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The 'Evil Triplets' of Pelvic Pain: An Interview with Michelle Lyons · Pelvic PT Rising

• 0:02
  Speaker 1: In the last 10 years, our field has gone from an unknown specialty to a household name.
• 0:09
  Speaker 1: This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve.
• 0:17
  Speaker 1: In order to help others get better, we need to be better.
• 0:23
  Speaker 1: This podcast will help you to become more confident with your patients, more successful in your practice or business and a leader in pelvic health, and we're going to have some fun along the way.
• 0:36
  Speaker 1: Join us as we rise together.
• 0:39
  Speaker 1: We're Jesse and Nicole Cozine, founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle, and this is Pelvic PT Rising.
• 0:53
  Speaker 2: Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine.
• 0:58
  Speaker 2: Hey, nicole, hello.
• 0:59
  Speaker 2: It is always a treat to get to talk to the Michelle Lyons on this podcast.
• 1:04
  Speaker 2: This is going to be her third time returning.
• 1:06
  Speaker 2: I feel like we need some sort of SNL like five-time gold jacket thing, for the Michelle is going to be our inaugural member of.
• 1:14
  Speaker 1: We should do that.
• 1:15
  Speaker 1: Actually, I think that'll be really cool, Michelle, if you're listening to your own podcast interview.
• 1:20
  Speaker 1: We will do that.
• 1:21
  Speaker 1: There's two more times that you got to do to get some sort of prize from Jesse and Nicole Pelvic.
• 1:26
  Speaker 1: Pt Rising podcast.
• 1:27
  Speaker 2: Yes, be careful what you wish for.
• 1:28
  Speaker 2: It Might not be tasteful, but it will be cool, so I am really beyond excited to have Michelle back.
• 1:35
  Speaker 2: She was obviously a huge fan favorite at PelvicCon last year.
• 1:38
  Speaker 2: She's going to be talking about two topics that I think are incredibly important and often misunderstood.
• 1:46
  Speaker 2: One is living well after hysterectomy and the other is the evil triplets of pelvic pain endometriosis, icy and pedontal neuralgia Really difficult things to talk about and treat, and I'm so excited that she's going to bring her wisdom and making it so practical for the people who are going to be at PelvicCon.
• 2:04
  Speaker 1: Yeah, she's just an amazing educator and a couple of things that I'll say about her topics.
• 2:10
  Speaker 1: You know when we, jessica and I, were going to ask her to come back to PelvicCon for a second time.
• 2:16
  Speaker 1: The really cool thing about Michelle is that she can talk about literally anything and we know that she's going to bring it.
• 2:23
  Speaker 1: She's going to talk about it with amazing, just presentation and amazing research to back everything up and just practicality to a lot of the things that she talks about.
• 2:33
  Speaker 1: And I'm really excited about the hysterectomy talk.
• 2:36
  Speaker 1: We forget that we are physios first or rehab providers first, and we have our start in getting people back after a surgery.
• 2:47
  Speaker 1: That was a little bit of a through line with Manira as well, with helping people after abdominal plasty, and I really feel like we can need to stop villainizing the fact that people have surgery.
• 2:58
  Speaker 1: Sometimes they're necessary and we have a huge place and a role for people to live well after hysterectomy.
• 3:05
  Speaker 1: So I'm really excited for that.
• 3:06
  Speaker 1: And then, of course, you know me, I am super stoked on.
• 3:10
  Speaker 1: I'm not stoked that people have pelvic pain, but I am super stoked on treating it.
• 3:14
  Speaker 1: And so these evil triplets of IC, endo and peneloralgia are all so intertwined and the diagnoses overlap and the symptoms overlap and patients think they have all three and sometimes they only have two.
• 3:28
  Speaker 1: All the things and I'm just really excited for her to break that down for us at Pelvicon.
• 3:34
  Speaker 2: So if you were listening to this podcast on the day it drops, the 28th of August, you still have a couple of days left until the end of August, that's Thursday this week.
• 3:43
  Speaker 2: If you are coming to Pelvicon, make sure you've downloaded our Pelvicon app, which is pretty frickin' bomb, that we have our own app.
• 3:52
  Speaker 2: And if you are missing out this year, either because you couldn't make it or because tickets were sold out, make sure you are getting the recording.
• 3:59
  Speaker 2: Honestly, I fully believe that either one of these talks with Michelle would be more than worth the entire price of the recording.
• 4:07
  Speaker 2: And you're not only getting both of her talks, you're getting 15 total talks from leaders, trailblazers in the field, the entire breadth of our specialty.
• 4:16
  Speaker 2: So make sure you're heading to Pelviconcom slash recording to get the early bird discount on that.
• 4:22
  Speaker 2: You'll get $50 off, and these are also, remember, eligible for CEUs this year.
• 4:28
  Speaker 2: So really excited about that, excited for you guys to hear Michelle's interview here and be able to hopefully hear her entire topic.
• 4:37
  Speaker 2: So, with no further ado, here is our interview with Michelle Lyons.
• 4:40
  Speaker 2: So excited to welcome Michelle Lyons back to the podcast.
• 4:48
  Speaker 2: If you guys have been living under a rock and have not seen Michelle's doing, she is a podcast author.
• 4:54
  Speaker 2: Now, newest thing we need to be talking about a course creator, a business owner and a Pelvicon speaker.
• 4:59
  Speaker 2: Michelle, thanks so much for being on with us.
• 5:02
  Speaker 3: Oh look, it's a pleasure to be chatting with you and, anyway, both of you are you're kind of my Pelvic Health idols.
• 5:08
  Speaker 3: I love what you're doing and I'm so excited to be going back to Pelvicon this year.
• 5:13
  Speaker 1: Michelle is back by popular demand and so we're excited to dive in a little bit to some of the clinical topics and we're going to continue the missing piece series, Michelle edition as well with some of her topics for Pelvicon.
• 5:27
  Speaker 1: But give us what you've been up to, Michelle, right now.
• 5:31
  Speaker 1: What are you doing in your day to day?
• 5:33
  Speaker 1: Give me the day in the life of Michelle Lyons.
• 5:37
  Speaker 3: So my days are pretty random From Wednesdays.
• 5:41
  Speaker 3: I see clients on a Wednesday primarily at Post Historectomy.
• 5:45
  Speaker 3: Appropriately and appropriately enough, I work in a big kind of cancer support center, so seeing folks on their recovery journey.
• 5:51
  Speaker 3: But just because you've had cancer doesn't mean you don't also have pelvic floor dysfunction, sexual health issues, ibs.
• 5:58
  Speaker 3: In fact, there's a huge correlation between breast cancer and pelvic floor dysfunction and irritable bowel.
• 6:04
  Speaker 3: So it's nice to be able to kind of bring all the different things that it's not just about the cancer.
• 6:10
  Speaker 3: So I kind of bring my health coaching and nutrition, as well as kind of my physio toolbox, into all of that.
• 6:16
  Speaker 3: So I love that because it kind of keeps things very focused and very real as to what people actually need.
• 6:21
  Speaker 3: And then the rest of the time I'm either creating a course, recording a podcast, sitting somewhere curled up with a book.
• 6:29
  Speaker 3: Bookshops are my crack den, so I was very psyched to hear that you're moving the conference just a little bit closer to Barnes Noble this year.
• 6:36
  Speaker 3: So thank you.
• 6:37
  Speaker 1: We sure are.
• 6:38
  Speaker 1: The conference is actually going to be in a really cool little area that is walking distance to a lot of stuff.
• 6:43
  Speaker 1: We listened to actually a lot of feedback from people from last year and I think the crown positive, where we're going to be, is just going to be really awesome.
