporto
it to go to south america to pioneer ultra sound my chief couldn't go and i was spanish his spanish and i had to look up chilly on the map and i literally gave one of the first horses in ultra sound in santiago chile in the nineteen eighty nineteen eighty i met my former husband there and then we found ourselves shortly after getting married and moving to france in france they would
kim_vopni (03:37.621)
wow
susan_guidi (03:46.62)
let me scan and i was devastated and i actually ended up doing a master's degree but i did all my research back at hopkins so hopkins was always a safe place for me but then i found myself always teaching the next big thing because i realized very early on as a young woman that doctors didn't seem as open to new technologies and things that would help women as i thought they would be so
kim_vopni (03:49.281)
wow
susan_guidi (04:16.64)
first things i were told with ultra sound was it's a tool looking for a use it's useless we have c t scanning we were going to scan babies with c t and that set me on this course of always looking at the next big thing so one of the big things i thought was endo vaginal ultra sound end of atuona ultra sound revolution nize being able to really see the pelvis for the first time because if we
and transadomerally people didn't realize it was like going to the bottom of the ocean especially in as patients so forget about finding perimentapaso post mental paso pelvic pain an metriosis ad no miosis those things were not even on the radar unless you had a big mass or huge vibroids you know we weren't going to see very much so the advent that started with fertility of endivaginal ultra sound even in the beginning the vaginal ultra sound was
onsidered invasive
i mean come on and and still to this day you can go and have an ultra sound somewhere in the states and i don't know how it is in canada where the stenographer will hand the probe to the patients and say you put it in
kim_vopni (05:32.661)
that still happens here too
susan_guidi (05:34.46)
so for me i felt like we were doing such a service it took me fifteen years of teaching to integrate locally and i gave some of the first courses and vaginal ultra sound the virginal probe as the standard of care in fact the mentor who i think before we planned this podcast that i worked with dr anna parsons who was a world famous reproductive endercronologist at the university of south florida
ere in tampa this was twenty five almost thirty years ago used the vaginal probe she called it image based gynecology so her vaginal exam was instead of doing this i think i can get up to your ores right she's the factional probe and i had an opportunity to work with her i actually sort of like i do
a lot of things in life i just sent her an email and said i have to if i have to empty our baskets i will work with you because she was doing she invented with something called the sailing infusion she invented this idea of being able to open the end of metro cavity put fluid which was conducive to sound and now see polyps and things it was long blowing she was doing stuff that every other doctor i worked with wouldn't have even imagined and one of those interests shortly befor
she retired was being able to probe for pelvic pain and that was kind of the last of my work with her so she opened up this world of realizing we weren't paying attention to women with chronic pelvic pain at all and it's horrible much less like women who have prolapse for instance still on this day i do stand up comedy
and i would joke you know what a pastor i mean for your viewers they don't know that people know what a pastry actually looks and feels like it's a donet hard rubber shape that's used to hold up your organs when there's nothing left to do when they're literally hanging out of you and i just kept thinking this is so awful this is the best we have in two thousand and this was before the pandemic um so my interest in the pelvic floor and being able to do a ginachological
susan_guidi (08:04.22)
ultra sound and offer the patient so much more because i always used to say that women hold everything in their pelvis their pain their sadness their traumas you know it's all held in the pelvis and we never address that and so then when i stumbled across your stuff i was like oh my god i just i want to have a cup of coffee with her and pick up brain for like three hours just to
kim_vopni (08:09.461)
hm
kim_vopni (08:29.521)
yeah
susan_guidi (08:34.18)
could take something back because if you did if you could say to a patient look there's actually some exercises that might save you from having to have sorcery or pin in your pants when you do jumping jacks or when you sneeze and that doesn't seem i mean of course in your world it is but to
kim_vopni (08:46.481)
hm
kim_vopni (08:56.681)
yeah there's been a there's definitely there has been for a long time a slow evolution and i'm noticing that there is greater i'm gonna say uptake of the preaching that i've been doing for a long time with regard to the importance of pelvic floor health so it's starting to become more talked about more people know about pelvic floor physical therapy now but it still has i would say a decent way to go on
you've come up with some of the similar barriers that i've encountered for longer and and some of those things still happen where there's not as much buying from the medical community with regards to pelvic flor physical therapy or imaging or other therapyes that could potentially be helpful and i think again it will continue to evolve and there will continue to be more collaboration i just feel like
i always say we need a village we need a village for our health care we need a village for gino and we we deserve the collaboration amongst different health care professionals we simply in my opinion cannot rely just on a doctor we need them for farmer schools we need them for surgery we need them for referals for things like ultra sounds we also could benefit from so many other providers and it's about the
ucation that comes from various opinions that allows us to then choose the best option for our bodies
susan_guidi (10:32.9)
