kim_vopni (00:01.66)
hey beth thank you so much for joining me today i have been looking forward to this conversation we've known each other online like most of my friends these days are online friends never been real life but we know each other but just i love the work that you do i obviously being a public health person i already have an immediate love for what you do but you have a really you've really specialized in an area that can be extra challenging with regard
beth_hoag (00:13.325)
one day one day
kim_vopni (00:31.54)
to pelvic health which is cancer recovery cancer diagnosis and i'd love to dive in a little bit more with you today about how that influence s the whole pelvic health function and lifestyle for somebody but before we go there i would love for you to introduce yourself and how you became a pelvic floor physio and then what got you into the world of ontology
beth_hoag (00:54.705)
yeah so maybe i'll almost flip that and say so yeah so i am as a physiotherapist in canada and i really my interest really started in on chology first and foremost in cancer and i grew up with a mother who had medastatic breast cancer for over fourteen years and so that really was a part of my world growing up and very literally at the beginning of physio therapy school i ronically i started physio school about two months before my mom ended up dying and so that i'm sure that there's no doubt that
kim_vopni (00:57.86)
m
beth_hoag (01:24.905)
had shaped my influence my my beliefs but i just felt so strongly there was so much that my profession could be doing to help this group of people but back then eighteen twenty years ago it wasn't being done and that really truly just became such a focus of my very early days so it really was always something that i wanted to do but i felt extremely strongly that a good cancer have physio needed to be a good orthopedic or sports if you will ororthophysio first and foremost so i started
career in private practice also and then eventually started to weave in cancer we have into it all self taught back then because there just weren't many courses so applying my orthapetics to my cancer and then massively fast forward to about seven years ago and i really started to appreciate public health and the role that that that was another huge missing piece in the cancer we have world and i would send my patients my clients to colleagues in the city public health physios ad they're all fat
lous vhiseosthe're fabulous but the resounding comment coming back to my clients back then was there great but and the but was pelvic health at least back then was so surrounding perynedal health pre post natal and though you know that physio was great they my clients were keenly aware that these physios didn't didn't have a lot of experience in cancer and they were and ore they were surrounded by babies and they were in fertile because of their treatment the cancer treatment so it became
i sort of triggering a place to be for some women so that's really what got me down the road of thinking while i can get this training why not and so i rostered and got my training of pelvic health i think about seven years ago now and i just blended in like it really is a blend that it's a conversation that i start day one with every client i screen every client for pelvic health when they walk in the door whether they're there for it or not and it just starts to normalize the conversation right on
kim_vopni (03:20.92)
awesome
kim_vopni (03:24.18)
yeah
beth_hoag (03:24.865)
get a lot of oh my gosh i had no ideas and and you know it's always an invitation to hey if you want to have this conversation we can if you don't it's totally your choice but but know that that option is there um and that's how it all began really it just just sort of organically snowballed into into doing both together yeah
kim_vopni (03:47.68)
i love that and i also love that you screen no matter if they wanted or not because i've often said that i sort of feel like pelvic pelvic should be like our vital science really there's you know asking about menstration all the time which that sometimes gets talked about but asking how is your platter working are you having a regular bell movement are you straining do you know do you haven't gotten all these things that i think should be so fundamental so you're preaching to the choir here as you know
beth_hoag (03:52.445)
yeah
beth_hoag (03:56.805)
yeah
beth_hoag (04:07.085)
yeah
beth_hoag (04:13.205)
yeah and and further to that right when you ask those questions how many times do people say oh yeah i leak when i confer sneeze but it's no big deal ave been that way forever and i just go who can we just circle back to that comment because let's unpack that a little bit and it's you know it's pretty fascinating and opening the conversations that we can have with people and the belief systems that we have about what's normal what's not normal like it's common but you shouldn't be pinin your parents that's just not normal yeah
kim_vopni (04:22.9)
yeah it doesn't bother me a time
yes yes
kim_vopni (04:40.08)
right right right right yeah so if you can just quickly what is the pelvic floor and how then coming to the ongcology and weaving that and how and this is that's a i realize a very big question nd answer how does cancer influence this group of muscles and the function
beth_hoag (04:47.965)
hm
beth_hoag (05:02.545)
right so so the pelvic floor i know i know i'm preaching to the crier here but the pelvic floor were talking about sort of think about the bony structure of the pelvis is being sort of the house and then we have the muscles the pasha and the organs that sit in that bony pelvis and surround that bony pelvis so when we're talking about about the functions of the pelvic floor we're talking about ability to urinate p ability to poop deficate sexual function and and organs
support as well and we can sometimes argue there's a lymphatic function in there in there too so you know the public floor just like any other part well it's just like any other part of the body right it has muscles it has bones it is connective tissue fascia but but it tends to be a taboo spot that we don't talk about which is why you and i are talking about it right and then in terms of how can there how cancer impact it um i guess the short version is enormously it very much depends