• 6:50
  Speaker 1: So you can catch Michelle.
• 6:52
  Speaker 1: If she's not watching some of the speakers, she'll be at the bottom of the noble.
• 6:55
  Speaker 1: Hey, do you read?
• 6:56
  Speaker 1: Because your husband's an author.
• 6:59
  Speaker 3: He is, he is.
• 7:01
  Speaker 1: Do you read his stuff too, or is that kind of separate?
• 7:07
  Speaker 3: So he's a poetry is his genre and so, yes, I do.
• 7:11
  Speaker 3: I do read his as well.
• 7:12
  Speaker 3: I cast an editorial eye over because I love him, but he's a horrendous speller.
• 7:17
  Speaker 3: Oh yeah, and you see, the thing is he's American, so he spells everything like in American way.
• 7:24
  Speaker 3: You know, they use out of color and things that are missing.
• 7:28
  Speaker 2: So we have to just do some corrections of things like that, because I imported him over here to Ireland so he has to adapt to our weird ways that's hilarious, although I feel like if you are a writer and a bad speller, poetry is where you want to be, because we read it and just assume that there was a reason for it.
• 7:44
  Speaker 2: Like man, that's deep.
• 7:45
  Speaker 2: I can't believe you left the E out of that word.
• 7:49
  Speaker 3: What does that?
• 7:49
  Speaker 1: mean, I mean that's awesome.
• 7:51
  Speaker 1: I love that.
• 7:53
  Speaker 2: Michelle, when we heard that you were starting a podcast, I think our reaction was probably the same as like everyone else's about damn time.
• 8:01
  Speaker 1: Oh yeah, right, how would you?
• 8:04
  Speaker 3: like this so far.
• 8:05
  Speaker 2: I know you're what five or six episodes in when we're recording.
• 8:08
  Speaker 2: Yeah, what has that experience been?
• 8:11
  Speaker 3: It just struck.
• 8:11
  Speaker 3: It's brilliant because I'm blessed, because I know a lot of clever people, which is a great segue for inviting the two of you on as guests to talk about business and pelvic health and all the rest.
• 8:21
  Speaker 3: But I'm hoping that you'll consider us no pressure, that we're on the spot here, yeah, but you know what?
• 8:25
  Speaker 3: I've had some really great conversations because I feel like sometimes in our world of pelvic health we're really good at nerding out with each other and what I want to do is kind of, you know, bring some of the newer research and the researchers who are doing it kind of into conversation about yes, that's great, but what does it mean for us clinically?
• 8:47
  Speaker 3: Because, like, for example and this is not me dissing researchers, but a study came out fairly recently showing that doing curl-ups does not make diastasis worse.
• 8:59
  Speaker 3: I'm going okay, super so, and Dot, dot, dot, you know.
• 9:06
  Speaker 3: So I had the opportunity of doing an interview with Gronja Donnelly, who is an awesome physio from Northern Ireland who's currently doing her PhD in all this field, and so she was talking about the research but making it very clinically applicable.
• 9:22
  Speaker 3: That's what I love.
• 9:23
  Speaker 3: It's yes, that's great, but how will it change practice?
• 9:26
  Speaker 3: So I've had some really great rock stars on.
• 9:29
  Speaker 3: I've had, you know, people like Gronja, and Emma Brockwell is coming up soon.
• 9:34
  Speaker 3: Elizabeth Culliton talking about her research with athletes in pelvic floor dysfunction.
• 9:39
  Speaker 3: Alex Mills-Bock him on to talk about her bulk insurance really great tools for helping people with pelvic pain.
• 9:45
  Speaker 3: So it's you know what.
• 9:46
  Speaker 3: It's an excuse for me to just hanging out with clever people and really understand where they think the future of our field is going, and it really excites me and kind of gives me hope for the future as well.
• 9:58
  Speaker 3: Yeah, as you know, we're in a good place, absolutely.
• 10:02
  Speaker 1: Let's call anyone out, but have you found a researcher yet who either hasn't been in the clinic for a long time that really does like have a difficulty like making that clinical leap Like or have you found anybody that you've talked to yet?
• 10:19
  Speaker 1: You don't have to name names.
• 10:21
  Speaker 3: Luckily, like everybody that I've talked to so far.
• 10:24
  Speaker 3: I mean, you know, honestly, like people like to give Carrie Bow.
• 10:28
  Speaker 3: I'm going to just say it, I'd like people like to give Carrie Bow a hard time with her research possibly one of the most prolific publishers of research, you know, over the past 20, 30 years, yes, and I think she's done a tremendous amount to bring the field forward.
• 10:42
  Speaker 3: Is she working clinically?
• 10:43
  Speaker 3: No, is that sometimes reflected in some of her work?
• 10:46
  Speaker 3: Maybe, but what she does is she surrounds herself with clinicians, and so I feel like there's been a real kind of change in direction for her.
• 10:56
  Speaker 3: You know, I shared a paper that she and her team published fairly recently on looking at exercise and prolapse, and I got a lot of pushback oh, we don't need this sort of research, it's all doom and gloom.
• 11:06
  Speaker 3: I'm not going.
• 11:06
  Speaker 3: Yeah, but no, knowledge is power.
• 11:08
  Speaker 3: We have to be able to take what's happening in the research and use our wisdom, you know, use that research then judiciously to help the people that we're working with meet their goals.
• 11:18
  Speaker 3: We can't just ignore the fact that prolonged Olympic weightlifting might not be the great place to start if you've got a prolapse.
• 11:26
  Speaker 3: But let's look at what the evidence says, and let's build on that.
• 11:29
  Speaker 3: If that's their end goal, okay.
• 11:31
  Speaker 3: Well, let's talk about pesteries.
• 11:32
  Speaker 3: Let's talk about what's your upper body strength like, what's your lower body strength like, and then how are you cross training your pelvic floor?
• 11:39
  Speaker 3: We can't just ignore research.
• 11:41
  Speaker 3: We don't like.
• 11:42
  Speaker 1: That's a great point, and I think that sometimes and even I sometimes I'm like oh, is that really clinically relevant?
• 11:48
  Speaker 1: And the anatomy is evidence, and a lot of the things that sometimes I say as well is I never want to get misconceived that I'm dismissing research, because I feel like you're totally correct, that we do have to pay attention to it.
• 12:00
  Speaker 1: I feel like we're sometimes we as a group of people get it wrong, is believing that it has to be all or nothing.
• 12:08
  Speaker 1: We're either evidence based or we're not, and that that's really where I feel like your podcast is going to really bridge that gap into.
• 12:15
  Speaker 1: We look at that and then we also say what does that mean clinically?
• 12:19
  Speaker 1: And it might not mean anything yet clinically, but what is it?
• 12:23
  Speaker 1: It helps us to ask better questions.
• 12:25
  Speaker 1: And what's the next stage of that research then?
• 12:29
  Speaker 3: Yeah, for sure.
• 12:30
  Speaker 3: And I mean, I think, if we go back to you know, when the phrase evidence based practice was originally coined, it is regarded as having three components We've got the research, we've got our clinical experience and then we've got the patient's preferences as well.
• 12:44
  Speaker 3: And I really think, if we are going to embrace this bio psychosocial model that we're all talking about, we have to bring the patient into the conversation as well, because there is a whole person attached to them.
• 12:56
  Speaker 3: They have, you know, a history, but they have hopes and dreams for the future as well, and our job is to sit down and do some joint goal setting.
