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Incontinence and Bowel Management for Women, Men and Children.
Women’s Health Physiotherapist Brisbane, Australia.
Pelvic Floor Dysfunction Treatment.

Hiking in Cortina and some tips to remember for next time

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Sunrise hits the Dolomites from our hotel room in Cortina

In my excitement to post about Venice, I forgot to write about Cortina and our visit to the other side of the Dolomites. As you know the hiking has been a highlight on this trip. With my trusty hiking sticks purchased in Cortina, (speaking of purchases – to any family members reading this blog, there has been a blanket decision made- no presents this time😦 just too heavy to cart around except for Beau who can’t read yet- he has a small pressi) we tackled some of the harder walks of the trip. We caught a gondola up to the top of the mountain (Mt Falzago) and then walked down via a new walk called Dolom Eu which has panoramic views into the valley where Cortina sits. They are so panoramic that I could hardly bare to look over the edge at the view (I am quite scared of heights).

Up the top where the gondola arrives is a building which features in the Sylvester Stallone movie called Cliffhanger – it certainly is aptly titled. Many of the places we have visited this holiday have had movies filmed at them and we will enjoy Netflixing them when we get home.

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Up the top of Mt Falzago where the movie Cliffhanger was filmed.

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The very scenic Dolum Eu walk (212 route)

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The panorama from the Dolum Eu walk

The sticks really do make a difference and I would never have made it to the top of some of the walks without them, (especially today after the Cinque Terre walk). To get back to Cortina we followed the number 206 trail until we reached the halfway spot for the gondola and we were able to catch the last one down. I was pretty exhausted by this time – so Bob working out where to find the gondola was a godsend.

What I’ve come to realise this holiday is, that what matters most when you are trying to keep in touch with your business when you are holidaying overseas is good wi-fi. We’ve had some excellent wi-fi at a few hotels (A Tribute to Music in Venice, Jungfraublick, Wengen Hotel Tyrol, Val di Funes) and some ordinary wi-fi (Hotel Europa) and some shocking wi-fi (La Villa degli Argentieri, Monterosso). In this day and age where a good internet connection means you can work from anywhere, it’s really a pretty basic requirement of any hotel.

The views from your windows? – you pretty much know what you are getting from the photos on the hotel website and how much you have paid for the tariff; all the pillows in Europe are shocking ……..fullstop; the beds are all two king singles joined so cuddling in bed is along quite a solid gap; and the breakfasts ?- well good luck if you are a coeliac because it’s cereal, bread, cheese and ham wherever you go. But one thing you can never be sure of is what is the wi-fi like when it says free wi-fi available! I do hope as a trend our Australian hotels generally supply a good service for our overseas tourists.

Another thing to beware of is, you could possibly come home with a new smoking habit that you didn’t have before you left, due to the enormous amount of passive smoking you will do certainly in Switzerland and Italy (for goodness sake Switzerland and Italy, get your act together and get Nicola Roxon as a consultant and reduce your cancer rates in 20-30 years). The cigarettes are way too cheap here and there’s one thing never missing from the hotel rooms and verandas is an ash tray – in fact the photo below is the biggest ash tray I have seen in my travels and the one beside it was ‘planted’ in the a very picturesque garden.

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Back to the hiking – in Cinque Terre the hiking can be harder because it tends to be much hotter here and the trails can be in poor condition. They are often closed – if there has been rain there can be land slides or the paths just too treacherous. But after today I have worked out that it is easier (in my opinion) to walk from Venazza to Monterosso rather than the other way around now having done it both ways. To get to Venazza, we had to catch the ferry from Monterosso to Venazza, as there was a national train strike today.

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At the end of the Venazza back to Monterosso walk.The sticks really do make a difference and I would never have made it to the top of some of the walks without them.

As a reward for another day of hiking a magnificent dinner at L’Ancora della Toguga – really takes the prize as the best value, spectacular setting and gorgeous food.

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L’Ancora della Toguga, Monterosso, Cinque Terre

Sadly the end is getting closer……..

Venezia: The home of the Architectural Biennale 2016

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The iconic images of Venice never cease to thrill. As the aeroport bus (the slowest boat in the world) brought us to Arsenale, the closest station to our hotel – A Tribute to Music – I still smiled with pleasure and sort of felt like I was coming home. It is my fourth visit to Venice – my first was in 1984, when we were DINKs (double income, no kids) and you can imagine the thrill then of seeing such an architecturally significant city. We had to bus (boat) it over from the camping ground and I believe we only stayed a day, but I still captured the spirit of Venice and longed to return one day. We come now because every two years the Architectural Biennale is held here and it is an opportunity for Bob to be immersed in the trends and concepts from architects in different countries around the world.

I never tire of walking around the streets of Venice and getting lost – eventually you do always make it back to your destination. We have walked for miles and miles this time and I am even starting to recognize the right direction to go. On Sunday night we experienced a different version of the Barber of Seville, when it was performed to an intimate audience in a Venetian palace, Palazzia Barbarigo,  apparently built in 955. Each act was held in a different room and the whole audience had to relocate for the next act. The opera singers were spectacular and the quartet equally so. It was to put it mildly one of those tremendous surprises. I had wanted to go to an opera in La Fenice, the Venice Opera House, (as I had read a novel set in La Fenice) but when I googled La Fenice- that concert at Barbarigo Palazzo was the first thing that popped up (and I didn’t notice) and I went ahead and booked. When we went to look at the venue, it looked very dodgy, no signage, no one there two hours before –  I thought ‘I’ve been done!’ But when we arrived and the opening overture commenced we knew this was the real thing. The pianist, Roberto Barrali  was so entertaining to watch with his expressive playing – well it was bellissimo!