kim_vopni (05:50.6)
mhm
beth_hoag (06:02.525)
on the cancer clearly that been diagnosed and been treated we have i think the ones that don't surprise people and where we talk about cancers of the pelvis so you know to any any the ginacological cancers utorancancer revolver cancer vaginal ovarian cancers in men prostate cancer colerectil cancer bladder cancer all of those typically don't surprise people because the're cancers that are housed in the pelvis the
that does surprise people is breast cancer and breast cancer is way outside of the pelvis and but i'm sure we'll talk about it at some point today it has a huge impact on the pelvis and that's usually my experience in my clinical practice has been when people are coming to me with a history or current pelvic cancer they're expecting a pelvic health conversation when they're coming to me for a cancer outside of the pelvis and breast is one of them the most common en they're not expecting that with that question
to the time and so those are the people we really can catch and help when we screen and start normalizing those questions
kim_vopni (07:09.9)
so let's go there right now with with regards to breast cancer because that's it's such a true comment that you're not expecting that to have anything to do with the pelvis but how does it relate so what is somebody coming to you with breast cancer and i have questions about when people are coming to you but i'll talk about that after so somebody's coming to you let's say they've been going through treatment for breast cancer why and how does it go to the pelvis how do you weave that in
beth_hoag (07:11.625)
hm hm
beth_hoag (07:25.865)
m
sure
beth_hoag (07:38.025)
yeah so well i mean obviously as we've talked about before i screen everybody so the conversation is an easy sagua right right off the bat but i say that the two most common reasons why breast cancer treatment has an impact on health pelvic health number one first and foremost is hormonal so a lot of women who have breast cancer not everybody but a lot of them have have an astrigendependency on their cancer so their treatments are focused on
kim_vopni (07:42.16)
yeah
beth_hoag (08:07.845)
suppressing that estrogen production or binding without getting too complicated so just they're targeting the astrogen will be simple here and so the problem with that is our pelvic floor his rich and astrogenreceptors so the moment we start to pull strogen out of the equation if we can call it that it has huge implications to the pelvic health and secondary to that unlike say you and i who are naturally going into
related menopause or parimenapuse symptoms a woman who who is having astrogen stopped i call it really or menapausitthe flick of the switch right it's that it's like literally either through surgery or chemotherapy or r ral drugs these women's astrogen is being i'm just going to say tampered with if you will or halted in some way way or shape shape or form so
kim_vopni (09:01.94)
some people call it like surgical or chemical menopause is that yeah yeah
beth_hoag (09:04.925)
exactly yeah so surgical metics would be when the overs are removed and breast cancer there would be if different reasons why that choice would be made and the other one is chemical menopause so using drugs so commonly with breast cane or cematherapy or any oralmedications that are taken a little later on or injections to suppress the overs functions so those would be consit are chemically induced menopause so theoretically if you stopped those drugs there's
kim_vopni (09:09.52)
right
kim_vopni (09:18.08)
right
kim_vopni (09:31.14)
got it
beth_hoag (09:34.505)
good chance that that woman might start to get their period again not always but so sometimes these are temporary changes and other times more commonly they're permanent changes but they're drastic permanent changes and so the impact on the pelvic floor is dramatic typically far more dramatic than someone who goes through metapastwith the natural age and can be pretty severe women who are on a drug called in romata inhibit and there's
few different types of drug names but the class of drugs we know that those women have almost twice the risk or double the chance of developing some of these menopause related symptoms then some one the same age who has i'm going to use air quotes here naturally gone through menopause or age related menopause so huge huge huge difference for those women um and without getting too complicated if we talk about a term called g s m genitourinary cyndermamena pause i know you talk about it
lot as well is that so these are the cluster of symptoms that we're talking about vaginal symptoms like dryness burning irritation pain with urination pain with intercourse increased frequency of urinary tract infections these are the cluster of symptoms that we're talking about with women breast cancer and these and these hormonally related related issues the second one i mentioned is i've already lost my train of thought yes as fast
related scar tissue i use the term scar tissue very i want to use that in a broad sense to clarify for your listeners and viewers a lot of us think scar tissue and think just what we can see that scar but we know that our system is a fashional web it's an interconnected woven system so even though a woman's scar might be up in their chest breast arm pit area overtime the impact it's far too complicated to get into today but the fashion of the impact that happen in their upper
body start to have an impact on their ribs on their diafram and we know that diafram is intimately linked with pelvic floor function and we start to overtime see an an implication that happens in the pelvis so big and that one tends to happen later on those are women that i see who had breast cancer their treatment might have finished a year ago two plus years ago and they start to develop these pelvic symptoms that they're not picking up on but through our conversations we start to identify and link back to
beth_hoag (12:04.545)
actually the impacts of surgery radiation on the n their public health
kim_vopni (12:11.58)