• 13:03
  Speaker 3: And so a couple of years ago I went back and did a post-grad in health coaching and that was really helpful for me in terms of just getting the basics of things like motivational interviewing and assessing readiness to change, because you'll know, nicole, clinically as well, you can tell somebody things that are going to make them feel better, but do they always embrace those changes?
• 13:24
  Speaker 3: Change is hard, change is really expensive, energy wise for our brains, and it can be scary.
• 13:29
  Speaker 3: You know at least if you're doing something, and even if you know it's going to hurt you, at least you know how it's going to turn out, whereas doing something different is all.
• 13:37
  Speaker 3: It's dangerous for your brain.
• 13:38
  Speaker 3: It can provoke anxiety, which of course will ramp up the pelvic floor even more and the brain and the nervous system.
• 13:44
  Speaker 3: So it's to try and take somebody from that fear by trying something new, to maybe a perspective of I wonder what it would be like if I tried that.
• 13:55
  Speaker 3: And then how can we create that sense of safety?
• 13:58
  Speaker 3: So we have to bring like a very regulated nervous system into the conversation and just again meet them where they are and say, ok, well, that's the goal.
• 14:05
  Speaker 3: Let's break it down into bite size pieces.
• 14:08
  Speaker 3: So what's the next step that we could take towards that goal?
• 14:12
  Speaker 3: That isn't big or scary or dramatic and just gently steer them in the direction that they want to go.
• 14:18
  Speaker 3: I mean, that's our job, isn't it to coach people to success and ultimately, to make ourselves semi redundant in the process as well, to give people the tools to fix themselves, because we're not I know we've talked about this before, we're not mechanics coming into fix people.
• 14:32
  Speaker 3: We want to give people the tools to help themselves.
• 14:35
  Speaker 3: Do I believe in wellness?
• 14:37
  Speaker 3: Do I believe in maintenance?
• 14:38
  Speaker 3: Absolutely, people go to the dentist every year.
• 14:41
  Speaker 3: People go, you know, get their cars tuned up every year, and I think it should be the same in our field as well, and I think that's definitely something that, as a profession, we need to look at.
• 14:51
  Speaker 3: But that's where I see a lot of physios kind of embracing, you know I don't even want to call them side hustles but doing things like getting teacher training and things like Pilates and yoga and health coaching, because that recognition that we're not just here to troubleshoot, we actually want to help people live well.
• 15:08
  Speaker 3: Wellness is more than the absence of disease, as I think it's the WHO say yeah, yeah, yeah, yeah, yeah.
• 15:15
  Speaker 3: We really just need to, you know, health promotion instead of just dealing with catastrophes as they arise.
• 15:22
  Speaker 1: Absolutely, and I, in training my staff over the years, I feel like that's actually an area where we actually have to spend quite a bit of time is like Everyone's all excited when someone is really jacked up, right, it's like, oh cool, that person's peneloralgia is really, is, really, is running rampant.
• 15:39
  Speaker 1: Great, I know what to do then.
• 15:41
  Speaker 1: But then at the point when they're coming in and saying like well, you know, two out of ten some days and I'm actually doing really well, then we kind of like shut down, is like okay, good luck, and yeah, and at the end of the day, like I really think that we have a huge role to play just what you're talking about in that help promotion, in the wellness, in the still guiding them into what do you want to do now and how can we still use our expertise to guide them through?
• 16:08
  Speaker 1: I think that so far, so often were okay, cool, well, I'm done.
• 16:12
  Speaker 1: Why wash your hands of it?
• 16:14
  Speaker 1: And then now you need to go to a personal trainer or a nutritionist or whatever.
• 16:17
  Speaker 1: There's places for that for sure lately.
• 16:21
  Speaker 1: But do we not also have for conductor at level education in some of those areas as well, and can we not be the little leader in that Also some really excited to hear you, to hear you echo that a little bit cool.
• 16:35
  Speaker 1: What does that make you think, jess?
• 16:37
  Speaker 2: So much about all of that just for my business perspective.
• 16:40
  Speaker 2: You know my mind always goes to that as well and I think one of the things that I really respect, michelle, about your I think career path as we talk now a couple of times on the podcast and in person at public, obviously I feel like you're very much led by just that question how can I better help?
• 16:58
  Speaker 2: And it's kind of pushed you to the forefront of the field, frankly, and push the field further, because I know we're gonna get into some of the clinical stuff.
• 17:08
  Speaker 2: But I feel like you know you're looking at things and then just saying, man, but what about this?
• 17:13
  Speaker 2: Like no one's looking at these hormones, I feel like is a great example.
• 17:16
  Speaker 2: Like that's a super complex thing that influences every aspect of our lives that none of us know anything about and, frankly, a lot of physicians don't know anything about.
• 17:25
  Speaker 2: And you just said like, hey, I need to learn about that.
• 17:28
  Speaker 2: Are you aware of that?
• 17:30
  Speaker 2: In the process of like going and doing all these extra things, I need to go learn about motivational interviewing and health coaching and hormones, or is that just a natural outgrowth of your curiosity?
• 17:41
  Speaker 3: Yeah, I'm kind of like you ever seen the movie up?
• 17:43
  Speaker 3: Yes, you know, dog the dog, I am dog in the squirrel, so I love pelvic health.
• 17:53
  Speaker 3: I really am passionate about this whole person perspective.
• 17:56
  Speaker 3: A lot of it came quite frankly, for, you know, I live in the middle of rural Ireland and so I don't have access to behavioral psychologists or you know holistic nutrition and I'm interested in or things like that.
• 18:09
  Speaker 3: So a lot of it was kind of you know I'm interested in it and it's not happening, so why don't I step up and do it?
• 18:16
  Speaker 3: I'm also like a nerd as well.
• 18:18
  Speaker 3: I just I love learning and going down research rabbit holes and kind of been able to find these pearls that are really going to change the way I think.
• 18:27
  Speaker 3: And then I get excited and I like to tell other people about them as well and I'm interested in these conversations and, by and large, our community of pelvic rehab aficionados generally very open to hearing about these things and there are.
• 18:40
  Speaker 3: There's such passion in our field to help people live well, but also controversial, perhaps I'm going to say I'm seeing a growing awareness that it's OK to have a successful business doing that as well.
• 18:58
  Speaker 3: It's been a long time.
• 19:00
  Speaker 3: There was almost a shame, I think, to talk about the business end of things and oh, even if I never got paid again, I do this because I love it so much and I want to help people, and that's great too, obviously.
• 19:14
  Speaker 3: But it's also OK to have a happy, healthy business doing what you love.
• 19:18
  Speaker 3: I think if you don't that way, burn out lies.
• 19:22
  Speaker 3: So it's about kind of creating a business that works for you, that you love, that you're passionate about and owning that.
• 19:30
  Speaker 2: I love hearing you say that, michelle, and it's something I've noticed as well as that outsider to the field and I don't know if that's, maybe you have some insight on where some of that might be coming from.
• 19:40
  Speaker 2: I just thought that that might be because it is such a female dominated field and that's a big area it's.
• 19:45
  Speaker 2: I think there's a stigma around, like health care providers and physical therapy like obviously I didn't go into physical therapy to get rich.
• 19:52
  Speaker 2: Do you have a sense of like where that came from?
• 19:55
  Speaker 2: Because I think you're 100% right.
• 19:57
  Speaker 2: By building a business that truly works for you financially, in terms of your lifestyle, in terms of the impact you want to have on the community in the world, I think you are going to be in it for the long haul.
• 20:07
  Speaker 2: You're going to be helping people for decades instead of burning yourself out.
• 20:10
  Speaker 2: But we really are fighting against that.
• 20:13
  Speaker 2: I like how you put that that shame about running a successful business.