but i think the more we talk about it um i'm actually doing this again and it's probably been fifteen years since i did it i lived next door to the catholic high school that my girls went to and when my oldest daughter was in ninth grade because i talked on ecology and ultra sound there was always all kinds of things in my car charts or you know i just all kinds of you know apparati n my car
kim_vopni (10:56.721)
sounds like me too
susan_guidi (11:02.98)
and i would find that some of the young girls would come to me and sort of talk openly about either some sexual experimentation or what their fears were something led to another and i got invited and i did an introduction to young woman's health almost fifteen years later my kids don't go to school there but i'm doing it again and the same issues i was contacted by a young woman and i think god if we still have in two thousand and twenty three in an elite catholic
school little girls that raise their hand and say the way they started their period thinking they were dying and bleeding out we're certainly got a long way to go to talk about pelvit health and how to reduce pain and have optimal sexuality blah blah blah blah because if we don't talk to them they don't get a refresher course when they're twenty or thirty you know
kim_vopni (12:00.761)
no and along the way they've had all these changes that have influenced their pelvic floor not knowing what's considered normal may be feeling shame and embarrassment not sure who to talk to and then you know many years go by and then all of a sudden they're now perry menopause or post menopause and they're thinking how is it that i've gone this long and now i'm just learning this and i love that you're talking to school the school girls because we if we're talking about bodies and menstration and sexual
health sometimes that's not even being covered but if we are teaching that in schools why not talk about this really important group of muscles called the pelvic floor and how it will be influenced by menstrual cycles how itll be influenced by pregnancies on child birth how it will be influenced by the transition into menopause i just feel like we have such a missed opportunity there and i know the u k has actually stressed and talked about the importance of teaching it in
i don't know yet if that's been implemented but why is that not a global practice that's happening right so so i want to go back to your your ultra sound first before we start to get too much into the weeds but yeah i know so good i so many of the listeners would be familiar with what what you were talking about before the ultra sounds that many of us who have been pregnant may have had where there's a probe and it goes all along the abdomen and you
susan_guidi (13:14.6)
i cover i could get in the week
kim_vopni (13:30.761)
see images of the uterus and baby and what have you so many of us are familiar with that and then the pelvic ultra sound as it sometimes called or verginaltra sound is a longer sort of wand probe that is inserted virginally that allows us to see other images and i have a story to tell you in a minute but i'd love for you to talk about what is endoverginal ultra sound how does it work and what is
susan_guidi (13:44.88)
one
kim_vopni (14:00.721)
looking for
susan_guidi (14:01.6)
oh goodness okay so here's the idea is that the uterus and the ovaries sit closer anatomically to the vagina than they do by approaching them from the external portion of your abdomen and one of the problems with conventional what we call trans abdominal ultra sound scanning on the outside that's like what a pregnant woman
often get um is that there are things that are barriers to sound before we often get to the uterus and ovaries one of those being pod cast sound is in it's lolla like it's the best way to conduct sound is to transmit sound through fluid so if you try and transmit sound through bone or on the opposite extreme something like
as it's like throwing a ball up against the wall it just comes right back at you so if we start from the outside and are trying to see a normal shaped uterus with no abnormalities and tiny overies there's a lot of podcast that sits in between it so unless we feel tortuously the female bladder and anybody who's ever had a gynicalogical trancepdomonal scan they'll just fall
kim_vopni (15:30.061)
know that feeling yeah
susan_guidi (15:32.22)
in their pants they feed on the table it's just there's no right or wrong it's just you're going to wait it's going to be horrible and so everybody associates this terrible exam but that still doesn't insure you that the bladder is going to illuminate enough up and over the uterus dependent on where it's at anatomically and your overs especially if for instance the left over sits up higher and out of the way and if you have constipation forget about it the vaginal pro
ah was initially designed for in fertility for us to be able to look at pholicals up close and personal in fact some brilliant people have often referred to endovaginal ultra sound as sano microscopy sano microscopy it's like putting a microscope in your vagina
and then you don't have all the obstacles that you often have by going on the outside of the abdomen because now not only gas is going to get in the way but if there's any intro abdominal fact again now you have to get to the bottom of the ocean to see these organs the vagina doesn't have a lot of perry the gina fact there per vol there's just not a lot of fact there so no matter often what the size of the patient we're going to get some pretty decent images because we're going
be up close and personal a lot of people associate pain with the vaginal ultra sound again there's all this you're going to go in the vagina you know what are you talking about and a lot of people have had terrible experiences because if the stenographer has been taught in an environment where the vain is like horrifying to them right they're often aggressive and then there's pain associated with it and then god forbid that on top
you've got vagenismis or chronic pelvic pain you've done the patient such a disservice but the nice thing is that vaginal ultra sound doesn't require a full bladder so you're done on an empty bladder you can use lubricant so there's no reason we should have pain and done well you know you can do it even in a young girl who uses campan so you just get this beautiful image of the uterus and overs that can