and it's you know just as you're talking i'm thinking menopause in and of itself so let's say the natural menopause that we reach there's challenges associated with that many people have some suffering associated with some symptoms chemical and surgical menopause we know we don't necessarily know why but a lot of people say just because of the there's no gradual onset it's just it's an immediate menopause now
beth_hoag (12:22.905)
hm
beth_hoag (12:28.165)
hm
kim_vopni (12:41.36)
and that is often the symptoms are typically more severe more challenging and then in the population we're talking about there's cancer that they have been dealing with the stress of that diagnosis the implications the treatment and it just like it's so difficult right it's overwhelming what they're what they're dealing with so the work you're doing is so incredibly valuable and i want to know how
beth_hoag (12:41.565)
yep
beth_hoag (12:45.645)
hm hm
beth_hoag (12:54.685)
yeah
beth_hoag (13:01.365)
yeah
kim_vopni (13:12.48)
come to you when do they come to you are they being referred by their physicians are they finding you through google searches or at what point do people come to you and and and and how do they get there
beth_hoag (13:24.085)
m yeah it's a little all over the map you know some some physicians referred directly but truthfully i find the vast majority of people find me through word of mouth through searches on google through chatting with a friend or family member who says hey i saw beth or hey i saw beth you tube page or i saw beth's chat with him just there these various word mouth ways
kim_vopni (13:28.02)
hm
beth_hoag (13:54.025)
um and i really do find actually that that is where probably ninety five percent of my clients come from is from from word of mouth and to me so i would love if every client got referred to me directly but truthfully and honestly i find that the women and men who find me through word of mouth they're invested they are they're invested the they want the help they're invested in their own health and well being and wanting to take the steps to really to really manage what they can manage
kim_vopni (14:07.04)
yeah
beth_hoag (14:23.645)
themselves and that's my jam my jam is is that you know we have to be realistic and this is actually really quite a difference from what i do versus another pelvic floor physio does is that we have to be realistic here that some of these things we can't undo it we can't we can't put a woman out of menopause because she needs to be there because of her cancer treatment we can't reverse our tissue or radiation fibrous from the radiation treatments because we just can't we can't do that so you know we have to
realistic with what we're dealing with and i don't beat around the bush i'm very sensitive with people when we talk about it but i'm not going to promise people that we can cure things but we definitely can manage them and we can definitely improve their quality of life so that all these reminders if you will of their cancer treatment aren't at the forefront of their mind all the time
kim_vopni (15:06.02)
yeah
kim_vopni (15:15.7)
right i want to come back to the scar tissue piece because i know that that's something that i talk about a lot not specific to cancer but cancer can be a reason why there may be scar tissue there so scar tissue as you said it's not just what we see superficially that is start of it but there's like the iceberg right there's a whole bunch underneath that we don't necessarily see that can disrupt blood flow and circulation and the capacity and movement of the tissue so
beth_hoag (15:34.245)
yep
beth_hoag (15:43.605)
m hm
kim_vopni (15:45.58)
talk about how there's often surgeries involved with cancer but there can also be radiation which can also leave scaring so are there differences between a surgical incision and a radiation and with regards to treatment how do you help with that both from what your treatment is and also self management also big questions right
beth_hoag (15:50.565)
hm
beth_hoag (15:56.665)
m
beth_hoag (16:07.845)
yeah these are all big questions but i was going to have just these are all big questions took the words out of my mouth i'm like okay let me see if i can unpack that one so so the two different types really types if we can call them that yes there surgical scar tissue associate with surgery and then radiation so if i get at if i forget part of my answer feel free to remind me and bring me back in so surgery wise it does start with a scar absolutely and let's talk about maybe just to be clear pelvic cancers just to simplify that
kim_vopni (16:16.6)
m hm
kim_vopni (16:28.1)
uh
beth_hoag (16:37.665)
onversation a little bit here m but so when we have pelvic surgery yes we have this superficial scar but we also have all the healing that's happening underneath that scar in the abdominal in the pelvic cavity from whatever surgery they had so it's never just about what we can see with the eye and so might my experience has been that we we certainly need to start working that superficial mobility of the scar through all sor
the different techniques i teach teach people any hands on technique certain stretches we can use taping techniques cupingthere's all sorts of tools and in the tool box we can use depending on the person um but the other thing we want to start doing is really thinking about the whole body including the pelvis and that's where movement comes into play i'm a big believer in movement a huge believer in the breath because of just that milking impact that the breath has on our whole abdominal contents and that gets the
so the organs moving as well so so it depends on when when someone's coming in you know if there if they're more recently post surgically we can really start to work that superficial and work into the deeper tissues if i'm seeing somebody a year or two after the surgery i can guarantee you there's a heck of a lot of deep stuff going on that that we need to use a different approach with but still again very manageable it's absolutely it's never too late to work on these tissues ever
too late to work on these tissues um one of the big things with the surgical scaring that i see when their pelvic scars i'm sort of above the pubic bone if you want to think about those scars really common i see urgency so needing to pay more often or in continence isodoceated with that urgency they just can't hold it until they get to the toilet and stress and content as well but i would say urgency and needing to pay more frequently are really common and so that's often associated with some of the deeper