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We have eaten twice now at a fabulous restaurant called Vinaria– which does wonderful variations on the typical Venetian menu. (In case you are wondering I am highlighting these places and activities for my own reference, so I don’t forget them – I am not receiving any rewards for their endorsement….although I am happy to discuss any offers…..!). One of the big shocks after we sat down, gazing at the view of the gondolas out the picture window was when a Venetian mother, father and baby with pram …and the Labrador all sat down in the best table in the restaurant. We have noticed dogs are welcome anywhere in Venice, but I was very surprised in this slick, modern restaurant. Mind you both the baby and the dog were incredibly well-behaved. Last night, we were sitting next to an Austrian couple who were arranging for their wedding to be held at the restaurant in two months time. They live and work in Austria but come to Venice every 3 months and stay for a break, so Venice is their second home, like Noosa feels to us.

There is a mystery and a complaint that I need to disclose and get off my chest.

What is wrong with Italian coffee???? I thought Italy was the home of coffee and for the last 3 visits in 2011, 2014 and 2016 the coffee has been getting increasingly disgusting. I know that one thing that ruins the flavour is the use of long life-milk and I want us to look after our dairy farmers because it’s when you come to Europe and only drink long-life milk that you realise how spoilt we are in Australia with the real thing. But I have been in training for a year now drinking black (decaf  Nespresso pods) coffee to get around the milk issue, so jumped straight into black coffee, but the coffee is yuk too.

My conclusion: Australia has nailed the art of making great coffee. End of story. 

We have been to a number of the Biennale exhibitions over the last couple of days. A particularly poignant one was one celebrating the life and work of Zaha Hadid, an Iraqi-born female British architect, who died in hospital in March this year, aged only 65 of a heart attack following a bout of bronchitis. I well knew of her work as she was one of my son’s favourite architects during his course and I was pleasantly surprised that she had been able to smash the glass ceiling of architecture – being a woman and an Iraqi! She was at the pinnacle of her career and was an iconic leader in architecture and role model for women in architecture and has designed many of the truly distinctive buildings around the world. There was a long BBC (Scotland) documentary on her at the presentation which I commend to you.

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Messner Museum Mount Kronplatz – Plan de Corones, South Tyrol, Italy. We went very close to seeing this lookout but time went against us- another reason to come back again to the South Tyrol region. 

After a couple of days trawling the external Biennale venues we needed a rest day and took ourselves over to Lido – the beach for the Venetians. Despite it being a very hot day, most of the beaches were deemed closed, but thankfully one sole beach area was open with the obligatory beach umbrellas and lounges. I only discovered the joy of doing this on our last holiday to Italy – having balked at the idea of actually paying (a lot of) money for the pleasure of lying raised under shade on a beach of pebbles or as in the case of Lido – dirt with a touch of fine sand. It was fantastic- reading a book, eating fritto misto and sipping on a pina colada. This day we had a discount rate of 18 euro which gave you 2 lounges, an umbrella and toilet and shower visitation rights – well worth the money.

Refreshed after our day off, we tackled the main Bienalle itself today. The highlight was the Australian pavilion – a great, newly-designed building (by Denton, Corker and Marshall) in a magnificent position on one of the canals down in the Arsenale.

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It’s theme was the importance of ‘The Pool’ in Australian psyche. It was a cool space on a hot day and the chairs called Anerie-aneme, designed by central Australia-based designer Elliat Rich and hand-made by Aboriginal-owned business, The Centre for Appropriate Technology Ltd were a welcome place to pop the weary body for half an hour. The reflections from the canal outside through the large glass window give the walls a life of their own. I would recommend you find the Australian pavilion and seek an artistic refuge.

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As a non-architect, I have found the theme this year ‘Reporting from the Front’ difficult to understand. It seems very nebulous and some of the presentations were difficult to relate to the theme. But what the name did allow for were quite a few related to war and refugee-related presentations. There was one on Blue – the UN peacekeeping buildings and camps and the feeling that these should have a more permanent feel to them, so that when the peace-keepers move out, there is some infrastructure for the remaining population.

Time to head out again for the night. We have become very decadent- many nights eating at 8.30, going to a Vivaldi concert tonight at 9pm – but Venice does that to you🙂

Until the next time….fino alla prossima volta!

 

Val di Funes the best sort of homuncular refreshment there is!

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We are sitting on the lounge (in that picture) at Hotel Tyrol, Funes , sipping a Prosecco and awaiting the sunset, hoping a rusty hue will descend upon the spectacular Dolomites.

I have been dreaming of  this part of the holiday for 12 months. And it hasn’t disappointed. If you remember I showed Bob a photo I had seen when I googled The Dolomites and I said I want our hotel to look at that view. Well it didn’t quite include the church in the view- see our own photos below- but to me it was even more magnificent. They just dominated the skyline and the colour changes as the sun hit different angles was magical to watch.

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The iconic photo taken by Bob- no google image there

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View from our balcony

We arrived two days ago to spectacular sunny weather and the imposing view of the Geisler group in the Dolomites from the balcony of our hotel room. All the hotels in this region and really all through northern Italy, have spectacular petunias and geraniums adorning their facade. Bob is impressed and incredulous at their magnificence and is madly googling how to grow flowers like the Italians and Swiss.

We hiked to the church above our hotel which had even better views and a beautifully kept graveyard with family plots and names going back over 100 years.

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After lunch we then headed off for a more major walk out to UNESCO Zentrum (walk 6 and returned on 35A/36). The scenery is spectacular with the Geisler group dominating every corner we turned. The trails are well sign posted and there is a map which is well worth the 9 euros it costs, as you can ensure you are heading in the direction of home when it most counts…as the legs are flagging. To get close to the mountains, there is a lot of UP. I have worked out I am excellent on the horizontal and downhill stretches of any of these walks and less so on the uphill walks.