susan_guidi (17:57.14)
it be obtained through a trans abdominal ultra sound we can use the two in combination because sometimes there is certain pathology like utorandfibroids that get so big that they sit beyond our range of being able to get up in the belly but for the most part especially looking at primentopasl and post mentapaso over vaginal ultra sound there's just nothing that compares to it
kim_vopni (18:24.441)
interesting okay a couple of things before we go deeper into the into it i just want to ask with regards to ultra sound uh can prolapse be seen in either the trans abdominal end or the vaginal ultra sound
susan_guidi (18:40.62)
you know that was an interesting question that you're thinking and i was reading through your book and looking at the exercises that you talk about hyperpressives right this idea of being able to sort of suck your belly and right and obviously pull up that sling right of the pelvic floor muscles and then pull things up my question is and that was part of the reason of talking to you is that could there be something now that we could use an ultron and perhaps it's already being
kim_vopni (18:48.901)
hm
susan_guidi (19:10.86)
where we actively wheel time get patients to practice those moves to say are you affecting the lower pelvis and when you let go do we see this descent
kim_vopni (19:21.881)
yeah they are being they are using ultra sound that the i know dian le has done some work with it and colleague of mindtrestisin who does hypopressive canada she's been working with a few people in ultrasonso yes they are doing and they've seen some really interesting things trans to my knowledge i don't know this one hundred percent but i believe it's trans abdominal ultra sound i don't know if they have done any vaginal ultra sound
susan_guidi (19:46.94)
be interesting i don't know why we couldn't you know you just have to have more of an open minded patient but i don't know why we wouldn't be able to tell i think you almost have to have a base line ultra sound because the patients that i've seen with prolapse i mean most of their things are just
kim_vopni (20:06.761)
yeah if we don't know what how it presented before is this different than what it was before so yeah
susan_guidi (20:14.6)
you bring up an interesting point and it's something that i've talked about for a long time and again i don't know when i don't even know if i'll be alive if this ever gets implemented but i often used to say is i think done well it would be awesome to have ultra sounds done at milestone periods in a reproductive cycle especially perymentapuzzle and postmen a puzzle because now you realize what am i taking architecturally into this part
my life what does this landscape look like after all these years of whatever it is that's happened to it you know do my organs sit a little bit lower you know do i have five rods that i'm taking in do i have perovariancists that are benign but are going to get over called like crazy because that was normal for me but it's not normal to our radiologist reading an exam in texas somewhere so
kim_vopni (21:10.681)
yeah it's interesting because i think a lot of a lot of testing thyroid a full comprehensive thyroid panel full comprehensive female hormone panel i look at practices like this and now what you said as well also as another one i'm like it makes total sense where if i think of the i appreciate there's costs associated with those but when i think about the cost associated with those to give base lines to act as a prevention versus the cost
the subsequent surgeries or farmer suiticales or missed work or like all of the other costs that happened as a result of what could have potentially been caught along the way and managed better i don't know why are health care systems i know i know that's a very big conversation but why why has prevention not considered
susan_guidi (22:03.34)
it's obviously
kim_vopni (22:09.721)
i just i'm hoping with
susan_guidi (22:10.66)
i think o us to you know to have conversations like this that in hopes that a few women listen to us and say this is no longer crazy talk you know for less than what you buy a designer purse i mean i charge two hundred and fifty dollars now but i use three dimensional ultra sound your images become make you the virtual patient i can re process them after you leave
kim_vopni (22:18.421)
m hm
yeah
susan_guidi (22:41.06)
we can tell you hormonal status hormonal status i mean it's just this terrific and we can assess pain so
kim_vopni (22:50.481)
okay so i want to i want to go on the hormone piece first and then i want to come to the pain i was originally we were going to focus on the pain but the hormone pieces is super interesting as well to you so what when you are doing an ultra sound how can what do you see on the ultra sound that would indicate the hormonal status
susan_guidi (23:11.32)
well i think it's looking at the ovaries in the follicular function ovaries have a terrible wrap in the business of dinachology if you came in and shadowed me you would hear on a daily basis why i have since i've since i've since i've been told i had assist i had assist removed my mother had this and i have since you know and
we've made sist this horrifying thing right you have since there must be something wrong with you instead of being told how do your ovaries work and one of the things that i like to do is and this i learned from my mentor and this was thirty years ago she had a small little screen for the for the patient to watch and she would say here's your uterus your uterus is antiverted it's this it's shaped normally
it measures this here's both your ovaries your late thirties you have seven fologals on this side you have eight on this side you have a corpus loutit looks like you ovulated from the left right we can tell all of those things and in women who are off in beginning as early as mid thirties starting to face either reproductive issues or autoimune issues like p co s and all these things we can start to say