caring that's going on underneath that scar and that sometimes can be very simply treated with specific techniques and if we're lucky we're good to go after that it's not usually always that lucky but but it can be that simple is my point on the radiation side of things it's different radiation we talk about something called fhibrosis and without getting too complicated here over time the radiated and this really is over time the interesting thing is most people think i've done radiation
beth_hoag (19:07.825)
two to three weeks after radiation we know the symptoms tend to ramp up and then start to settle down but then most people think cool and in the clear and then unfortunately couldn't be farther from the truth for a lot of women men people anybody is getting radiation what we know the body the body continues to heal for months even years after radiation is complete and we know this from studies looking at some of the tissue content and what's going on in those tissues at the cellular level so two three even full
years after radiation the body is continuing to heal and be impacted from that directly and so what clinically it looks like um is in terms of how people present is over time they feel like they are getting tighter or they're starting to feel like they can't they need to pay more frequently or they can't hold their year in you know these gradual symptoms that are getting worse and worse and worse or they're just they've hit a point
they're not getting any better so and those are the ones i find that when people depending on the clinition they see when you go to see a pelvitfrphysio if they haven't made the link back to radiation hose can get missed um so so thou and the other piece i just want to add to that with radiation is the way i describe it to people think about like a bit of a shrink wrap effect is what's going on so depending on the type of radiation again this is a big question with a big answer
we can have external beam radiation so it's a machine from the outside of the body or we can insert something into the body that then releases radiation internally and those have very different short term impacts side effects which we won't get into but long term it's more the external beam as my experience has a bigger more global pelvic impact because it just it hits more tissues so over time if we think about that pelvic bowl that we were talking about early or sort of slowly shrink wrapping the hips start to get
tight the back starts to get tight the joint where the spine connects to the pelvis starts to get tight the pelvic floor can start to get hyper engaged and everything just gets tight and that starts to have a negative impact on low back hip pain and pelvic health over time so there's my long answer
kim_vopni (21:25.74)
which sometimes it was a great one you stayed around unchecked and so when you think of low back so thinking of dr shine defer study looking at you now ninety five percent of women with low back pain have some form of pelvic ortis function if that person has been dealing with that and now is dealing with a cancer diagnosis going through the radiation treatment that already pain they were having is now potentially becoming exacerbated even more
beth_hoag (21:40.645)
yep
beth_hoag (21:51.485)
hm
you got it yeah and yeah and we have to think back to your you know with that study we know we know there's a link between low back persistent low back pain hit pain and pelvic floridas function with almost all women i think five per cent don't but you know most women have this link and then you layer on the potential of surgery the changes that surgery produced in radiation um and it's important to layer that in because that helps kind of give us a picture for what we're dealing with and what we can
kim_vopni (21:55.6)
yeah that's that's so interesting
kim_vopni (22:07.1)
yeah yeah right
beth_hoag (22:24.205)
expect to improve in what we know we can't
kim_vopni (22:27.2)
and there's people who would have surgery and radiation yeah
beth_hoag (22:30.565)
absolutely i would say probably more do than don't yeah so you get this body that's healing from surgery and then then you load it with radiation and and it's it's a bit of a dark colored joke in oncology but we talk about radiation being the gift that keeps on giving and not the kind of gift we want right but but it really is because we have these long term impacts and i'm not trying to paint a doomsday picture here right there are so many things that we can be doing to help this otherwise i wouldn't be doing what i'm doing
kim_vopni (22:34.44)
right
kim_vopni (22:50.58)
right
yeah
kim_vopni (22:58.4)
yeah right
beth_hoag (23:00.625)
but i just think it's important to have that lens when when we're looking at it from a from a cancer perspective in terms of what's going on in the body and why
kim_vopni (23:08.58)
right and surgically there can be the removal of part or all of an organ or organs and or there can be the removal of a tumor the cancer you know i think of a friend to had colin cancer recently and there was an immediate the so there was a colostomy first and foremost then there was a surgery to remove the cancer and part of the coln and then there will eventually be a reconnection
beth_hoag (23:15.905)
hm hm
beth_hoag (23:27.665)
hm
kim_vopni (23:38.44)
so there's often multiple things happening along the way as well so so that just immeditly adds to the complexity but i also want to ask about chemotherapy so what the immediate thing i think about chemotherapy is is chronic vomiting and the intrabdominal pressure on the pelvic floor that's that's where my thought goes
beth_hoag (23:38.705)
uh yeah yeah for sure yeah
beth_hoag (23:50.305)
m hm
beth_hoag (23:59.105)
it's like a yeah i didn't even think about that but sure yeah yeah i mean i will say that that any nausea drugs have gotten so much better so if anyone's listening to this and being fearful of kimo in my fifteen years of working in cansarehab i've seen a change and looking looking back to the years ago when my mother went through kimo massive changes so there's been a huge change in the drugs and
kim_vopni (24:02.8)
yeah
kim_vopni (24:10.06)
m