The next day we did a full day hike (starting from Waldschenke near St Johann’s Church Trail numbers 28, 34A, 34, 36, 36A, 35, 36B, 36, 33- all of this meant a 600 metre vertical climb up and down) and got very close to the base of the Dolomites- part of this is the well known Albert Munkle path (of the Geisler group of mountains) which runs parallel to the mountains.

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It is a beautiful trail and because its a proper trail rather than a service road for the ‘refuges’ (which are amazing restaurants high and deep in the national park) there are rocks to clamber over and massive tree roots to step around, ensuring concentration is required to ensure safe footing.

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Geisleralm Restaurant at 1996 metres 

When I was telling people that I was off to Switzerland and Italy to walk and corrected them if they said the word ‘hike’, I had no idea that what we were attempting was quite so hard. I am now a fully fledged hiker (albeit much slower than the estimated times on every signpost) and I now own proper hiking sticks to prove it. I borrowed a pair from the hotel and they were so helpful I purchased my own in Cortina to tackle the enormous walk today.

The best part about hiking in such beautiful country is the high value ‘homoncular refreshment’. Walking surrounded by beautiful scenery, where it is peaceful and quiet with the only loud noises being the odd jangle of a cow bell and just the sense of achievement at the end of a 4-6 hour walk has certaily reinvigorated my senses! Plenty of times I wanted to stop or ring a taxi and say:‘Please come and get me’ . Of course ringing a taxi wasn’t possible, but I did slightly wish it. Bob just kept saying one foot after the other…not long now. Bob and the sticks got me there.

After two days at Val di Funes, we said goodbye and headed around to Cortina to see the other side of the the Dolomites. The wireless internet has been terrible where we are staying in Cortina, hence the slowness of this blog. But as we head to Venice tomorrow, with supposedly great internet, I will catch up on the absolutely spectacular vistas of Cortina then.

 

 

 

 

 

 

Farewell Switzerland, Hello Italy

We farewelled beautiful (yet cloudy and wet) Switzerland and passed into Italy. The most obvious difference was as the driver announcements came on there was a lilting, musical announcement from the conductor/driver, who was also obviously a comedian because all the Italians in the compartment had a good laugh and were shaking their heads in amusement. None of that in the efficient Swiss trains!

Today was a 9 hour train journey to get from Wengen (Switzerland) to Bolzano (Italy), with about 6 train changes. I think it would be fascinating to construct a research study into comparing fitness levels and their pelvic floor dysfunction in women between the ages of 50-80 from Australia (who drive everywhere) and Swiss women, same age cohort (who commute via trains and end up walking huge distances at a very fast rate between platforms – because it’s mandatory due to the slick timing of interconnecting trains). As I said in my last blog I am really clocking up the steps and today it was up and down steps and ramps, carting luggage and hoping like crazy Mr Efficiency has got the right platform (so far spot on).

Thirty two years ago we travelled down from Cortina into Roma and felt like I had literally melted. We had been travelling around in a campervan for many weeks through freezing Great Britain (where the water had actually frozen in the pipes at one of the camping grounds); then across to equally freezing northern Europe and then through the Dolomites. Today I had the same experience. It was very cold and wet at Wengen so we rugged up accordingly and by the time we stepped out of the train it was 28 degrees. Bellisimo!

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We chose Bolzano to train it to because it is the spot we pick up our car – the only driving we are doing this trip, because to see the true beauty of the Dolomites you do need a car (or a bike- I have heard of many who cycle around and through the Dolomites). As soon as we crossed the border the sun did start to shine so I am very hopeful for a warm, dry Italian experience.

Bolzano is a wonderful surprise. It has a vibrant town square where all the townsfolk of any age criss-cross on their bicycles, (helmetless and licra-less) as they get about their business. There are the mandatory geraniums and petunias adorning every building and the architecture is beautiful. There are food cafes and restaurants around the edge of the square, adding further life and colour and further in the town there were markets selling magnificent fruit and veggies. For a Monday night the whole town felt exciting and alive. I love Italy!

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Markets at Bolzano

We stumbled across a funicular up to a town high above Bolzano- there are actually three villages up there and a railway that links them all – truly spectacular vistas.

 

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Funicular up to a stunning view of the Dolomites

After all that walking, we felt we had earned dinner and ate at our own hotel’s cafe (Stadt Hotel Citta), which overlooks the town square. Yes that is a Pina Colada in the background of a very healthy dinner. Note to self – I mustn’t ever have one again because it was way too delicious.

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Tomorrow…Val de Funes

Off we ggggggoooooo on the Croft’s European Vacation!

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We are off and racing on the 60th birthday European Vacation. Of course you all know my birthday was back in August and it will actually be Bob’s birthday (for the THIRD time) that will actually occur while we are in Italy. But August is way too hot and busy to be hiking around the Swiss and Italian Alps and it is sort of special to be able to have one of our birthdays over there.

The plane trip to Dubai was pretty good – knocking over three movies and catching 4-5 hours sleep- followed by a pleasant daytime trip to Zurich which had unfortunately had spectacular cloud cover meaning no spectacular view of the Alps.

(On a side note and I know I did promise myself and others that I would stick to travel blogging and not be banging on about bladders, bowels and pelvic floors for this three weeks, but I do want to just say I found it very disconcerting to be calmly sitting on the loo at Dubai airport (after what seemed like a very small amount of time… and you know my favourite saying to patients is: “When emptying your bladder- if you make the time to go to the toilet, you have to TAKE your time!) and suddenly, without my permission or any action on my part, the toilet starts flushing. What the??? It is also worthy of note that in the absolutely ginormous Dubai International Airport there seems to be a dearth of female toilets. Honestly architects and designers, women do use the loo and I know you are possibly right into bladder retraining on their behalf, but don’t be lousy. The queues were huge.)

