Sometimes we inspire greatness and in this case, we have inspired a Pelvic Floor Evangelist in Janice K. from Boston.

 After Janice took Level 1 Total Control training 2 years ago, she wrote me and said she wanted to help us come up with a shortened version of our Total Control workout for ladies who want to make sure and exercise the three Pelvic Pyramid muscles, but who don’t have an hour.

This week, Janice emailed me her “Six Minute Pelvic Pyramid Workout”, which I include as a holiday gift to all of you.  Do this combo workout everyday to stay “Fit, Sexy & In Control!”  Do them before you get out of bed; do them right before you go to sleep.  Just Do It/Them!!

Thank you, Janice!

6-MINUTE Pelvic Pyramid Workout [The power of “less is more”]By:  Total Control Instructor Janice Kahn Using:  Neutral Spine                Rib-Cage Breathing 

1. Transverse Abdominals (TVA) – front of the Pelvic Pyramid

Landmark: 2^nd and 3^rdfingers of both hands rest gently along bikini panty line (2”in from hip bones towards navel, 1” down)Image: Corset gently tightening; theraband, pulling navel away from a birthday candle flameExercise: supine (hooklying) position, knees bent with feet on floor 10 short contractions: inhale to prepare, exhale to engage1 10-second hold: remember to breathe!For extra credit: 10 clams each side, TVA hold sustained, breathe 

1. Multifidus – back of the Pelvic Pyramid

Landmark: palm or back of hand rests on either side of spine at waist                Image: lengthening the spine, stretching a candy necklaceExercise: sidelying position; top leg is long, ankle rests on a 6”ball, a pillow folded in half, or a small towel folded, bottom leg is bent [looks like #4]                Remember to activate TVA and sustain through the exercise!                Inhale to prepare, exhale to engage TVA                10 short press down on ball/pillow/towel with top leg and release                1 10-second hold                Switch sides and repeat 

1. Pelvic Floor Muscles (PFM) – floor of the Pelvic Pyramid

Landmark: lightly place two fingers on perineum, reach from behindImage: drawing up a crystal tampon, elevator lifting up one floor, stopping the flow of urine or gasExercise 1: fetal position (no TVA, normal breathing) – using landmark10 short contractions – WALTZ – “squeeze and lift, relax, relax” or think of “on – off – off”; followed by 10-second restExercise 2: supine position (check that buttocks are relaxed during exercises)1 10-second contraction followed by 10-second rest1 “Elevator” contraction: squeeze and lift one floor and hold for 5 seconds, then gently squeeze to bring the “elevator” up one floor at a time 4 to 5 floors, and relaxRemember: never to engage the PFM more than to floor 6 – 8. CONGRATULATIONS!

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Last week the FDA issued a public health notification on the use of surgical mesh for treating uterine prolapse and stress incontinence.  Here is the link:  http://www.fda.gov/cdrh/safety/102008-surgicalmesh.html.

Some things to know:

• About 380,000 procedures are done annually in the U.S. using surgical mesh.
• Over the past three years, FDA has received over 1,000 reports of complications from the nine surgical mesh manufacturers.
• These complications have included erosion into the bladder, urethra or vagina, pain or even reports of bowel, bladder or blood vessel perforation during insertion of the mesh.
• There are various kinds of mesh - from biologic to synthetic – and different procedures may use differnt amounts of mesh.

 The FDA issued guidelines for physicians, but what I wanted to say to you is that if you are having an operation for prolapse or stress incontinence repair, you may want to ask your doctor a few basic questions:

1. How much mesh is being used?
2. Where is it being placed and how is the incision performed?
3. How many of these procedures have you done and where/how did you get trained?
4. What types of risks are associated with the procedure and what are the potential complications?
5. What warning signs should you look for in the weeks following surgery?

For me, a patient who has had, herself, some complications associated with the gold standard of pelvic surgery involving mesh, I must say that this FDA warning is a good thing.  To me, it reiterates the need to talk to your doctor and highlights the importance of you being an aware consumer.

No procedure is without risk, but to minimize the risk of any surgery, you should have confidence that your doctor does these procedures regularly, is well trained in the products he/she is using and, perhaps in the case of mesh, which is a foreign object being placed in your body, uses just what he/she needs in the situation.  This is not a case for “bigger is better.”

I have also learned as a patient, that you are your own best advocate, so ask questions and keep asking questions until you are comfortable with the answers.  