• 20:18
  Speaker 3: Yeah, I can speak kind of, I suppose, to my experience this side of the Atlantic.
• 20:21
  Speaker 3: First of all would be that certainly historically I'm going to say historically I mean like the 60s and 70s and maybe the 80s A lot of people went into physio who were maybe, you know, kind of white middle class marriage to somebody who was possibly a doctor or surgeon, because they met in the hospital and who didn't have to do it for the money and so that wasn't a big issue for them.
• 20:46
  Speaker 3: And then, you know, when I moved to the US, of course you know there was a different emphasis on productivity but scandalous low pay for physios and I think that's what I would say working in an insurance model, and I can say that because I've been there and I've done it.
• 21:01
  Speaker 3: And when you look at other parallel kind of health care professionals nursing is a great example they have really taken the bit between their teeth and run with it in terms of redefining their roles and expanding their roles and I think I think, jesse, you may have just hit the nail on the head in terms of it has been a very female dominant profession and I think that's a great example of how I'm going to go back to on the way into record this to a podcast with Glennon Doyle and she has a researcher from the Horton School of Business on with her and she's talking about, you know, the art of negotiation and how, as women, you know, we're afraid to look aggressive or bitchy or pushy or how did she get successful?
• 21:44
  Speaker 3: And, honestly, you know, the same scrutiny is not often turned on the male equivalent.
• 21:52
  Speaker 3: Well, but I think it's changing and I think it's realising it's changing slowly, but it is changing.
• 21:58
  Speaker 3: I think it's being able to stand up and say, well, look, you don't have to, you don't have to accept this, you know?
• 22:05
  Speaker 3: Kind of talking about Glennon Doyle, there's a quote from Abby Womback, who I adore, and in her book Wolfpack about leadership, she talks about how be grateful for what you have and demand what you deserve.
• 22:18
  Speaker 3: So, yes, and it doesn't have to be either, or, you know, and just to know your worth and to be able to sit deep in the saddle and say no, thank you if it's not meeting your needs.
• 22:30
  Speaker 3: And if it's not meeting your needs, to also be brave and go out and create a scenario making it sound very easy, obviously, but go out and create a scenario that does meet your needs.
• 22:41
  Speaker 3: Is it easy?
• 22:41
  Speaker 3: No, it's really hard work because if you're self employed, you know to get from A to B.
• 22:47
  Speaker 3: If you're, you know you.
• 22:49
  Speaker 3: Basically you eat what you kill.
• 22:50
  Speaker 3: You know quite literally and I say that as a vegetarian, but you know what I mean.
• 22:56
  Speaker 3: If you're not out there, if you don't know the basics of running a business, you are going to be chasing your tail for a really long time.
• 23:03
  Speaker 3: If you don't know your numbers, if you don't know what you need to survive, if you don't know how certain parts of your business are performing, you're making life really hard for yourself.
• 23:12
  Speaker 3: It is the most gratifying thing in the world to be your own boss.
• 23:16
  Speaker 3: It's really hard, but I think that's the future.
• 23:19
  Speaker 3: Just a little shout out to anybody who's doing this Please do not diminish yourself by calling yourself a mompreneur or a fempreneur.
• 23:30
  Speaker 3: You are an entrepreneur.
• 23:32
  Speaker 3: Okay, so that's just my soapbox and I'm going to just step down office.
• 23:36
  Speaker 3: Yeah, that's powerful, though.
• 23:39
  Speaker 3: I find that so diminishing?
• 23:41
  Speaker 2: I right there with you, michelle, and you know we and some of the people that we coach, we find that we ask them how do you introduce yourself when you meet somebody?
• 23:48
  Speaker 2: New and new business owners will inevitably introduce on my physical therapist and we're sitting there saying, like we've seen your numbers, you employ three physical therapists.
• 23:59
  Speaker 2: You're making, you know, seven hundred fifty thousand dollars a year.
• 24:02
  Speaker 2: You're fucking business owner.
• 24:03
  Speaker 2: Like on that, like why are you like, oh, this is the degree that I got, as opposed to like oh, I'm running this bad ass business that is helping thousands of people in my local community.
• 24:13
  Speaker 2: Like that's your introduction.
• 24:15
  Speaker 2: It's not like, oh, this is what my degree is in.
• 24:18
  Speaker 3: Yeah, I kind of giggling shyly about it.
• 24:20
  Speaker 3: No, it's step up.
• 24:21
  Speaker 3: You worked hard for us.
• 24:22
  Speaker 3: You paid for us in different ways.
• 24:25
  Speaker 3: Yeah, I'm on us on is enjoy us.
• 24:28
  Speaker 1: Yeah, I love that, especially as a new mom myself, like I feel like they're.
• 24:32
  Speaker 1: It's actually interesting.
• 24:33
  Speaker 1: There's like an identity in being a new mom and being like, oh, this is like an extra hard part of it, but it's hard for everybody, whether you have it or not.
• 24:43
  Speaker 1: So it's just like, yeah, I run two businesses and I have a kid and like that's it just is what we're doing, like I'm a entrepreneur, not a mom, plus something else, kind of on the side.
• 24:56
  Speaker 3: Yeah, yeah, yeah, absolutely.
• 24:58
  Speaker 3: You're a businesswoman, you're a grownup yeah, freaking awesome.
• 25:03
  Speaker 2: Love it, love it and I think this is a segue because you gave us Abby Walnut.
• 25:08
  Speaker 1: We're doing that.
• 25:10
  Speaker 2: So we're talking World Cup, what are you doing with the World Cup?
• 25:12
  Speaker 2: We were talking before we get on and you're just like oh yeah, world Cup is in Australia.
• 25:16
  Speaker 2: So I've been focusing a lot on that.
• 25:17
  Speaker 2: So I'm taking that kind of opportunity you gave me by just mentioning a female soccer player.
• 25:22
  Speaker 2: And what the heck is going on, michelle, with the World Cup?
• 25:27
  Speaker 3: I had this really great opportunity.
• 25:29
  Speaker 3: Have you ever heard the saying have the sorts of friends who would mention your name in a room full of opportunities?
• 25:35
  Speaker 3: I'm really lucky that I do have friends like that, because Emma Brockwell and Sinead Dufort you know, of course, they're rock stars.
• 25:44
  Speaker 3: You know them.
• 25:44
  Speaker 3: They've been working with FIFA over the past year on their new women's health statement and they needed somebody to come in and contribute to the menopause section, and you know that's one of my passion projects as well.
• 25:56
  Speaker 3: So I've been working with an amazing global team with FIFA to really bring their women's health position statement, because we know that the biggest killer of women worldwide is heart disease and we want to keep women physically active and engaged in sport for as long as possible.
• 26:13
  Speaker 3: So just because your career as a player at an elite level or at an amateur level that might be coming to a close from a first team perspective, we know that many women are getting into coaching or refereeing and we want to look at some of the challenges that they might be facing and, of course, what we're going to do about it.
• 26:28
  Speaker 3: So I've been working on compiling all the research and making action plans about this and then part of the reward for doing all of that is yeah, I'm going out to Sydney for the World Cup finals in August, so I will fill you in when I see you in September.
• 26:42
  Speaker 3: Yeah, yeah, you're going to have to, Unless I get arrested for stalking Abby Wamba, because you know that's a possibility too.
• 26:49
  Speaker 1: Dude.
• 26:49
  Speaker 1: But that is really, really awesome and talk about a way to make an impact by using our knowledge in a different way, like that is so cool, it's very exciting.
• 27:00
  Speaker 3: I'm really honored and yeah.