After 27 hours of travelling, we still had to jump on a train and head to Wengen – 3 hours from Zurich (and about 4 train changes). If going to Switzerland, I promise it does cost and an arm AND a leg to travel on the trains. I would recommend a Swiss 3 day pass if going to the Jungfrau region as all the trains and cable cars are very exy. The 3 day pass costs 180 CHF (Swiss Francs) each which is much less than what we have forked out for all the transport over the last couple of days. We didn’t plan to do all the train and cable car travel because we thought we were walking most places, but the weather sadly failed us and we had to use the trains and cable cars.

The first morning after our arrival, we decided regardless of the cloud cover and rain, it was all systems go for Jungfrau. We missed it 5 years ago due to rain and cloud and i wasn’t going to miss it this time. There was some early morning sunshine and to get the “cheaper” (135 CHF instead of 170 CHF each) fare up there we had to be on the 8am train and leave on the 1pm train. There are plenty of picture opportunities on the way up – IF and its a big IF- the clouds and mist stay away. Once they descend, you have absolutely no idea what majesty lies out there.

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Sun peeking above one of the peaks on the way up in the train.

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View on the way up to Jungfrau above Kleine Sheidegg

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Aletsch Glacier viewed from Jungrau- its 22 kms long and 1km deep

Jungfrau and the region around Wengen is truly spectacular and because yet again the weather has prevailed, it guarantees a return trip sometime in the future. It is so peaceful, with babbling brooks and cowbells the only sound to pierce the peace and quiet. Today one of the highlights was a walk from Stechelberg to Lauterbrunnen (I am hosing in 10000 steps on this trip).

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The babbling (well it was really roaring) brook we followed on the walk.

Wearing my new Schilthorn beanie which I had to buy up there because I saw it was minus 4C on a sign!

We are off to the next set of Alps in the Dolomites in Italy at the crack of dawn tomorrow. It will be 9 hours on the train and I am mostly praying to the rain gods (to stay away) because I am breathlessly awaiting my view from our Val de Funes hotel.

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I hope the view is like this

Gute nachte and abschied von Wengen (Good night and farewll from Wengen)

September 8th: World Physiotherapy Day 


There’s nothing like remembering it’s World Physiotherapy Day on the 8th September at 11.55pm on 7th September. What do you do – ignore it and lie awake wishing you’d realized earlier and posted some masterpiece to commemorate your beloved profession and your mates who do good stuff around the world every day changing lives (hopefully for the better)? Or get your iPhone and type a blog one finger hoping not to disturb your hubby asleep beside . Yep you guessed it. No tossing and turning for me – fully awake and writing. In fact September is quite overloaded with “special” days, weeks and months as highlighted tonight on Gruen and many of them are incredibly relevant to what I do- but they did manage to leave an important one out – World Physio Day. September has amongst others Women’s Health Week, Prostate Awareness month and a new one for me which is very worthy- Steptember. 

The theme for this year’s World Physiotherapy Day is ‘add life to years’—aligning with the World Confederation for Physical Therapy. The message builds on the findings of WHO’s World Report on Ageing and Health and a range of reports indicating the contribution and cost effectiveness of physiotherapy in healthy ageing.

Of course there’s not much point in adding years to life if the quality of those years is diminished due to Urinary or Faecal Incontinence or other pelvic health issues. So seeking assistance from your Continence and Women’s Health Physiotherapist is going to  add value to those extra years. Part of our daily mantra to patients is to also exercise (pelvic floor safely if necessary) and to encourage healthy eating and avoiding smoking altogether, and drinking alcohol in moderation (except if pregnant when the new guidelines say zero alcohol consumption).

Seeking help for these personal issues is never easy – pelvic floor issues can be stigmatized and associated with shame and put in the “too hard basket” for many women and men.  The benefit of highlighting what we do on such a day as World Physiotherapy Day, is that one extra person may just make a phone call; Google their nearest WHPhysio or do a walk-in and book an appointment. And that prompt may just be the turning point in the quality of any extra years of that person’s life that are achieved.

Happy World Physiotherapy Day to all my #pelvicmafia colleagues, and to all Physios world wide who work hard every day to add life to years.

The next blog will be coming from Europe- get your senses ready for some visual treats!

Women’s Health Week: Let’s think differently about Menopause

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Recently I had a patient lament that because she had been forced into early menopause due to treatment for an oestrogen dependent/driven breast cancer she would no longer be able to achieve her goal of running or even walking a marathon as her prolapse would not tolerate the pressure/effort. When I spoke to her (via social media) I cheekily called menopause ‘a thought virus’ and that I would make it my goal for her to achieve her goal and yes she will finish that marathon.

Every day in my job I try and reassure women that menopause doesn’t have to be the big bogey that it is made out to be. In fact I found menopause quite liberating- once I stopped buying pregnancy testing kits and actually believing I wasn’t going to fall pregnant at 52. There is also a certain freedom that often comes with the timing of menopause – your children start to leave the nest. Now whilst this can be sad – not having their presence there every night when you come home from work; not having the elevated washing pile; not having the mountain of washing up; being able to cook one meal a week and then just eat the leftovers every night, night after night…..yes it is sad, because you miss them. But it can be a quality time for you to ramp up your own hobbies, to cook whatever you want and eat it at whatever time takes your fancy, to reclaim your relationship (and run in the nudie between the bathroom and the bedroom, or saunter slowly even!)