what are those fogles doing you know this over looks like it's almost postman apostle what i offer
kim_vopni (24:50.481)
so you see that because you don't see as many folicals is that right
susan_guidi (24:53.62)
so what's interesting is it's even better than that with great technology but it's so exciting i know i'm like but it's i have like the latest equipment in ultra see that's always what i've done so it's literally like doing a dissection through overiesand what you see in the post menoplasa overies we become egglis right i always say they go to hawaii they pack their bags and off they go right and characteristically there's an ultra sound appearance
the folicals are almost non existent and there becomes this almost like rim around the over that is just the classic postman apostle so it's an inactive over right so you can start to see and see i do a lot of infertility work there's often one in fact i'll even go as far as to say there's a war course over one over seems to do the work she must be the female over you know
and the other one so there are things like that we can tell where you ovulated when you oviulate so if you came in and you were on day twelve and i see a big fat corpus luteum is the secondary sist that develops i shouldn't even use the word sis but that develops post ovulation we can see signs of that and they get funky looking too those are over called all the time but i studied with this woman all we did was research for two years on studying the corpus luteum
the corporussudium gets over called as masses and potential cancer and blableblah dependent on where you are over and over and over again so there's so much and then there's the whole world of p c o s and it's endemic i don't know what it's like in canada but p cos as a condition i've never seen so many cases of p c s
kim_vopni (26:47.521)
interesting so yeah in corpus luteum so that's and that's our projestorone source and when we don't if you weren't looking and didn't see you know you said you can tell where you've ovulated from if you're not seeing that on either side and there's no corpus luteum that's a sign of the perimenopaus where we're now missing that ovulation and were therefore not getting the projestorone to offset the estrogen and then we get the estrogen dominance and you know all that kind of thing so that is so interesting and so
that would be such helpful information to so many people i remember going through parymenopas thinking i was crazy i thought i was having heart attacks i thought i had all these things before i knew the term peri menopause and all the all the reasons why everything was changing
susan_guidi (27:29.8)
and as a stenographer what i witnessed because i was so passionate about women and i've always been chatty kathy you know i'm cuban so i guess that's just my i talk to them and i would realize when you are in the age that you start to go into perry menopause it's like when she gets crazy in your life you know your early forties many women now
s have young babies because they started a little bit later they might find themselves still heavily involved in their careers right so they have careers they have young children they have a spouse that may or may not be helpful but we know women do eighty percent of most of the stuff you know that has to do with the home and the kids ter the default parents they might have elderly parents so now it's it's this storm of
just managing putting out fires right and then all of a sudden you're over start to say oh hell no this month no you know we're not doing it you can't possibly have a baby and when you start to like have times where you do where you don't you're going to see that reflected in your menstral cycle right and then the symptoms that go along with that but when i was young when a four year old
would come in it was just i would see that you know whoever the attending was that would just pat the women on the head and here's the beginning script for so oft and anti depressence and so you look at the chart and no but he's talking to them as like are you happy in your marriage are you okay is everything okay how's work for you how's the kid or you have a child with autism are you losing your mind you're managing that and your job and your husband and your parents and now
men parts
kim_vopni (29:31.281)
and things asking them about their mental cycle has have you noticed some shifts do you notice any clots is it painful yes and incontinent symptoms and all that yes
susan_guidi (29:38.04)
are you on the birth control polaveyou been on that for twenty years you know there's just we opened up a can of warm and it was a passion of mine because i personally went through it when i went through a tumultuous divorce in my early forties it was crazy make my i found out my former husband was gay this was not something a cuban catholic girl grew up learning that that might happen and i remember
kim_vopni (29:51.361)
hm
susan_guidi (30:08.7)
my gun called just said well let's get you some zoloft and i took solo for like two or three days and i was a big runner and i remember feeling like i had an auto body experience and was like i'm not doing so loft i will use exercise i started boxing because i knew i had to find a voice and an answer for the insanity that i was dealing with and then physio
kim_vopni (30:26.901)
i love it
kim_vopni (30:37.281)
yeah
susan_guidi (30:38.04)
ally your body is changing right and that can last for ten years ten years if not earlier because the data shows that it might even start that thirty five you know we have so many patients that go into premature vary and failure very early on so yeah i think the psychological components that women face at that stage of their life are never harder you know
kim_vopni (30:41.101)
yep
yep
kim_vopni (30:56.181)
yeah
kim_vopni (31:08.481)
and all of this information would help ease some of the confusion and the anxiety and the worry and concern that goes along with all of that so you talked about ovarian insufficiency so primary ovarian insufficiency is something that could happen potentially earlier so that's something that you could tell as well and then you talked about p cos can you talk a little bit about how what do what are you looking for what do you see in people with p c s with your