• 27:02
  Speaker 3: I still a little bit of getting over the imposter syndrome.
• 27:04
  Speaker 3: Business at first, you know, but Michelle, Lyons has a heart syndrome.
• 27:09
  Speaker 1: Like news flash, it hits everybody.
• 27:12
  Speaker 1: It hits everybody, it's there.
• 27:15
  Speaker 2: You are going to be, michelle, been racking up the frequent flyer miles, going from Ireland to Sydney, back to Ireland and then joining us in Atlanta for Pelvicon in September.
• 27:27
  Speaker 2: This is.
• 27:28
  Speaker 2: We are so excited for this, and we get to talk about your topics here on the podcast.
• 27:34
  Speaker 2: So, nicole, what do?
• 27:35
  Speaker 1: we have to talk about.
• 27:36
  Speaker 1: Michelle is going to be talking about Pelvicon 2023.
• 27:39
  Speaker 1: Number one, the evil triplets of pelvic pain icy endo and penenaleralgia, and living well after his drachyme.
• 27:46
  Speaker 1: Michelle, are you excited about these topics?
• 27:50
  Speaker 1: Obviously.
• 27:52
  Speaker 3: I am super excited about these topics because, oh you know what, this is where we can shine in managing people who've gone through these diagnoses and really elevate their quality of life.
• 28:05
  Speaker 3: And the evidence is there to support us People who, you know, particularly with endometriosis.
• 28:12
  Speaker 3: I was at the World Endo Congress in May in Edinburgh and what was really refreshing about that was there was a really strong emphasis on the role of both nutrition but also of physio to help people live well, because there's a really there's a high failure rate in terms of surgical management for endo.
• 28:29
  Speaker 3: We know that people can have persistent pain after medical management or surgical management, and this is where we shine, and so it was great to see researchers showcasing this and getting a little you know, a lot of buy-in, I felt, in the medical community who were there.
• 28:44
  Speaker 3: I would say probably out of the 300 people at the conference, I'd say it was maybe a dozen physios there, but we made our presence known, we were there, and that, for me, is really important because if we can get everybody on the team sailing in the same direction, that's going to help people live well with these diagnoses.
• 29:05
  Speaker 3: Big emphasis on things like central sensitisation, which I feel is really having a moment in pelvic pain, particularly some great research coming out about that.
• 29:13
  Speaker 3: Natasha Orr published a paper just earlier this year showing that if you use the CSI to check for central sensitisation, we don't have to guess.
• 29:21
  Speaker 3: We can actually assess it and test for it.
• 29:23
  Speaker 3: But does it cut off a 40?
• 29:25
  Speaker 3: And that is really high specificity and sensitivity for endometriosis.
• 29:30
  Speaker 3: And there's such an overlap between central sensitisation and inflammation.
• 29:35
  Speaker 3: And again, we have the usually have the gift of time with the people that we're working with who have endo, so we can talk about things like sleep, about pacing, about non-no-susceptive manual therapy but using things like TENS machines, about really getting the lifestyle stuff bang on point and then adding on the pelvic floor element and getting back into movement again.
• 29:57
  Speaker 3: And that's actually got a really good and growing body of evidence behind it.
• 30:02
  Speaker 3: I would say particularly over the past three years that's really expanded our horizons and we need to embrace that.
• 30:08
  Speaker 3: It's a whole body inflammatory condition.
• 30:12
  Speaker 3: I still think surgical excision, preferably with histological confirmation, is the best we probably have at the moment.
• 30:19
  Speaker 3: But honestly that's not always available to everybody for socioeconomic or geographical reasons, or maybe they just don't have the capability of going for surgery.
• 30:29
  Speaker 3: Now they're choosing to manage their symptoms medically and with lifestyle interventions.
• 30:34
  Speaker 3: So people have a buffet of choices and they make those choices and it's our job then to support them, and we have a great toolbox.
• 30:41
  Speaker 3: I'm going to be sharing some of the evidence around the components of that toolbox when we meet up in September.
• 30:47
  Speaker 3: But I'm hoping to take some of the fear away from diagnoses like that because I feel like they can be a little bit scary.
• 30:54
  Speaker 3: If you know, you've got somebody with endo or with IC or with pudendal issues coming in.
• 31:00
  Speaker 3: I see again and again in all the pelvic rehab groups.
• 31:03
  Speaker 3: But is there any evidence for how we can help people after hysterectomy that after Peltocon you will be able to say yes?
• 31:11
  Speaker 1: and here it is Again, awesome.
• 31:13
  Speaker 1: You know, I do want to go back to.
• 31:15
  Speaker 1: It's interesting.
• 31:16
  Speaker 1: I love that you point out that we have a huge role to play with endo, but there is a medical management piece that needs to also be addressed.
• 31:23
  Speaker 1: I think that IC is one of those diagnoses too that is now starting to.
• 31:28
  Speaker 1: It was just reclassified as a primary pain condition and it's not a bladder condition anymore, as the name might trick everybody to think.
• 31:35
  Speaker 1: That the central sensitization part of all of these condition is really where, like you said, we shine and we can look at the neuromuscular and musculoskeletal underpinnings of the pain generating issue and then also make sure that they're managed in a different way.
• 31:52
  Speaker 1: But it's not either, or it's both, and like we have a role to play simultaneously, and I feel like sometimes the maybe you can speak to this too.
• 32:00
  Speaker 1: I don't know if you see this in the field as well, but I feel that sometimes, like the more complex the patient for me, I get the most excited.
• 32:07
  Speaker 1: I'm like, oh my gosh, we have so much that we can do, and I feel like sometimes that can be really overwhelming, especially to a new grad.
• 32:13
  Speaker 1: What would you say to a new grad that is overwhelmed with somebody that comes in with that evil triplets diagnosis, the IC, and though and they, you find out that they have penile nerve involvement.
• 32:24
  Speaker 1: Like what would you say to that new therapist that's like, oh my gosh, I think I need to send them right back to their physician.
• 32:29
  Speaker 1: I don't know what to do.
• 32:30
  Speaker 1: What would you say to?
• 32:31
  Speaker 3: them.
• 32:32
  Speaker 3: The most important thing that you bring to the table is a regulated nervous system.
• 32:38
  Speaker 3: I am never going to stop saying this, because the energy that you project, without getting too woo, is going to set the tone.
• 32:45
  Speaker 3: If you were projecting an air of overwhelm and panic, the patient will pick up on this.
• 32:50
  Speaker 3: These are people you know with the end up.
• 32:52
  Speaker 3: Particularly we know that, if you look at the recent literature, anywhere from seven to 12 years is the length of time from onset of symptoms to diagnosis that's not even counting to commencement of appropriate treatment.
• 33:04
  Speaker 3: So these people have been gasless.
• 33:06
  Speaker 3: They've had bad treatment options offered to them, they've had a lot of promises made to them and now they're coming to see you.
• 33:13
  Speaker 3: So the most important thing, as they say in the hitchhiker's guide to the galaxy, the most important thing is not to panic.
• 33:18
  Speaker 3: Okay, calm energy, all right, and then find out what their biggest problem is, find out what their goals are and then baby steps, to kind of paraphrase Greg layman, we want to calm things down and then we're going to build things up again.
• 33:34
  Speaker 3: So we use our manual.
• 33:36
  Speaker 3: Therapy has a huge role to play in central sensitization.
• 33:39
  Speaker 3: I'm not saying that we all need to go off and be amateur psychologists dealing with this.
• 33:44
  Speaker 3: What we do have to be those psychologically informed.
• 33:47
  Speaker 3: If we're working with people with persistent pelvic pain, and that's really important, so we use things to calm the system down.