kim_vopni (24:18.1)
interesting
beth_hoag (24:28.425)
and the drugs to help with nausea so my experience truly isn't that a lot of my clients come in saying they've just been vomiting constantly constantly constantly i would say that's actually rarity from what i see versus the rule i mean i'm not saying it nausea doesn't happen it does but in terms of excessive vomiting i just i just don't see it very much truthfully yeah which which is a good thing um i would say actually more
kim_vopni (24:37.36)
oh good
kim_vopni (24:48.2)
m oh good interesting
kim_vopni (24:54.32)
hm
beth_hoag (24:58.125)
i see with respect to kimo for thinking about i don't know why but my brain just got me thinking about it is about diary and constipation truly i see that is being being the bigger issue is the management of that and we do know that chronic constipation has an impact on on urinary function so so really i talk a lot with my clients about about how we can manage that again we can't control everything because these kimo drugs are causing somethin
kim_vopni (25:06.22)
m m
kim_vopni (25:26.8)
right
beth_hoag (25:28.025)
these problems but there are tips and tricks that we can talk about to help manage it especially on the constipation side the other thing i see moise is again we kind of circle back to the hormonal impact and we've already had that conversation right is that chemically induced induced metapaus that is the other big one that i see with from the impact we've already had that conversation already so we don't need to do that but those yeah those are the big ones that i can think of with kemetherapy
kim_vopni (25:45.76)
hm
hm
yeah yeah yeah
beth_hoag (25:58.745)
hm
kim_vopni (25:58.9)
do you work with like align yourself with a practitioner to help from the management of the hormonal piece i know like hormones right now the conversation is all over social media menaplauses all over social media and i mean it's it's i interesting to watch the evolution because there there has been so much fear associated with hormontherapy and i think there's been so much research that is now coming out to really shed some light on some
beth_hoag (26:11.005)
oh is it ever
uh uh
beth_hoag (26:22.305)
yeah yeah
kim_vopni (26:28.72)
what created the fear um but obviously you know the thought of breast cancer or any cancers and estrogen is still there and so how do you help people navigate that and a specific very you know no point intended specific question is local vaginal istrogen so is that because right now we don't have links to any cancers of any kind at least from what i've seen in the research so is it something that still could potentially be of benefit to people either undergoing or post
beth_hoag (26:30.785)
hm
beth_hoag (26:38.945)
hm
beth_hoag (26:47.465)
hm
beth_hoag (26:52.725)
yeah
kim_vopni (26:58.82)
treatment
beth_hoag (26:59.385)
yeah that's a really good question and i chuckle because you're right it's metapausis all over social media right now and and it's a huge topic in my world and it's a hot topic in my world and it's a contentious topic because in my experience has been i think there's still a lot of misinformis actually he's a taunt in this information still out there there is still this huge fear from that women's health initiative study that blanketed
harmon therapy as unsafe and definitely if you had a history of a hormonally sensitive cancer like rust cancer very in cancer it was off the table challenges and i won't even get into all of it but we were really talking about oral harmon therapy there and even then the conclusions aren't accurate but when we're talking about vaginal estrogen is an entirely different story is an entirely different story yet the labels that are still being put on on this
form of treatment is it's an astrogen so it's unsafe if you have a hormonally sensitive cancer which everything that i have read and i've read a lot it's not true it's just not true that we're that we're not getting the same absorption levels of astrogen by any stretch of the imagination as we would have if we were taking an oralhormontherapy or if we were not in menapaus now i have to be you know conscious that that is not my area of xpertthat's out of my scope i certainly cannot and never will
kim_vopni (27:59.3)
yes
beth_hoag (28:29.225)
say to a client you can safely take vaginal ostrog that's not the conversation we have so back up in terms of is what some good studies and i'm terrible at spitting out the name of studies but i can share with you so you can share with your listeners but there's some good studies looking at comparing vaginal estrogen to to hioloronic acid based form
and all the compounds right and it actually shows that they are the hilronic acid based compounds are just as good if not as good as a close to is good are just as good as the vaginal istrogens so so the recommendations now are that for women who have a hormone sensitive cancer that the first line of action if you will or are these hyloronic acid based volvovaginal oisterizers
so i talk about my clients it's the secret sauce that hilronic acid is the secret sauce that you want in your in your estrogen part of me in your fulvavagenal creams or oysterizers so i like i have i have a list on my website that anybody can pull off they just seem to be there just the common ones that i typically tend to recommend that that my client based because they're uber sensitive especially if they've had radiation so there are more out there but those are just the ones i tend to recommend on
so they're easily accessible via lists that i've got my website none the less we know that these are and i really find ninety eight percent of my clients ninety nine percent it's enough it does the job and makes them so starts to minimize these dryness symptoms the one it doesn't is ut is that one really does need vaginal ostrogen so if for whatever reason my client is not responding their symptoms are not easing as much
we agree together is reasonable then i refer and that's where that conversation has to happen and it's a tough conversation because it's tough to find a gynachologist who is knowledgeable enough and i do not mean this disrespectfully so who is knowledgeable and comfortable enough with with what the evidence is showing and someone who has a hormone sensitive cancer that's hard it's really hard to find somebody who has