alta sound
susan_guidi (31:39.08)
well i am not a physician i am just a stenographer well not just a stenographer i'm an old lady stenographer so that really i mean it does i paid my dues but you know what i find about medicine i went into medicine to make people feel better i always thought fundamentally was it not our job when they left us that you just made their world just a little bit better and when i see a woman who comes in with p cos
ere's almost a little bit of an appearance not always right but often you will hear a woman that comes in that will say she's struggling with being overweighed um you might find that as you're just sitting there and looking at her in the chair that she might have some excessive hair some of them might say oh gosh i have to get it waxed or laizered or it's every
it's crazy um and then when you put the vaginal probe and look at the uterus but particularly the ovaries what you find is a bunch of what we call almost a string of pearls or rosary bead kind of appearance so where the over has eggs and they're often all of different sizes in a normal patient who's of reproductive age in a patient who has p cos you
multiple multiple multiple sometimes twenty twenty five tiny tiny little policles little sis but they never get any bigger than like two or three millimeters so it's essentially this over that isn't doing its job and what i think the data shows right now which is fascinating to me is that there's probably a lot of environmental influence right
but there's an insolent resistance often in these patients so something about them i think needs to re look at an inflammatory issue like either perhaps not eating gluten or watching like where are continuous glue cost monitor what are your sugars doing to the day are your sugars responding because you're not telling anybody you're drinking a bottle of wine to night you know i'm not saying that that
susan_guidi (34:08.82)
causes it but i think the stress and all of the things that some of these women are dealing with are abcascibating and then sort of leaving them in this state that can be managed different especially if we start to address their sugar issues like the blue coat scottess do follow her oh my god another woman who i would like killed to just praying you know because just like your work we don't have to accept that
kim_vopni (34:26.641)
yes yes yes
kim_vopni (34:33.74)
yes
kim_vopni (34:38.581)
yes yes
susan_guidi (34:38.98)
yes normal
kim_vopni (34:42.161)
and it's interesting it will be it will continue to be interesting i guess what happened with covid it sort of forced the hand of many practitioners to move on line and for us to look at health care delivery differently and it opened up a lot of people's eyes to the possibility that there are other providers there are other philosophies there are there's so many amazing health practitioners health promoting practitioners in the world and
it's now what what i have seen anyway my own medical doctor she chose to leave allopathic medicine because she said i don't i don't know root causes i'm not trained to treat that i'm throwing drugs at people it's not how i want to practice medicine so she left allopathic medicine and went to pursue i don't know if she's doing functional medicine or what she's now going to do haven't followed up but and i heard that a few times where people were sort of a little bit
this illusion may be about what they went into was it really truly serving people and again that's kind of where i think now there's such we absolutely need allopathic medicine we need those practitioners for so many things i don't believe they should be our only source of health promoting advice i think we have such an opportunity again for that collaboration to happen and i hope that that that is going to continue i've seen it happening a bit more now and i'm hoping that it will
continue so that we have these multi disciplinary clinics that have all of these people that don't have to see all of them but they all potentially could help for the best interest of this patient to help them be well and live well and not be stuck on a medication they feel as the only option
susan_guidi (36:34.78)
or surgeries that often don't serve them as well you know
kim_vopni (36:37.261)
or surgery yes yes yeah yeah so i want to talk about pain this is this one was interesting to me how how can you diagnose pain with ultra sound and so there's many different types of pelvic pain
susan_guidi (36:55.32)
and so that's sort of an interesting question may be to throw back at you and then i'll tell you where i think because that was one of the things i wanted to pick your brain about so as your experts do you conduct a vaginal example and then do you probe them for pain with your finger because that's what's done in pelvic floor therapy isn't it
kim_vopni (37:19.321)
correct so i am not a pelviclorphysical therapist so i do not do internal evaluation and treatment i work in collaboration with pelvic health physios who are who that is what they are doing and then i have exercise and life style and poster breath you all those different types of strategies that can then help that person with specific certain like not all pain diagnosis but so things like
susan_guidi (37:22.38)
okay
kim_vopni (37:49.461)
you know obviously a hyper tonic pelvic floor so really kind of over active non relaxing muscles that's something that i could assist with mdisperonia like painful sex again depending on what the causes are what the root causes are of that painful sex can potentially play a role in there as well but but more so pelvic floor physical therapist they excuse me they do an internal evaluation with gloved fingers to feel forward
one to look for organ position to assess the capacity of the person to contract and fully relax their muscles they may assess them with their fingers yes digitally they may assess them in certain positions so not just laying down on the table but may be standing upright may be doing movement like a squat maybe on their hands and knees so they can assess in all sorts of different positions because the presentation of organs and the reaction time and force of muscles change