• 33:55
  Speaker 3: We're looking for non, no susceptible inputs here.
• 33:57
  Speaker 3: We're looking for quick wins To start getting a little bit of success.
• 34:03
  Speaker 3: If something is painful to move, we don't go near that.
• 34:05
  Speaker 3: You know, for people with endo, particularly if they have like deep infiltrating endometriosis, I steer people away from doing a lot of internal work because you know and loves to live in that space between the vagina and the rectum and on those usual sacred ligaments and if you're going straight in to internal work you're flaring things up without having the capability of settling things down.
• 34:28
  Speaker 3: You're probably never going to see that person again, whereas if you can start peripherally calm the system down talking about using a tens machine you know Fiona Rogers and I did a chat on my YouTube channel last year looking at 10s for endometriosis it's a great low cost way to get good buy in, to start moving things in the right direction.
• 34:48
  Speaker 3: The most important thing that you can do is believe patients when they tell you their story as well and just find out what matters to them and then say, yes, I've seen this before, I have a plan.
• 34:59
  Speaker 3: What do you think?
• 35:01
  Speaker 3: you know, ask them what's worked for them in the past, what hasn't worked for them in the past, and really just get specific on their goals.
• 35:09
  Speaker 3: But it's all about calming their nervous system down and once you've got a little bit of buy in with the brain and the nervous system, then you start progressing down that road of opening up some horizons for them in terms of movement or functional goals.
• 35:23
  Speaker 1: Wonderful.
• 35:24
  Speaker 1: That is some freaking great advice.
• 35:26
  Speaker 1: I feel like you'll need to bookmark this podcast and like listen to it again when you're freaking out about like how can I help this person?
• 35:34
  Speaker 1: You can help them.
• 35:35
  Speaker 1: This is awesome, great.
• 35:37
  Speaker 2: Awesome.
• 35:37
  Speaker 2: One of the things we've been doing on the podcast recently, michelle is a series.
• 35:40
  Speaker 2: Nicole calls a missing piece things that are overlooked, dismissed, maybe pushed aside and not done early enough, potentially in a plan of care For one or both of your topics.
• 35:51
  Speaker 2: Is there a missing piece that you feel like you know we're?
• 35:54
  Speaker 2: We're just kind of, you know, brushing over that we should be paying a lot more attention to.
• 35:59
  Speaker 3: So I'm going to surprise you and not go for bowel health here, because you know I'm moderately obsessed with constipation.
• 36:06
  Speaker 3: I am just going to say that if somebody has IBS type symptoms or painful bowel movements with a cyclical pattern, there's a really high probability that it is endo.
• 36:17
  Speaker 3: So I'm just going to put that out there.
• 36:18
  Speaker 3: We just kind of a segue into what I think is the missing piece, and the missing piece is that we should all be asking people who menstruate, people who have a usress about their menstrual cycles, about their hormonal health.
• 36:30
  Speaker 3: You know we were chatting a little bit before we came on and I taught for Herman Wallace for years about pelvic pain, about all the things, and we didn't really talk about the hormonal impact, about knowing what's happening at each phase of the menstrual cycle, about looking for patterns.
• 36:47
  Speaker 3: You know, with that, like some staff, 50% of people with IC have endometriosis.
• 36:54
  Speaker 3: But are we always asking those folks about is there any correlation with your period?
• 36:59
  Speaker 3: I wrote down some numbers here 63% of people with endo have IBS, 40% of them have pelvic floor dysfunction, 32% of them have abdominal wall pain and then between 33 and 74% of people with endo have provoked vestibular dynea.
• 37:16
  Speaker 3: If we are not asking people with these diagnoses about their menstrual history as well as their obstetric history.
• 37:24
  Speaker 3: I think we're really missing the boat here in terms of helping them get to grips with what's actually going on and building a picture.
• 37:31
  Speaker 3: And I will say oftentimes, because we have that little bit of extended time in that relationship with people, you might be the first person to put the piece of you know the puzzle together that it could be endometriosis.
• 37:44
  Speaker 3: Like if you've had a referral from a gastroenterologist, someone's coming to see you with IBS, but it's only really bad cyclically around the menstrual cycle.
• 37:53
  Speaker 3: Then automatically, like if you take nothing else away from this chas, take this.
• 37:58
  Speaker 3: Please.
• 37:59
  Speaker 3: Think that it could possibly be endometriosis, because delayed diagnosis and treatment really allows the disease to progress.
• 38:07
  Speaker 3: We can do better in helping people with endo live well and supporting them in getting good diagnoses and treatment for their cause.
• 38:16
  Speaker 3: So ask people to track their cycles, look for any symptoms and we're seeing that really coming out in the research now and looking at athletes and pelvic floor dysfunction, looking at endo.
• 38:26
  Speaker 3: But again, like all these disparate diagnoses as well, most of them will have some sort of hormonal input here as well.
• 38:34
  Speaker 3: So understand the role of estrogen, understand its mighty powers and how it can influence everything.
• 38:40
  Speaker 3: Whether we're talking about pelvic pain, whether we're talking about musculoskeletal issues of menopause and tendinopathies, it really, really matters.
• 38:49
  Speaker 3: You know, and understanding, even at a kind of granular level, the effect of estrogen fluctuations on vulvar health, if you're seeing somebody who you suspect maybe in a low estrogen state, would you recognize the signs of that?
• 39:03
  Speaker 3: Are you aware of the latest position statement from NAMS about topical estrogen therapy and what that might mean?
• 39:09
  Speaker 3: Because there's a lot of physicians out there who were still back in 2002 with the WAI study.
• 39:17
  Speaker 1: It's been 20 years Seriously get it together and we can be the first people to like, seriously like what?
• 39:24
  Speaker 1: Yeah, and for those of you who don't know, that means the NAMS is the North American Menopause Society has a position statement on the fact that estrogen, especially topical estrogen, but even other estrogen can be extremely beneficial for people, for folks for genitogernary symptoms, and also not harmful, and that's the biggest takeaway.
• 39:44
  Speaker 3: Even if you've had breast cancer.
• 39:45
  Speaker 1: Yes, that's the thing, and so it can be a way for us to allow.
• 39:51
  Speaker 1: This is actually one of the only times that I will lead with like a paper or something for like a person to go home with.
• 39:59
  Speaker 1: Normally I'm not like a huge proponent of here's this research paper patient who doesn't really care, but this sometimes is like it's well written, it's easy to understand and it's something that they can be like oh, that's exactly opposite of what my physician said.
• 40:14
  Speaker 1: Holy crap, like this is weird.
• 40:16
  Speaker 1: And then they can come back to us and be like oh, what did that make you feel like?
• 40:19
  Speaker 1: And there's a lot of fear around estrogen.
• 40:22
  Speaker 1: But I think that me going through my IVF cycle and stuff actually got me a lot more interested in my own hormonal cycle.
• 40:30
  Speaker 3: Yeah.
• 40:31
  Speaker 1: On IVF.
• 40:31
  Speaker 1: You basically manipulated all to get everything already for baby and stuff like that, and so we actually came back from that type of stuff.
• 40:40
  Speaker 1: And then I'd taken your course as well, your hormone course, and we did a whole revamp here at Public Sanity about, hey, like remember what's happening?
• 40:50
  Speaker 1: What does it mean to be in the luteal phase?
• 40:53
  Speaker 1: What does it mean to be in the ocular phase?
• 40:55
  Speaker 1: Yes, and we had I mean, there was a lot.
• 40:57
  Speaker 1: We would have gotten an F on a multiple choice test.