beth_hoag (30:59.245)
knowledge base because most my experience has been from stories from clients is most are uncomfortable going that road which i think is really still sad i think that will get better it will get better but i don't think we're quite there yet so that's when i send with my client i say here couple of research articles read through them send them to your dock ahead of time if you can or give them to them and leave them with them to read but it has to be a conversation between them and their physician
kim_vopni (31:16.3)
yeah
kim_vopni (31:30.06)
yeah i think the interesting thing that's that i'm grateful for especially well i'm grateful for a lot with the topics of menopause but it's bringing more awareness to pelvic health because of g s m because g s m is being talked about vaginal dryness is being talked about a lot more so it's indirectly making conversations around pelvic health and because because that umbrella term of g s m has been continents and pre laps and vaginal dryness and everything underneath it so that's been
beth_hoag (31:40.505)
yeah
beth_hoag (31:44.505)
hm
beth_hoag (31:50.905)
hm
beth_hoag (31:57.405)
m hm
kim_vopni (31:59.86)
resting to see as well and i am a huge supporter and believer in the evidence and both anecdotal experience with hihloronic acid for so many reasons so i love that you mentioned that are other are there any other supplements that you've seen that people take that help them whether it's oral or dietary or anything
beth_hoag (32:10.805)
m hm
beth_hoag (32:22.805)
i'm shaking my head if someone is watching this no i mean and i say no because that's it's not my area of expertise to be completely honest i absolutely have sent clients to i have a great natural path in the city that i refer to she's very evidence informed and i tend to refer my clients to her for that dietary nutritional piece that can be very helpful and you know i consulted once
kim_vopni (32:31.74)
right
kim_vopni (32:44.62)
yep
yeah
beth_hoag (32:52.765)
a functional medicine dock and spoke with her about these these cases these women who are struggling and at the end of the day yu know this was just one person but you know actually said you know we can't can do the hormones and i agree right so you know we do have a limitation with with the reason why some of these things are happening it depends on the symptoms right of what we're trying to treat if we're trying to treat volva vaginal dryness yeah highleronic as can make a massive difference and it can help with pain within
kim_vopni (33:06.76)
yeah
kim_vopni (33:12.88)
right right right
beth_hoag (33:21.765)
of course m amongst other things but if we're talking about other symptoms then we start to get a bit more limited at least within my scope and that's when i start to refer out because you can't know everything right yeah yeah
kim_vopni (33:33.0)
m yeah i love collaborative i think we we all deserve a collaborative health care and i think we should have a health care team so to speak but m so when so you've talked about how people can come to you sometimes because they've been referred but most often its word of mouth and i i'm curious as to if those people are coming to you soon after a diagnosis or after they've gone through treatment and they're now sort of on the other side and looking to improve
from there and like what would be ideal obviously i know what your answer is going to be but just have you say it what would be ideal for somebody coming to work with you
beth_hoag (34:15.305)
so in a perfect utopian were all the ideal would be to somebody see somebody before they have any treatment you know in a perfect world knowing what what someone's base line is before they start any of these cancer treatments can be an enormous can be enormously helpful because the reality is a lot of us do have pelvitfloor issues for example and so if we can identify what's going on now and start to intervene now before surgery radiation
then the better you are going in the better you are coming out the reality is that a lot of people don't even know about someone like me when they're getting diagnosed and let me tell you they're not thinking about physio when they've just been diagnosed with cancer and i i truly my experience has been that a lot of people are not just don't have the capacity to add another thing to their life when they've been diagnosed
cancer and i get that and that and so when some people call me prep i have that conversation with them and say there's two options here we can see you start or we could follow up with you about three weeks after your surgery which is another great time to see people and by then the surgery is done nerves are a little bit lower you know they have gotten through that piece and then we can dive in and i really find actually i know the evidence is really pushing for prep and yes there benefits to it but i also find that an early post of equally
t and i find the people mental space is usually much much better they're ready and capable to absorb more which makes sense but i think the other piece really to push home is it's never ever ever too late never too late is i think with that the challenge is the farther out people get from their cancer treatment the less people link what might be going on with their previous cancer treatments so
i certainly encourage people just to kind of keep that in the back of your mind if you're starting to get any symptoms if whoever is listening to this is a therapist as a physical therapist listening to this my message to physio is always don't discount that history of cancer as very possibly being part or a large part of the contributing factors to why that person is sitting in front of you in that moment
kim_vopni (36:41.54)
um coming back to actually no let me talk about this first so the person comes to you at whatever time they come to you what does a treatment plan look like so you've kind of you've alluded to the fact of your big believer in the benefits of movement the benefits of breath you have some hands on manual techniques that can be beneficial to free up some of the stuckness or that shrink wrap that we may be experiencing so what does a treatment plan look like for somebody
beth_hoag (36:48.345)