Last weekend, I was honored to speak at a retreat for breast cancer patients and survivors in southern New Hampshire called Knowledge, Strength & Grace, the brainchild of Dr. Carolyn Kaelin, Harvard oncologist and herself a breast cancer survivor.   This amazing 3 day “camp” (literally held at a Y family camp on Lake Winnipesaukee) was free for the 200 women who attended – many from metro Boston, many of whom had never been out of the city, nor state, many of whom who had never been on a boat before.  The retreat was a combination woman-bonding experience (featuring all things pink), oncological update (showcasing lectures by Brigham Women’s and Dana Farber’s finest physicians on topics like alternative treatments for breast cancer), and fitness and educational breakout sessions.  This is where I came in.

Dr. Kaelin asked me to come and give two educational sessions and one fitness sessions for the women, of course around their pelvic health and featuring many of the moves, tip and topics from our Total Control program.  By request of the women attending the educational sessions, I ended up doing two fitness sessions after each of the educational sessions and in doing so, had the experience of my lifetime.

It’s funny, I was so nervous before I got to the retreat and I actually (for the first time in my life) had “speaker’s block” when it came to segueing from breast cancer to pelvic health.  I thought, “How could I make what I wanted to share with these ladies – all of whom who had looked at the face of the big “C word” and survived – relevant and important to them?”  Luckily, I posed that question to my husband, Kim, who is an amazing public speaker and himself an ardent “Pelvic Floor Evangelist.”

He said, “You know, at the end of all the breast cancer treatments, these women are still women – they all run the risk of having out of control bladders or falling uteruses from childbirth. “  When I checked into the average age of the participants (60), I realized he was absolutely right and if they were menopausal, they stood a big risk of dealing with issues like incontinence.  A condition, as we know that while it does not kill you, it can ruin your quality of life. 

I also knew that cancer treatments like radiation and chemotherapy wreck havoc on your body – even if they are targeting breast cancer.  Vomiting after radiation can cause stress incontinence.  Radiation can also cause tissues like the vagina to thin, which can lead to painful intercourse.  Chemotherapy drugs do lots of unpleasant things, but for estrogen sensitive cancers, like breast and ovarian, treatments literally turn off estrogen production, which throws a woman right into early menopause, and all the fantastic menopause symptoms (including vaginal dryness, urgency and even stress incontinence).

So, armed with what I knew about these women’s demographics and probable treatment side effects, I did my thing.  The first thing to accomplish, in 90 minutes, was to try and get them excited about their pelvises again.  I did it by talking about how critical the pelvis is to their structure, their sexuality, their continence, their femininity. I shared with them the basics of pelvic anatomy, what can commonly go wrong and what they can do to immediately make a positive impact in their pelvic health and fitness.  We ended with a seated demo of the Pelvic Pyramid muscles which was a hint of the exercises in the fitness sessions following.

In each of the fitness sessions, these beautiful women – all so excited to be learning things that might keep them out of the bathroom every 30 minutes, or help them do a fitness walk without leading, or might help them eventually sleep through the night – went through a mini-Total Control program in a 45 minute session.  I sent them home with their own copies of our Total Control DVD, so they could practice what they’d “learned” at home, as well as a copy of our book, “You Go Girl, But Only When You Want To!”

From their immediate feedback and the emails I have received, I know they enjoyed their learning and their exercises, but here’s what I got out of the experience:

• A deep respect for the resiliency of the human spirit – particularly the spirit of women – in the face of tragedy
• A sense of wonder for how someone can go through so much in their life, yet maintain a wicked (even sick!) sense of humor
• An appreciation for the miracle of our bodies – even if beaten down by cancer, scarred by surgery, radiated or flushed with drugs – it can be beautiful, strong and vibrant on the other side of illness
• A humble gratitude for the ability to share what I knew with them; to be able to teach them a little tip that could make them smile and also change their life for the better, all at the same time

I hope to be able to go to this fantastic event another year.  I hope to work with some of the cancer research and treatment centers in Chicago to bring something like Knowledge, Strength & Grace to the Midwest.  If only we can find a location as spectacular as a wooded YMCA camp on an island in a lake in Southern New Hampshire! 

If you are interested in attending Knowledge, Strength & Grace next year, post a comment with your email and I’ll forward it along to the people in Boston.  If you are interested in something like this in Chicago, let me know! 

An interesting site I found in my research about sexual side effects and coping mechanisms for cancer patients is from the Mayo Clinic:  http://www.mayoclinic.com/health/cancer-treatment/SA00071

Have a wonderful week!

Yours in pelvic health,

Missy