Last year I attended a workshop on Women’s Health Physiotherapy and Menopause run by Michelle Lyons, one of my Irish physio friends/colleagues from Facebook, which was fantastic and she had the following two definitions of menopause.

The first definition is the one which I (and of course Michelle) would love everyone to embrace, as I think it gives more hope to women that menopause is just a natural time in a woman’s life, which may of course have varying degrees of comfort or discomfort.  What also needs to happen is, we need to change the conversation about menopause to stop the risk of handing down from generation to generation thought viruses and a dialogue of negativity about this particular life stage of a woman.

The first description of menopause:

“The joy of menopause is the world’s best kept secret. Like venturing through the gateway to an ancient temple, in order to claim that joy, a woman must be willing to pass beyond the monsters who guard its gate….as thousands of women from all cultures throughout history have whispered to each other, it is the most exciting passage a woman ever makes”.

Now read the next description by Theresa Crenshaw in 1996:

“Menopause is not a natural condition; it is an endocrine disorder and should be treated medically with the same seriousness we treat other endocrine disorders, such as diabetes or thyroid disease”. 

Really?!? Oh come on – we can do better than that surely?

We know there are many changes that happen (or are blamed) on menopause, but I would like us to think more positively about it as a life stage and instead of expecting all the bad things, maybe get help and address the physical changes and look forward to the positives.

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Take up new pursuits which have scientific proof to be helpful for cognitive, cardiovascular and bone health such as dance.

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Dance class at Studio194

So for my patient I will encourage her to take one day at a time and be focused on her recovery from chemo (which I know she totally is and with the love and thoughts of her many friends and relatives) and once she has rid her body of her cancer, she can then move her attention to the goal of that marathon. I know for a fact that she will slap that down just as she has other barriers and roadblocks that have appeared in her life.

In the meantime for all us other women, in this – Women’s Health Week – here are some worthy Facebook memes (how did we get up and start the day without some of these little gems before Facebook?)

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Although I am not sure about that “make someone else’s bed”– another good thing about being an empty nester is you don’t even think about bed-making!

And finally, as you grow older, try and grow stronger – in mind and body – because the world can be a tough place and I know being strong will enable all women to embrace everything that gets thrown at them.

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Happy Women’s Health Week – let’s share the conversation about embracing superlative Women’s Health in Australia.

Pain relaxation class

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You may remember that I took over the pain relaxation class a couple of months ago. I want to report to you about this class.

Monday has become a long day – with me now starting the day at 7.30am and rocking home by 7.30pm. If I didn’t love the concept and content of this class so much, I probably would have just stopped it.

But I do love this class.

Because I love teaching people about how to conquer their pain. Every patient teaches me something new, gives me feedback about what works for them and what doesn’t. And I can tell you there are so many people in pain. In case you are wondering (and you are in pain) – you are not alone.

Did you hear that? YOU ARE NOT ALONE!!!

Why is that?

Life is very hectic and busy. Technology has confounded our days. Contact with people has escalated infinitely – which can be great with productivity going through the roof, but the opportunity to get burnout and suffer anxiety from the contact, is magnified greatly. Stressors are everywhere, if we are not careful. If we read something into nothing, then a harmless bit of banter turns into a catastrophe. If we have a family interaction that goes awry then your guts start to churn and before you know it your aren’t eating at all…or you’re eating all the wrong things (comfort food).

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When we get anxious, we breathe badly. We can breathe shallowly, in our upper chest, and fast- blowing off lots of carbon dioxide which makes us feel light-headed and not thinking straight.

When we feel anxious, we can feel our bodies tightening. Our muscles tense, our chest can tighten and our heads can feel like they will explode. Our knees can feel weak and like we want to curl up in the corner and hide.

So what do we do?

We can succumb to the anxiety or we can attack it with gusto and a plan to bring it under control.

So if breathing is a problem, remember to regularly slow your breathing down, to breathe into your tummy and to have some nice big sighs to cleanse the system. See the breathing gif at the beginning and end of this blog. Load it onto your phone and keep using it regularly through the day.

If thoughts are an issue, try to become aware of what are useful thoughts and what are thoughts that are called thought viruses.

Rumination is a common problem. Failure to let go of thoughts that are not productive can eat away at you and lead to a build up of cortisol and other negative hormones in your body which ramp up your body’s response to pain and anxiety. Overthinking, repetitive thinking, rehashing – these are all negative for your brain and your second brain- your gut- and then you start to feel physical symptoms like nausea and may even get bloating and abdominal pain.

Thoughts are an output of the brain and do have an effect on your body- never underestimate the power of good thoughts to make you feel better.

Each week in the pain and relaxation class I am now including some pain education nuggets as my hero Dave Butler would call them. He and Lorimer Moseley of Explain Pain fame have produced volumes of them in their two (soon to be three) books and I commend these books to any health professional who treats people or patients in pain. I want you to tackle this pain/ anxiety issue with the determination of a golfer who wants to get his handicap down, or a dancer who wants to perfect some steps.

the protectometer book

Don’t do a half-baked effort – get all the tools in your tool box and then practise them daily, even hourly, even every 10 minutes, if that’s what it takes to calm down the nervous system. Smile when you can; move and exercise when your brain, or your pain might be willing you to do otherwise; and let go of those thought viruses. I promise you, you will feel better.

IMG_4068

(If anyone knows where I got this great gif from, please let me know so I can acknowledge it).

If you want to book into the class it is on Monday night from 6.15pm and you are in Brisbane you can ring (07) 38489601 and the girls will help you book in.

 

Turning 60 -a time for reflection?