• 41:00
  Speaker 1: As a group, we would have failed a test on it at the beginning.
• 41:05
  Speaker 1: It's something just to go back to.
• 41:06
  Speaker 2: you know we forget, and that's where I want to.
• 41:08
  Speaker 2: You know.
• 41:09
  Speaker 2: The second, like the follow up there, michelle, is you know you mentioned that.
• 41:11
  Speaker 2: You know you've been teaching for Herman Wallace.
• 41:13
  Speaker 2: You hadn't heard any of this stuff, hadn't taught me this.
• 41:17
  Speaker 2: Is this your course, that people need to?
• 41:18
  Speaker 2: If someone's listening to this podcast and I know I'm asking you to teach your own horn, but you know all you know I feel like you have a finger on the pulse of the field.
• 41:26
  Speaker 2: If somebody is listening to this and feeling a little bit called out or like, oh, I know I should be doing that, but I don't.
• 41:31
  Speaker 2: I mean, yeah, I send them home with a menstrual tracker, but then I get it back and I don't really know what I'm looking for.
• 41:36
  Speaker 2: Where do they go?
• 41:37
  Speaker 2: Like, what would be the next step you would give to somebody who's interested and wants to learn how to do this?
• 41:43
  Speaker 3: It's kind of like Sophie's choice that asked me to pick my favorite child.
• 41:46
  Speaker 3: But yeah, it is my favorite child my hormonal course, because you know we go from menstrual to maternal, to menopause and just to to understand the effects that hormones are going to have on pelvic health but also on the person attached to that pelvis as well.
• 42:01
  Speaker 3: So we talk a lot about, you know, in that low estrogen state when you're postnatal and perimenopausal, you know that's probably not the time to be going for your PB because your tendons are going to be missing that estrogen You're going to need to know.
• 42:13
  Speaker 3: You know that in the luteal phase you're probably going to be trending a little bit more towards constipation, but then when you start your period you're probably going to be trending a little bit more towards diarrhea, just because the dance between progesterone and the prostaglandins.
• 42:25
  Speaker 3: And it's to be able to talk about these things with some confidence, to understand that estrogen has a direct effect on muscles and tendons and ligaments and connective tissue and mental health and all the things, but to be able to talk to your patients about that with some authority, no matter what life stage they're at.
• 42:43
  Speaker 3: If they're a young, elite female athlete, you're worried about reds.
• 42:45
  Speaker 3: So being able to ask them about their period, because we still see a lot of younger female athletes looking at losing their period as kind of this badge of honour yes, I'm training hard enough, my period has stopped and we have to be like, hmm, probably not a great idea, and possibly even from a sporting performance perspective, would we recognize the signs of anemia?
• 43:07
  Speaker 3: You know, it's not just about feeling tired.
• 43:09
  Speaker 3: It could be manifesting as breathlessness, just your legs feeling really heavy when you're going for a run.
• 43:14
  Speaker 3: But insomnia is another side effect of anemia.
• 43:17
  Speaker 3: So just knowing, as I said, the mighty powers of estrogen throughout the female life cycle if we are going to work in female pelvic health, I think it was really.
• 43:27
  Speaker 3: It was a missing piece for me.
• 43:28
  Speaker 3: So then again, you know what I'm like.
• 43:31
  Speaker 3: I had to get on my soapbox and tell everybody else about it, just want to help and make sure everybody else is as excited about estrogen as I am Wonderful.
• 43:37
  Speaker 2: Wasn't that the way that great courses are done?
• 43:39
  Speaker 2: Right?
• 43:39
  Speaker 2: You're creating something that you wish had been available for you when you were looking for this.
• 43:44
  Speaker 3: That was really my goal.
• 43:45
  Speaker 3: To be perfectly honest, I usually end up saying that about all my courses, because right now kind of a lot of my work is focused around oncology rehab and so I created courses that because I was doing research to create evidence based strategies for the people I'm working with.
• 44:00
  Speaker 3: I was looking around to see if anybody else had done it before.
• 44:02
  Speaker 3: So I didn't have to reinvent the wheel and it wasn't out there to what I wanted and needed.
• 44:06
  Speaker 3: So that's really been my kind of MO.
• 44:10
  Speaker 3: If I see something is missing and I need it, I figure other people might need it and benefit from it as well.
• 44:16
  Speaker 1: Yeah, absolutely hey.
• 44:17
  Speaker 1: I have one other quick question regarding hormone stuff.
• 44:19
  Speaker 1: When you identify potentially with when you get a patient and you've had them now track their mental cycle for, I'm assuming, a couple of months and then you're kind of like, okay, I think we actually see a pattern here.
• 44:30
  Speaker 1: When you refer them back out to their physician, are you requesting that they get hormone testing done at different parts of their cycle or are you just doing like a day three sort of what has your experience been it?
• 44:45
  Speaker 3: depends.
• 44:46
  Speaker 3: Certainly, if somebody is over 45 or they're in perimenopause, there's really no point in doing blood work because everything is fluctuating wisely at that point and because some months you're ovulating, some months you're not.
• 44:57
  Speaker 3: So we generally just say if you're over 45, we have a working diagnosis of perimenopause and that's the current nice guidelines you know would support that, because you could literally have different levels of estrogen and FSH from one day to the next.
• 45:12
  Speaker 3: If somebody is in a state of low estrogen, it's going to be fairly obvious from, you know, looking at their vulva but also tracking their symptoms as well.
• 45:22
  Speaker 3: And so generally we can obviously get blood work, particularly say, for example, if we suspect somebody is in premature ovarian insufficiency, kind of early onset menopause, and that's really important because we have to be very protective of their bone health.
• 45:39
  Speaker 3: Like estrogen is kind of, you know, it can be either angel or devil depending on the type of estrogen we're talking about and the levels that we're exposed to.
• 45:46
  Speaker 3: It feeds endometriosis, it certainly drives it.
• 45:49
  Speaker 3: We know that after menopause the type of estrogen that we have estrone can be provocative for certain cancers like breast cancer and endometrial cancer.
• 45:57
  Speaker 3: So estrogen is about four different chemical relations siblings, and their family name is estrogen and it's really.
• 46:05
  Speaker 3: It's about understanding the symptoms and then being able to say look, I think you need to go back to your GP and ask about this, this and this.
• 46:11
  Speaker 3: And that's where I can get a little bit tricky.
• 46:14
  Speaker 3: If someone's on an oral contraceptive, to be perfectly honest, because you know we talk about the menstrual cycle being the fifth vital sign but if someone's on the pill, that's all blunted, you know, and it just makes it a little bit more tricky, particularly if you've got somebody maybe with hormonally driven pelvic pain issues, I would say particularly particularly with the pain issues, particularly particularly around the vestibule.
• 46:36
  Speaker 1: Yeah, Also.
• 46:37
  Speaker 1: I mean, we can talk about that for hours and days.
• 46:40
  Speaker 2: One thing I want to just quick point out from what your guys is we're talking about there going back to like a little bit of the business cycle and the role.
• 46:48
  Speaker 2: Right, you guys just casually talked about, cool, we're going to do menstrual tracking for two or three months.
• 46:53
  Speaker 2: You guys might not even realize the implication is like you're working with people for two to three months this is not four or five business until their insurance kicks them off and it's gone, like you can't do some of these things that you guys are talking about.
• 47:05
  Speaker 2: I think it's kind of cool that it's like the air that you guys breathe, but some people out there in some insurance practices are saying like I've never actually worked with somebody for long enough to track three cycles through the thing.
• 47:15
  Speaker 2: So it was just an interesting aside for me.