susan_guidi (38:26.36)
against the fingers right
susan_guidi (38:39.76)
so
kim_vopni (38:49.181)
is with different influences of gravity or movement or that type of thing right so so with with like my my interest in when you were talking about pelvic pain is again there's so many presentations it could be in the volveofaginal tissue could be at the entrance to the vagina it could be pain thinking about something happening and actually not involving any touch whatsoever so there's lots of
susan_guidi (39:18.88)
and that's interting one right this idea of chronic pelvic pain it's almost that's one of the things that i felt like i could speak to because what i would see is the patient is that what did you call the first one the the hyper not so that's what i in vision is a woman who's sorry
kim_vopni (39:19.341)
ancus
kim_vopni (39:37.241)
so disperuniof non relaxing like hyper tonic
kim_vopni (39:48.281)
that's okay
susan_guidi (39:49.46)
i don't know who is talking to me but i feel they need to have an opinion i feel like those patients you can almost physically sometimes see them they're doing this inside right
kim_vopni (39:51.121)
yeh
kim_vopni (40:06.641)
and sometimes like with certain with with some non relaxing pelvic floor or potentially vaginal atrophy um potentially vagenismis the probe may not even be able to be inserted
susan_guidi (40:22.28)
and so what you end up finding so i've learned this from doing young girls because my always was a big thing was that you can almost have early onset of aginismis because you're anticipating pain right that's why often young when they have sex for the first time it wasn't pleasurable because i often say women the vagina a freak in muscle like it's a muscle like crazy so if you want it could keep a mat truck out and so you see that
kim_vopni (40:36.201)
hm
susan_guidi (40:52.08)
interest sound because what happens is is that one of the techniques that we help like being able to even do the exam is that patient who presents they put their feet in the stirrups right and you know i am really gentle and kind and i show them the probe and really lubricate the and the probe if this was the probe it's just the end of the probe that actually goes in the vaginal canal but you can see their late
go like this and every part of their body is doing that and so you literally go in and you feel like you're hitting a seam at wall so one technique that i learned from my mentor was that they have to trust you right but you have to get them to let their legs just fall out if they close them like this you're up against that and you can see that that mentality of a patient especial
if they come in and say they're having pain with sex right with intercourse is because they're already anticipating the pain so imagine their poor husbands right not poor husbands because for that right but they're going to try and go in up against this and no one's taught them that probably through your technique and posture and breathing and letting their legs open all of a sudden that entroidis relaxes just a bit
and when it does then once we're past the entroidice everything is a piece of key so the pain in some patients that's an evaluation that we can do and you can see that and you can almost sort of say hey here's what you've got to practice doing if you're attempting sexual intercourse and there's so much more to that that's my world right the other thing is using the probe the same way the pelvic physio does right is almost in a clock
like fashion to sort of test in you know sort of twelve o'clock three o'clock six o'clock nine o'clock where are they the most reactive to pain and some patients are reactive to pain in the tubal areas so we often wonder if they're not suffering from just a low grade sapangitis right just throw so the tubes you know this
kim_vopni (43:16.761)
can you describe what sap and jadis is
susan_guidi (43:22.1)
that can be sucked up if i did a study with this great guy out of canada and lions and one of the things he showed with ultra sound was the uterine and demetria waves so our uterus we're in the part of the cycle that if we're in reproductive age that we can get pregnant the uterus sucks things up right it's brought from the vagina technically sperm to bring it up to our tubes but the same way that happens
we can have low grade sort of just germs or what have you and sometimes you can just be suffering from a little bit of this sort of low level inflammation of the tubes that can be treated often with anobiotics with have us to weak course and the patients come back and they no longer have the pain and that's where ultrasondcan probe is it there but
just like you you can't go to just anybody you have to be able to have somebody who understands the anatomy so well and has such a good picture that you can do this type of exam i don't pay for this you know
kim_vopni (44:34.421)
so the the virginal ultra sound is not like from a pain perspective is there it's not the imaging where you're looking for pain it's the reaction of the use of the probe
susan_guidi (44:47.5)
actually because you can go right to where the tubes are and probe that there you can see it you can probe the overs you can probe the uterus um but i think in mine world in terms of what i've seen women suffer for is this idea of holding all our pain in our contraction and maybe you can talk a little bit about that what type of person is that a type a personality where does that
that from stress is that childhood womb was they had a history of all of it right
kim_vopni (45:20.661)
that's all of the above yeah yeah there's there's so many different factors and there's no there's no one type of person that is more like it can happen to anybody for all sorts of reasons so at what point would you so when we were before we started recording we talked about a mutual connection tracy share who is the pelvic guru she is a pelviclor physical therapist in orlando so tell me how you know her but then i also want to
al about you know where when do you feel like this could provide value over seeing a pelvic flor physical therapist should they be done in conjunction potentially