 

mum and me

Me turned 6o, Mum 91!!, Jill photo-bombing in the background

What’s worse than turning 60? Well my Mum (who is 91) reckons it’s having the youngest child turn 60! I’d say she had a point except that everyone at my family party reckoned that Mum was spectacular – engaged, beautiful coiffured hair (the Queen copies her style – she is younger than Mum after all), and drove herself too and from the party – so independent in a rather exaggerated way.

So my new goal is to aim to be at my youngest child’s (Michael who is 25) 60th in 35 years, drive myself there, be able to remember my children’s names and still have hair!

family photo at 60th     cakes 60th

My kids and husband conspired to have a surprise party, but Bob folded under the pressure of keeping the secret and was looking much less stressed after he came clean on the birthday plans. I was instructed to do nothing and complied by going to one of my favourite pursuits at 5.15pm, (the witching hour for babies and party preparations when one realises there is way too much to do before the guests arrive) by going to a dance class at the studio with my second family- my dancing mates. As usual I left the dance class with a smile on my face and humming Michael Buble.

dancing class ailsa

(Just to let you know that this is Ailsa receiving some flowers and champers from me for being the most regular client at Studio194 since it opened on August 4th 2015. She has been to virtually every dance class and a Pilates class every Tuesday since we opened and she herself says she feels fantastic for all that dancing exercise (it’s not really exercise, its just fun) and Pilates under the watchful eye of Monique, (as one client described of Monique- “You can run but you can’t hide from Monique”)

But the best part about my birthday was, that everyone complied with my request to not give me a present and to rather give a donation to HADA. There may have been the odd bottle of beautiful champers, some glorious flowers or a dinner voucher to go along with the donation but people have been very generous to HADA. Now with recent stories in the media about a very well-known charity having considerable amounts of money siphoned off for dubious purposes, it is wonderful to know that when my kids, my mother, my friends and staff all donated to HADA, 100% went to funding operations to help women with fistulas and prolapse in Africa.

Recently I received an email of thanks from HADA showing the amazing work that the Medical Training in Africa crew are performing while utilizing the money raised below.

fistula repair operations July 2016

Hello friends,
Judith Goh, Hannah Krause, Jackie Smalldridge, GI Tan, John Taylor and I have just returned from Uganda, where we did a prolapse and fistula camp at Kagando hospital. Once again we were welcomed by a large group of ladies with big smiles and cheery dispositions – all the more so after we were able to help improve their previously desperate lifestyles. The ladies in the above photo have all had VVF repairs – as evidenced by their indwelling catheters running into their brightly coloured buckets. They are now dry – most of them having spent months to years being continually wet and smelly. Their joy is obvious!
We operated on 52 patients with prolapse, 29 patients with Vesico-Vaginal fistulas, 26 patients with Recto-Vaginal fistulas and 10 others with causes of incontinence requiring less major surgery. In addition, one patient presented with a large rectal prolapse, and one with a huge thyroid mass (she had a lump – just at the wrong end of her body!!). We were able to fund their operations by the general surgeon at the hospital. 19 patients were managed on the ward with conservative medical treatment for their incontinence (all after previous successful closure of their fistula).
The total cost of the camp was approximately AU$46,000. Thanks to your overwhelming generosity, we have been able to fund this camp and will be able to return to Kagando in December to conduct another prolapse and fistula camp.
These women are deeply grateful for your generosity and wish to thank you for changing their lives.
We will be heading off again in mid-December, and will keep you informed of our work.
Kind regards,
Barbara Hall

Now that is inspiring. I am way too sookie to go to Africa – worrying about silly things like parasites and the like but these devoted doctors head off 2, 3, 4 times a year and just completely change these women’s lives. Extraordinary!

So I reckon the least I can do is encourage friends and relatives to give a gift of giving.

Try and spread the idea. #giveagiftofgiving

While Tuesday 9th August was a very happy time, the period before was actually very sad with the passing of my sister’s partner, John O. I think sometimes in the hurley burley of life we can take things for granted and I know that John had much more living to do and felt cheated at losing his battle with cancer at only 68. And after listening to the tributes at his funeral from his family, friends and work colleagues, I know they feel cheated. What I know most is that every day my sister will miss her soul mate, who she sadly only met in later life – because they were truly a wonderful match, joined at the hip with their views on politics, social justice, Noosa and good food.

Whilst I have known John for 16 years, he was such a humble man, that I only really pieced together his life achievements once he actually passed away. His work with indigenous affairs in the Northern Territory, Alice Springs and Melbourne were at the coal face, the micro level- whilst still holding beliefs that the big picture issues must be addressed. When others were retiring at 65, John recognized that the young and disadvantaged needed a voice when facing drug charges and returned to study further to attain counselling accreditation and began a new career up at Noosa, while also soaking up some sun and walks on the sand with Lynne.

What I know is that Friday was a special day when John’s loved ones and friends gathered together – hugged, laughed, cried, listened to superb music – Cold Chisel, Leonard Cohen and the haunting music Bunyarra Mockva – The Voices of Red Heart as we watched the photographic memories. It was a special day which I know John would have loved.

Vale John O.

 

 

 

Global Pelvic Health Facebook Group Tackles Prolapse Rate!!

woman talking thru a megaphone

In a few weeks I will be presenting again to the general public on prolapse and every time I do one of these talks and I put that stat in and “50% of women over the age of 50 who have had a vaginal delivery will develop prolapse it still really impacts on me. Because when you think about the population of Australia 24 million- say 50% are female. And from the Bureau of Statistics, in 2011, 297,126 women gave birth to 301,810 babies in Australia. Onset of labour was spontaneous for 54.8% of women giving birth. Most women (67.7%) had a vaginal birth and, of these, 82.1% did not involve the use of instruments.