hm yes
beth_hoag (37:01.505)
hm
beth_hoag (37:07.265)
yep
kim_vopni (37:11.52)
like how often would they be coming to you and what would their home or self care practice look like
beth_hoag (37:16.885)
yeah so the little tricky answer because it entirely depends on well everything you know what someone's coming in for where they're at in their recovery or treatment for cancer and et cetera et cetera so sort of global what i can say is at the end of a first appointment my goal with everybody and i'm very up front with clients is that you know my goal the end of that first appointment is to have a feel for what's going on in your body for you to understand what's going on in your body and
why things are happening because i am a firm believer that if you don't understand what's going on your body how can we expect you to learn how to manage it and treat it so by the end that's my big key and to send somebody away with some things to start working on because when i bring somebody back i could be anywhere it from one to three weeks depending on what's going on what i'm really curious to know is how did you do with the stuff that you started working on because i find a lot of people think that they had
to have hands on and somebody else has to fix me and i feel that's a really big disservice that our health care system has done to all of us and yes you know you do need other people's experts and hands at times but i always find it really helpful to bring someone back and say how to do without those few things that targeted exercises i gave you or things to do and i'm going to say eighty percent of time people say you know i already feel better and so that just starts to give people confidence that oh my gosh
i can have some impact on this i can have some control over this and some agency in this that i do have a big role to play in my own recovery and then from there it really depends you know if it's someone that has a lot of scar tissue or facial restrictions i often want to get my hands in there a little bit more frequently so it might be once a week or every second week for i usually say let's give it three to four treatments tops if if we're doing the right stuff we should notice some changes nothing is going to be gone but we absolutely should notice improvements
and then further treatment just depends it really depends from that three to four treatment point as to how much they need ultimately my goal is to get people as independent as possible the reality is is that persons sitting in front of me is the boss of their body and that if if i can empower people with the knowledge the tools and the skills and the confidence that they that they need to manage them
beth_hoag (39:46.705)
as well that then i'm doing my job i'm not saying that's always easy but you know i think that's really huge so for their treatment really really depends on where someone's at you know my goal is obviously to get somebody out the door and never need to see me again except on the street to say high but some people do find there are there are a handful of people because of whatever reason that i do need to see on once every six eight week basis or maybe even once every three months
and that i will be honest took a long time for me to come to grips with when i first started working in this world because in sports and otho were really taught to help fix someone's injury and get them out the door that's not always realistic and i the client basis that i work with now and at first as a younger physio i thought what am i doing wrong like i'm a terrible physio i can't discharge these men and women all of them and then i started to realize oh wait a minute i can't undo radiation vibrosis i can't whatever whatever right
kim_vopni (40:28.24)
hm
kim_vopni (40:37.56)
hm
kim_vopni (40:46.86)
right
beth_hoag (40:47.205)
so everyone now i find that whatever someone's toolbox is for managing it they do really well up until let's just i'm going to pick a random date the three month mark and then they start to loose some ground and they need a little bit of help to get them back and then they're off again they're effective and off and off and going so that that is not uncommon i would say in this population
kim_vopni (41:08.54)
so to manage that from a self care perspective i know things like vaginal dilators pelvic wands can play a role are those something that you help educate people about and are there other products or techniques that you would be teaching them
beth_hoag (41:17.905)
hm
absolutely
beth_hoag (41:25.005)
yeah so vaginal dilators and the pelvioons obviously looking at the internal piece right so those are going to be for example more typically someone who's head radiation internally to the vagina and that really causes a stenosisor and narrowing to the vaginal walls so yes i love these tools because that teaches independence right so that that that women can associate oh i'm getting these symptoms weight i stopped using my dial i haven't used it in three
kim_vopni (41:30.12)
hm
kim_vopni (41:47.88)
right
beth_hoag (41:55.105)
maybe i should use it once or twice the week and see if it helps so those are great tools and as are even external not internal type of work so we can do lots of great external i know you do this as well with likyogatuna balls or any type of like air filled ball to do release into the external pelvic floor if you will from the outside in lots of great hip stretching i'm a huge fanatic about yoga for the right population but you know a lot of these twists
tensions in yoga and lengthening through the front of the body are all fabulous ways to start to keep managing these things um and then there's sometimes even different tricks with plodies balls that we can do direct sort of release work on the belly depending on the issue at hand so really popery if you will but you know but it doesn't doesn't have to be complicated you know it's not that that my clients have to purchase hundreds of dol
it's worth of equipment right to manage their things i think the big key thing is consistency and knowing your body because i think one of the common questions i get is am i going to have to do this every day for the rest of my life and unpacking the meaning behind that question is beyond the scope of this talk but you know the way i address it is everybody is different and people hate that answer but it's true and what i mean by that is i'm also a big believer and getting to know your body