susan_guidi (46:01.14)
yes i mean i think just like you said in the middle of this conversation wouldn't it be great if this was a tribe of providers you can say oh i know you know you're suffering from pepin what are you having and then i've learned from you the type of language to say oh you have it with this you have it with that you know here's a great book you can try but in the meantime you know let's see if we can get you in to see tracy and that's how i
learned of er and realized that pelvic floor therapy wasn't even just for with it it was for men with chronic pelvic pain as well and it was just this whole world of this idea of getting a message but of an area that no one ever talks about being able to loose in those muscles or like you said we have knots here you have the pelvic equivalent of that
so much pain is held in our pelvic there's this a midwife taught me this well she didn't teach it to me but she used to i used to hang out with her and was called mian message are you familiar
kim_vopni (47:13.461)
nominal message have the r vigo technique
susan_guidi (47:15.92)
yeah so it was just about being able to kind of put our uterus back in balance know and you can see that with ultra sound you can see how things like constipation and fibroids and things like that change the orientation and we can sort of manually move it so that patients have maybe some relief and then there's the whole world of constipation
kim_vopni (47:44.241)
yeah yeah
susan_guidi (47:45.84)
it's syndetic how many women suffer with constipation and you know we don't talk a lot about african american women who i think have an increased incident certainly in my patient population i think from the time they're little there's some language that's being told to them i don't know what it is i haven't done enough psychological research in that category but i would say as opposed to my caucasian pay
tiens african american patients and they just accept constipation it's just normal and it shouldn't be it's a noxious horrible you know also
kim_vopni (48:26.841)
yeah i'll be doing a whole episode dedicated to constipation with some of my favorite help people so i'll have several conversations on that but so tracy i know she's very well known around the world for pudendafudendal neuralgia and this is it can be debilitating chronic pelvic pain does can your imaging help provide any further help
susan_guidi (48:30.8)
yep
kim_vopni (48:57.221)
diagnosing that at all have you worked with her on that
susan_guidi (49:00.66)
i would love to i tried to kind of reach out to her after my physician retired because it was mostly anna that was referring the patients and then anna retired and then the pandemic but since i've been like you said on social media i'm finding oh there mig be a voice for all of this and there are some dynamic women that are changing the narrative like crazy
that would be an interesting study so tracy if you listen to this podcast you know call me i would love i just think we could use ultra sound collaboratively to say oh susan look for this but i feel like i need a little bit of a pelvic floor specialist to guide me you know
kim_vopni (49:52.821)
yeah fair enough so at what point um what you've mentioned kind of maybe landmark times where people could come in and have base line testing but also if they are experiencing pelvic pain or things they're not quite sure of maybe they know they have p cos at what point should they and i guess especially in canada you need to request that from your doctor so they would request vaginal
ultra sound correct
susan_guidi (50:24.26)
so i don't know how patients could see you right but now i started a practice twenty four years ago that said i'm not taking insurance because insurance will never pay me for one the caliber of the ultra sound machine i have the latest technology i started doing three dimensional ultra sound which is this ability to look at the uterus in three planes and the over
it's it's beautiful it's amazing it reduces the amount of time we have to scan so if we've got a patient with pain we can do an acquisition and they get off the table in less than five minutes right so we've just got these techniques that insurance i knew would never pay me for um and you know i just decided that if a patient wanted to see me electively they need
two because the only patients that we're going to see me electively were those that had gone above and beyond and realized they had listened to someone like you they had seen someone like tracy and realized that what was being conducted in most be practices with corporate medicine and now post pandemic i'm sorry is suboptimal were not training young stenographers to really
do this type of work giving them five minutes to scan you know we're not using three d so we can't save the image so we can post process it and we're certainly not training the stenographer to say what's your lifestyle like can i recognize p cos if i scan over can i recognize one over that looks post menopasile and the other one that is the dom you know the over that is the war corse can i reck
nice adnomiosis i think you said you had history was it you that is adnomiosis is a really tough diagnosis you have to be trained to know how that looks and that's a big changer the same thing with fibroids on and on and on and on and on and
kim_vopni (52:29.221)
yes yeh
kim_vopni (52:46.001)
so if you're you have your own private practice then excuse me and are you do you have a physician in your practice
susan_guidi (52:55.72)
and i'm going to say something super controversial i was married to a radiologist but i'm sorry radiology nowadays they're in a room in texas reading exam after exam after exam after examine fact the guy from canada who i obviously am obsessed with ted lyon said years ago the biggest problem that we were seeing in radiologies we needed to bring the radio
just back on the floor they're not in the room with us so an old lady like me who's been doing ultras for forty something years those guys wouldn't know how to scan if their life dependent on it
kim_vopni (53:27.941)
right
kim_vopni (53:39.921)