So it translates to an enormous number of women!

(Some other stats from that year: overall, 32.3% of women gave birth by caesarean section in 2011, a 0.7% rise from 2010. The caesarean section rate among first-time mothers was 33.2% in 2011. Among women who had already given birth at least once, 28.8% had had a previous birth by caesarean section.)1.

Now does this 50% figure have to be an inevitability or is it that we are letting down the women of Australia (and the US, UK Iceland, Africa etc etc) because we health professionals (physios, GPs, Obs and Gynaes, Urogynaecologists) are not educating enough and making a compelling argument about simple lifestyle factors and the preventative role of the pelvic floor in pelvic organ prolapse management?

If we had an orchestrated public health campaign (such as the highly successful ones about smoking and wearing seatbelts) in Australia, about prevention of prolapse such as the points listed below, could these targets be reached?:

  • Pelvic floor muscle strengthening to maximise the potential of the muscles following a vaginal delivery.
  • Matching downward forces of coughing, sneezing, bending, sit to stand etc by engaging the pelvic floor muscles first- known as ‘the knack’
  • Good bowel management such as the correct postures and dynamics for defaecation and appropriate consistency of the stool (yes bowels bring down prolapse!!)
  • Extol the virtues of more routine use of pessaries (to the medical fraternity) to allow women to be able relax to exercise and lift their children when they are toddlers
  • And another big one pelvic floor safe exercising.

On pelvic floor safe exercising– there is a lot of detailed research going on around the world about activities that raise intra-abdominal pressure, with debate as to whether some of the restrictions that physios like me talk about, are over-zealous. Restricting women from doing certain exercises needs to come with a caveat that it would be wise to have your risk assessed by a Continence and Women’s Health Physio depending on the strength of your muscles, the stretch to your ligaments or fascia or the damage to your pelvic floor such as levator avulsion, nerve damage or prolapse as a result of the vaginal delivery. If women were absolutely encouraged to exercise through their lifetime but in a safer way to minimise risk of further prolapse, to be fitted with a pessary to facilitate good support while exercising and to have regular yearly checks to monitor the state of the pelvic floor then I am sure those statistics could be lowered! I can tell you from years of experience that women feel angry when they realise the activities they have undertaken without any warning from their trusted instructor, have worsened their prolapse.

Now recently a number of us Women’s and Men’s Health Physiotherapists – otherwise known as #pelvicmafia – formed a new group called the Global Pelvic Health Facebook Group – driven by a desire to collaborate in a global way to tackle this worldwide phenomena of pelvic floor dysfunction – a silent yet manifestly common problem worldwide.

The goals of the group are to professionally challenge each other to improve outcomes for patients worldwide by:

  • sharing patient case studies;
  • distributing pertinent research articles;
  • highlighting clinical pearls and even
  • adding the odd artistic contribution such as seen in the photos below (yes we are a cultural lot!)

great-wall-of-vagina3-550x365

Great Wall of Vaginas MONA Gallery, Hobart

I think we as a new group could set targets like the scientists do with global warming- what if we set an aim to reduce this prolapse rate through public education by 10% in Australia by 2020; by 20% by 2025 and by 25% by 2030. How cool would that be if we as a new group actually got out there with megaphones (metaphorically) and literally blasted every media outlet with this message that simple manageable things like the knack; good bowel management and safely exercising (if it is warranted by proper assessment by a Women’s Health physiotherapists looking at objective data like is there a Levator Avulsion?, what is the GH+PB (genital hiatus plus perineal body length) measurement – does it fall into the risk dimensions for prolapse?; how much perineal descent is present on a curl up, cough with and without the knack?).

If these things were properly assessed and a judgement made and guidelines given to the women, the inevitable MAY NOT HAVE TO HAPPEN!!!!

Now another reason this may not have to happen is highlighted in this case presentation by a woman who has been touched in a very personal way by prolapse. Her name is Amy Dawes and she has given permission to give her real name as she is being very brave and ‘coming out’ about her issues. But as she says – “I don’t really feel brave, I feel like it’s my duty to be a voice”. This young women is extremely articulate and in fact is presenting her story at a medical conference soon, which is incredible, because the health professionals attending will be able to see the pain and suffering that happens with birth trauma and prolapse which raises it beyond just the ‘feeling of a bulge’ to how it impacts on all aspects of a women’s life. All too often, after health professionals see patient after patient, they get almost desensitized to the impact of these common occurrences and think women are being dramatic when they cry and stress about the changes to their once uncomplicated lives pre-vaginal birth (regarding exercise, controlling wees and bowel motions) when there is significant damage.

Here is Amy’s story:

In the lead up to the birth of my daughter in December 2013, I had become set on a natural birth, I wanted my daughter to get those important antibodies from the birth canal and after doing my calm birth course I was all set to breathe her out.

Except nothing can really prepare you for the pain. After 9 hours of laboring, vomiting and scratching the paint off our bathroom walls, the midwife on duty at the hospital finally said we could come in. I was desperate for the epidural I said I’d never get and 2 hours later relief was mine. When I was 10cms dilated we went to the next stage, an hour and a half of pushing and still no baby, that’s when we realised our girl wasn’t going to come into the world without help.

It came to an emergency decision between a caesarean section or high forceps, I wasn’t told the potential risks that lie with a forceps delivery and as my pelvic floor muscle was torn off the bone and my perineum cut, then torn (leaving me with a 3rd degree tear), they sent my new baby and partner out the room and ordered 2 units of blood, I lay there shaking and wondering whether I would die. The subsequent days where a morphine-induced blur until the unexpected afterbirth pains that came at night left me in agony, with every cramp I urinated in my bed, with no clue to what was happening- I just lay in a bed of urine. I was tied to a catheter for 5 days, I didn’t change a nappy till my daughter was a week old!