and that can be tough at a time when your body has some people feel has failed them it's not a safe space to be at some point in time so that that can be quite a journey in and of itself about getting to know the body and getting to trust what you feel in your body and so if it's pretty impossible to know if you're starting to feel tight again if you don't if you're not good at tuning into your body if you're not if you're not
taking the time i guess or investing in yourself enough to take thirty seconds to take a deep breath for example and sort of check in so and that's what i always say tor client and they say am i just being sensitive about this and i say well know actually you know what you're tuning into your body and you're listening to what your body needs and you've got tools in your tool box to help manage that and that to me i think is the biggest piece of empowering people is to have that that connection to their body and then knowing what to do yeah
kim_vopni (44:22.18)
yeah you bring at the point of feeling you know some people feeling betrayed or let down or like their bodies failed them and when it comes to pelvic health when teaching pelvic for exercise and breath and the influence of the diagram in the pelvic floor there is this need or all need we want people to be able to connect and understand the relationship and sort of maybe go inwards so to speak and as you say it may not be a safe place for them and with all of the varia
beth_hoag (44:46.565)
yep
m hm
kim_vopni (44:52.04)
treatments we've talked about there could also be some disruption to the ability to feel right so right so already sometimes there can be challenges for many reasons for somebody to i don't feel when i'm doing a keg i don't feel that i'm relaxing or i don't feel that my pelvetfloor is moving and there's lots of reasons why that's happening and then when we add on this layer of what we've been talking about there could be some nerve disruption there that scar tissue can again
beth_hoag (44:58.925)
absolutely haven't even touched on that you're right absolutely yep yep
beth_hoag (45:14.705)
yep
hm
hm
kim_vopni (45:22.34)
kind of interfering with that and so i'm assuming that's a big role so how do you help ideally try to free up some of that feeling
beth_hoag (45:24.285)
hm
beth_hoag (45:31.545)
yeah so if i take just your specific example i often will start from the outside in and what i mean by that is actually maybe i'll layer on top of that is is so exquisitely important that we feel that that whoever is doing this feels safe and and i can't stress this enough so you know after after surgery after radiation the map our brain
but that part of our body has been altered physically and it's been altered neurologically and and even psychosocially has been altered so the brain i sort of joke that it's recalculating it's trying to kind of re map and figure this part of our body out so anything that we do whether any touch that we introduce self touch that we introduce into this space whether through our hands or through a soft ball for example absolutely has to be safe if your body
is getting and these are words that my clients use the hbgbs or that yuh feeling then i want you to back off don't stop but i want you to back out into a zone that feels safe because if we are pushing and forcing the nervous system into a sensation or position that doesn't feel safe where it feels threatening we are not not only we're not going to get very far we're actually working against our bodies and the way our nervous system is set up to function so
that is the biggest sort of foundation of anything we do so what that looks like depends for each person because everybody's safe space or young zone is different so it's about first figuring out what that looks like for that person and then starting to work with it so i sort of forget the original question but if i'm just thinking assuming that let's say the pelvic floor is toned well it could be toned because the nervous system is feeling threatened it could have nothing to do with a surgical scar it could just be that this
not a safe space so figuring out the technique for that person to start to dip their toes in to maybe nudge into a little bit of the nervous system going i'm not sure about this but i'm okay with this to pushing into ye does that make sense i'm not really sure quite with the original question any more but but that is huge that is huge as the foundation for any any way that we start to work directly or indirectly with the pelvic floor
kim_vopni (47:49.24)
yeah yeah yeah
kim_vopni (47:55.02)
yeah
kim_vopni (48:01.1)
yeah and and as we're wrapping things up i one thing that you've said consistently and many people do and i think i hear more and more now is it depends and in this world of social media where a lot of people are going to google or going to instagram or what have you in following people in with various levels of expert tis with with well intention there's many programs and
beth_hoag (48:01.245)
yeah
beth_hoag (48:12.745)
yeah yeah
kim_vopni (48:31.7)
i have them myself where we are trying to provide help to as many people as possible not understanding anybody's unique situations and a lot of the time it's going to work and some of the time it's not going to because there is a lot of the it depends and we would love to work with absolutely every single person want one but that doesn't not everybody has the capacity on both sides of that conversation so so i think i hope that people take away
beth_hoag (48:38.005)
right
right
beth_hoag (48:55.305)
yeah exactly
kim_vopni (49:01.0)
this some things that can help them self manage but also planting the seed that working with a practitioner can really be such an integral part to furthering that healing yeah
beth_hoag (49:14.645)
yeah yeah absolutely i think that's a really great message yeah
kim_vopni (49:18.18)
yeah yeah so thank you for sharing your wisdom thank you for the work that you do and yeah i hope that everybody takes i know i took a lot of value from this and i really really appreciate you sharing thank you
beth_hoag (49:31.125)
my pleasure thanks for having me