so sorry who do you have in your clinic that helps you make the diagnosis
susan_guidi (53:44.9)
it's me i mean when i add anna so it's just me and then the radiologist gets read to have a formal report but i know that sounds super controversial doesn't it
kim_vopni (53:45.941)
it's you okay
kim_vopni (53:52.101)
right
and does the patient
well i mean it's the it's the way that it has been done to now is and it used to be and it's i've noticed a little bit of a change but at least in my experience when i go for an ultra sound the screen is not shared with me you all you can look at is the face of the person and you know it depends on what they're looking for you're thinking is that a good pace is that a bad phase and then they're like okay i'm all done and the results will be whatever your doctor will be in touch with you so it's this
susan_guidi (53:59.58)
it's the state of health
susan_guidi (54:13.74)
no
kim_vopni (54:28.201)
this the time and the uncertainty and and we we aren't allowed this information about our own bodies and to me right
susan_guidi (54:37.54)
it's craziness i have sixty foot flat screen t v that was my doing twenty five years ago because my doctor friend had a small one i was like why don't we put a big flat screen so when i did my room that's what i invested it because my thing was if i did one thing i didn't give a damn how controversy it was i was going to give you the best ultra sound possible and i was going to tea
you about your anatomy not joe rows anatomy but your anatomy how does it work how does this look this is why you need to come back or you look great you don't need anything for a while you know it was and i grew up in an academic center so my whole youth was spent teaching and teaching at least fifteen or twenty doctors around me and then when i came to conventional obstetrics and ginochology thirty five years ago this dictate came
kim_vopni (55:10.721)
right
susan_guidi (55:37.6)
it said you are not allowed to speak to the patients and so you know what happened nobody speaks to the patient what is that about in a half an hour you can learn about their lives you can learn about what they eat you can learn about whether they had sexual trauma you can learn so much that says take a little magnesium let's get you to exercise let's get you to drink more you need more fib or you could read kim's book and there's some exercise
that maybe we'll save you with that incontinence that you've been suffering for did you ave ses trauma
kim_vopni (56:12.221)
and when the people can see the imaging of their own bodies there's power in that there's there's this knowledge that again that's kind of what i was referring to as well with what happened with covid was we for so long there's been gatekeepers and we haven't been able to access our own body information our own health information and now there's companies that you can do blood tests on line you can like there's so much more the c g m as you
about continuous glucose monitors we have access to now so much that gives us puts us in the position of power and again i'm not saying we don't need allopathic medicine we absolutely do but but let's yes and let's include the patient the person in the discussion in the in the process and allow us access to our own health
susan_guidi (56:55.18)
my sons are i believe in it but
kim_vopni (57:12.081)
information so i love what you're doing with sharing the screen and helping people understand this is where this is this is where this i see this happening and giving them a place even that could potentially be their starting place right at the point for them to start with and then go to a doctor then go to a physio then go to wherever
susan_guidi (57:25.68)
i weep
susan_guidi (57:30.7)
give all the patients a copy of everything they get it's really his check hit compliant imagine that goes directly to their celphone so that if you had an expert in canada or say you read the example right i could send it to you on your phone and you could take a look and say here you know this is this is where it's a right but you would be surprised and i'll tell the patients this all the time you said your doctor is not going to look at this
doctor s not going to look at this and make it available to you it's all available your doctor is not going to look at this and it's a shame because we've come so far with this technology and it would save the system so much money to not have to put all these ban dates on top of stuff when we address the initial issue and i think that's why we have to start back at young women and start
all over again you know with when i teach to them and they'll do this in two weeks i start with a netters frank neter if anybody has ever taught anatomy i love frank neer a neter slide of a volva and when these kids walk into the room and their ninth graders to seniors the first picture they say is a shumangus volva and they all lose their minds and then all of a sudden we use humor
and my stories and my more stories that growing up like inevitably will always get one of the kids that ask missus kitty you know i popped my cherry and i'm like there's no fruit in the vagina there's never been any fruit in the and you uncover these myths because you realize how many times are we show evolved up do you even know what it looks like down there
kim_vopni (59:23.261)
the volve is not the vagina
susan_guidi (59:24.98)
and the valves ladies and the vote is not there's just i am so excited because i see women doing great things were changing the landscape of this so in the few years that i have left doing this and it's a lonely job being way ahead of your time it's a lonely job but i've had some patients that we may
all the difference in the world for you know
and you do
kim_vopni (01:00:00.281)
thank you for your thank you for your work and and for sharing a little bit about about how you can play such an amazing role and helping people better understand their bodies and what's going on inside and i'm grateful for pioneers like you and hopefully there'll be more collaboration amongst us pioneers in the futur
susan_guidi (01:00:22.06)
yep all right my dear you're so welcome it was an honor
kim_vopni (01:00:24.521)
thank you so much