I could barely walk for around 4 weeks, much of that time was spent in bed, crying and wondering what I had done – my body now felt alien to me. However it wasn’t till my daughter was about 16 months old did I really feel the impact of the birth trauma.

Bio-feedback improved my faecal incontinence although without management I still have the odd accident. My biggest question then was ‘when would I be able to exercise like I used to?’ Exercise was a massive part of my life pre-baby – it was a huge part of my identity.

The obstetrician I was seeing said the physio (who had advised pelvic floor safe exercises) was just playing it a safe and that if I did prolapse then I could just get surgery after I’ve finished having kids.

I eased myself gently back into training and one day after a short run, I just knew something wasn’t right, a heavy feeling which I now know was as a prolapse. After examination from my physiotherapist, I was told that a bilateral levator avulsion was the cause and that’s when the bottom (literally) dropped from my world.

Not only would I no longer be doing the sports I loved but every day simple tasks that I once took for granted, like being able to lift up and cuddle my toddler, run, jump, sneeze, cough or perform basic functional movements like squatting and bending, became a constant source of worry – ‘have I made it worse’?

Yet I’m a mother running after a child all day long, how could I possibly avoid these tasks?

I felt completely alone, literally like I’m the only one with this and all at once overwhelmed by my bodies limitations. Here’s the thing with pelvic floor dysfunction, because you can’t see it, no one knows it’s there, so no one really knows how much you are suffering, yet my postpartum physiotherapist likened my injuries to that of being in a car crash- and some people thought I was lucky for not having a caesarean!

When I found out about my avulsion I felt like my quality of life was completely altered I found myself filled with anger, frustration, sadness and anxiety. I would revisit questions that plagued my mind -How can someone do that to my body? – damaging it beyond repair without informing me of the risks involved with forceps deliveries, LONG before I was in the delivery room.

When planning for a baby we certainly didn’t budget for the thousands upon thousands of dollars spent on doctors, physiotherapy, counselling and psychiatry.

A year after my initial diagnosis, I had a 3D/4D Ultrasound and I was able to visually review my bi-lateral avulsion and Stage 2 bladder and bowel prolapse. I have made the decision not to pursue surgery as it’s my understanding that prolapse surgery has a 30% risk of failure, however with a bi-lateral avulsion that risk increases to 80%. At the age of 35 I am not prepared to spend my time in and out of hospital. What concerns me is that surgery was viewed as the answer to my problems, where I feel that doing everything to avoid pelvic organ prolapse is more important than thinking surgery is the solution when it happens.

I never thought I would be able to make peace with what happened that December day, but I am thankful to be here now as a voice for so many who choose to suffer in silence. Pelvic floor dysfunction has serious power over everyday life, affecting all areas of your world and the people around you. Whilst I still think natural births are a beautiful thing, my wish is for women to have an opportunity to be provided informed consent about the risks involved with childbirth, especially forceps, so decisions don’t need to be made in emergency situations, without proper information, without informed consent.

Thank you Amy for your wonderful personal account and being brave enough to come out about it. With stories like these perhaps our global health target will be achievable as we spread the word about prevention to the next generation of mums and health professionals.

In response to Amy’s articles I have had a wonderful comment which deserves to be included in the article. It is from Liz Skinner a researcher and midwife who works with Professor Peter Dietz who has published around 200 articles on Levator Avulsion and is leading the conversation about birth choices for women.

Thank you so much Sue and Amy for this invaluable information and personal experience. I am at present working tirelessly with Prof Hans Peter Dietz and his team in Sydney to change clinical outcomes for women.
More women are bravely coming forward after forceps deliveries with these terrible injuries and despite the embarrassment they are realizing that change is imperative.

Childbirth is universally seen as a predictable and positive life experience despite women’s claims of pelvic organ prolapse, dyspareunia (pain having sex) and faecal and urinary incontinence after vaginal birth. Major pelvic floor dysfunction, often due to forceps use in labour, can affect 20-30% of primiparae. Such damage is rarely considered as compromising postnatal psychological health.

Traumatic vaginal birth, followed by the embarrassment and isolation that results from pelvic floor and anal injury, requires investigation as a major contributor to psychological problems post-partum. Such injuries are commonly dismissed as ‘trivial women’s issues’ and subsequent psychological symptoms confused with tiredness, pre-existing marital disharmony, postnatal depression (PND) or other psychosocial factors and treatment becomes inadequate. Unfortunately the literature on this topic is sparse and almost entirely ignores obstetric history.

Maternity services worldwide do not recognize pelvic floor dysfunction as a cause of mental health dysfunction regarding morbidities that impact women’s sexuality or lifestyle.

Findings in a study that examined the effects of vaginal birth trauma, mostly after forceps deliveries, noted postnatal mothers were not informed by clinicians that their genital area would be so damaged and many stated that ‘down there’ felt totally foreign, disgusting and changed beyond recognition. These women suffered from dissociation, avoidance, numbness, flashbacks, severe anxiety, panic attacks and nightmares from a traumatic delivery, sometimes years later, and often during sexual relations. Furthermore, decreased libido, dyspareunia, lack of intimacy and marital problems exacerbated women’s psychological consequences.

A great need exists to learn how to prevent women from sustaining somatic and psychological injuries by acknowledging their concerns and providing accurate diagnostic and therapeutic services.

Great words Liz and let’s keep these conversations building so outcomes can be changed!

#Globalpelvichealth #pelvicmafia #reduceprolapseincidence #spreadtheword #breakthesilence #pessariesarentjustforoldwomen

  1. http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Chapter3202008
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