• 47:18
  Speaker 2: But you guys need to be following Michelle's stuff podcast.
• 47:22
  Speaker 2: Michelle celebrate moolibri.
• 47:24
  Speaker 2: I'm butchering pronunciation, I'm sure.
• 47:26
  Speaker 3: So close, so close.
• 47:29
  Speaker 1: Wait, say it again.
• 47:31
  Speaker 3: Muley Ebrity.
• 47:32
  Speaker 2: Muley Ebrity.
• 47:34
  Speaker 3: There you go.
• 47:35
  Speaker 2: Come here, michelle, we do this, and then I say it, and then you tell me I'm right, but it still doesn't sound half as good as you do, and I think it's the accent.
• 47:42
  Speaker 3: Oh, you're very kind, we'll go with that.
• 47:44
  Speaker 3: You're getting better, jesse.
• 47:45
  Speaker 3: You are getting better.
• 47:46
  Speaker 2: Yes, that's all we can do right, be better, better than yesterday.
• 47:49
  Speaker 2: We'll put all of your links to the course, to everything else, in the show notes as well, but be following you on Instagram.
• 47:56
  Speaker 2: We always want to close with a little bit of a lightning round.
• 48:00
  Speaker 2: So, michelle, if you are ready, what is the most Irish thing about you?
• 48:05
  Speaker 3: Why use one word from 50 will do Great.
• 48:11
  Speaker 2: Isn't that the exact opposite of poetry, though you guys must have like a great relationship.
• 48:18
  Speaker 3: Well, we just had our 25th anniversary at the end of last year, so it's going OK.
• 48:22
  Speaker 3: It's going all right, cool.
• 48:25
  Speaker 1: Michelle, do you have any pets?
• 48:27
  Speaker 3: little fur baby friends I do.
• 48:30
  Speaker 3: I have a rather emotionally needy, neurotic German short-haired pointer, Stella the dog.
• 48:37
  Speaker 3: She's a rescue, so we're not sure how old she is, but she thinks she's kind of, you know, Showa-sized, but she is.
• 48:45
  Speaker 3: She's a curvy lady, shall we say.
• 48:48
  Speaker 3: She's embraced her inner chunk, but she is.
• 48:50
  Speaker 3: She's our pet and she very much rules the roast in our house Wonderful.
• 48:55
  Speaker 2: I love that.
• 48:55
  Speaker 2: What's something that you're really excited about in our field?
• 48:59
  Speaker 3: I am excited about expanding horizons, I think, like we started talking about at the top of our chat here, I think we are going to take him maybe a little bit of a leaf out of our nursing colleagues book in terms of expanding our roles, but I think we can actually take us a step further than they have because we already have that kind of framework for private practice.
• 49:19
  Speaker 3: So this side of the Atlantic, physios have always had direct access in private practice.
• 49:24
  Speaker 3: It's not a new thing here at all.
• 49:26
  Speaker 3: So we've always had that kind of level of autonomy here and I'm seeing that mindset kind of creeping in now in the US as well, which gladdens my heart because there's so much knowledge and so much information that we have to impart outside of a medical approach or a surgical approach.
• 49:45
  Speaker 3: It's very exciting to me because we know this.
• 49:49
  Speaker 3: I did an Instagram post recently asking could pelvic rehab save lives?
• 49:52
  Speaker 3: And yes, it can, because, as I said, heart disease is the biggest killer of women worldwide and Jodi Dacic did a great study 2021, showing that for one in two women, pelvic health is a barrier to exercise.
• 50:10
  Speaker 3: Now we know that exercise lowers your cardiovascular risk by about at least 30 percent and people who exercise are more likely to make better health related quality of life choices like nutrition and all that sort of stuff.
• 50:21
  Speaker 3: So literally by changing somebody's pelvic health, you could be saving their lives, and that excites me.
• 50:30
  Speaker 1: Really a huge role for us to play into remember All right.
• 50:34
  Speaker 1: Last question, Michelle If you were not a physio, what would you be doing?
• 50:43
  Speaker 3: I would be a librarian, yes, yes, I'd be with all my book friends all day.
• 50:48
  Speaker 3: That's a nice, that's a nice thought, that's a neat little picture of like in an ultimate universe.
• 50:54
  Speaker 1: Michelle is a librarian somewhere.
• 50:56
  Speaker 2: Clearly never been yelled at by a librarian to be quiet.
• 51:00
  Speaker 3: Oh, you see, I can already do that.
• 51:01
  Speaker 3: I've already got that skill.
• 51:04
  Speaker 2: Perfect, Awesome.
• 51:05
  Speaker 2: Well, Michelle, thank you so much for being on and in terms of what you're excited about expanding our role, expanding our horizon, I mean that's something that you are on the forefront of doing and we're so excited to bring in you on the podcast, to have you at Pelvicon.
• 51:18
  Speaker 2: I think that's something that it's really been cool to see and get to know you a little bit over the last couple of years.
• 51:23
  Speaker 2: So just appreciate you so much and I'm so excited for those of you who have not had a chance to listen to Michelle speak live to actually get to hear her at Pelvicon.
• 51:30
  Speaker 2: It is going to be so much fun.
• 51:32
  Speaker 1: Special for sure.
• 51:33
  Speaker 1: All right, thanks, michelle, appreciate it.
• 51:35
  Speaker 3: Love you guys, thank you.
• 51:39
  Speaker 2: Nicole.
• 51:40
  Speaker 2: Every time we talk with Michelle, I feel like it could just go on for forever.
• 51:44
  Speaker 1: Every time.
• 51:44
  Speaker 1: I seriously feel like I could talk to her for forever, but I did want to pull out one thing for all y'all who think you have a little bit of imposter syndrome.
• 51:56
  Speaker 1: Michelle Lyons admitted on the PelvicPT Rising podcast that she's got a little bit of this imposter syndrome when she's going to the FIFA World Cup and doing all of the really amazing things with women's health that she's doing there, and so if any of you are like I can't do this because I'm not sure about myself, blah, blah, blah I want you to remember that it happens to us all.
• 52:22
  Speaker 1: I have said it sometimes.
• 52:23
  Speaker 1: Michelle Lyons has it sometimes, and so you just got to get past it and do the thing.
• 52:30
  Speaker 2: Yes.
• 52:30
  Speaker 2: So, guys, I hope you really enjoyed this conversation with Michelle.
• 52:34
  Speaker 2: Make sure to check her out on social media.
• 52:37
  Speaker 2: If you haven't already, I'd love to getting into diving into this.
• 52:40
  Speaker 2: If you have not yet purchased your recording and you're not going to be able to come, make sure to go to PelvicConcom Slash recording, do that.
• 52:47
  Speaker 2: You've got three days left to get that early bird discount.
• 52:50
  Speaker 2: You're going to want to do that, and so don't be kicking yourself for not getting that before we get started.
• 52:56
  Speaker 1: And then make sure to follow Michelle and listen to her podcast on the celebrate Amulia Britti podcast, which is new and it's about 10 episodes, and Jessica Riala has been on that podcast.
• 53:08
  Speaker 1: I've been on that podcast beyond the Rogers a bunch of really cool people in our field and of course it's a wonderful to listen to Michelle.
• 53:17
  Speaker 2: Absolutely so, guys, as always, please reach out to us.
• 53:20
  Speaker 2: Let us know if you enjoyed this podcast.
• 53:22
  Speaker 2: If you did, please drop five stars and a review in the comments.
• 53:26
  Speaker 2: Make sure you subscribe.
• 53:27
  Speaker 2: As always, we want to keep this conversation going.
• 53:31
  Speaker 1: And let's continue to rise.