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Female Pelvic Health with Dr Sarah Apple | SexPharmD · Pharmacy Podcast Network

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  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
• 0:37
  Speaker 2: This is the sex farm D podcast with your host, Dr.
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  Speaker 2: Nadia Archambault, licensed clinical pharmacist and certified sex therapist. With
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  Speaker 2: a focus on women's sexual health and wellness, Dr. A
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  Speaker 2: is here to cover important health topics and answer all
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  Speaker 2: of your questions about subjects that can be applied to
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  Speaker 2: pharmacy practice. And now, here's Dr. A.
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  Speaker 1: Hi, everyone. Welcome back to another episode of Sex Farm D. Today,
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  Speaker 1: I have a really amazing guest. I'm so happy to
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  Speaker 1: have you on, Dr. Sarah Apple with Happy Pelvis Cookville. Welcome.
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  Speaker 3: Thank you.
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  Speaker 1: I'm so happy to be here. Um, I met you,
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  Speaker 1: was it, it must've been over six months ago, right?
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  Speaker 1: Just trying to remember.
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  Speaker 3: I think I was still on maternity leave.
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  Speaker 1: Yes, that's right. Um, and so the reason why I
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  Speaker 1: have Dr. Apple on today is because she does something
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  Speaker 1: that a lot of other clinicians are not doing. And
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  Speaker 1: I think it's really cool that you're doing it for
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  Speaker 1: a woman. So I'm going to have you introduce yourself
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  Speaker 1: and what it is that you do so our listeners
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  Speaker 1: can hear all about it.
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  Speaker 3: Sure. Thank you. Yes. So I am Sarah Apple. I
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  Speaker 3: am a occupational therapist who specializes in pelvic floor therapy.
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  Speaker 3: I specifically work with adult women. So treating pregnancy, postpartum symptoms,
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  Speaker 3: any type of urinary or fecal leakage, prolapse. I always
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  Speaker 3: kind of try to say it like any of those
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  Speaker 3: classic symptoms you hear women kind of dismiss or talk about.
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  Speaker 3: That's what I kind of help with.
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  Speaker 1: Yeah. And I think that's amazing because I've worked as
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  Speaker 1: a sex therapist. I've worked with physical therapists, occupational therapists
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  Speaker 1: who help patients with issues like vaginismus, pelvic pain. And
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  Speaker 1: I had no idea that was even, that was even
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  Speaker 1: a specialty or a thing. And I commend you. I
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  Speaker 1: think it's really, really incredible. How did you get into
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  Speaker 1: that practice? What drew you into that?
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  Speaker 3: Yeah, honestly.
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  Speaker 1: So I was in grad school.
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  Speaker 3: I also hadn't really heard anything about it. And there
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  Speaker 3: was a student that was a few years older than me.
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  Speaker 3: She was doing her, we have a capstone is what
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  Speaker 3: we call it, which is a student led project basically.
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  Speaker 3: And she was doing it in just pelvic floor therapy
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  Speaker 3: in general. And I was just like, that's the coolest
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  Speaker 3: thing ever. And then, of course, when you dive into
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  Speaker 3: the research more, it's this huge need on all spectrums, men, women, kids.
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  Speaker 3: And that need is just not being met. There's definitely
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  Speaker 3: more advocacy and education around it, but it's still very
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  Speaker 3: limited even today.
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  Speaker 1: It is limited. It's hard to find. And it's hard
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  Speaker 1: to find someone like yourself where that's what you specialize in.
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  Speaker 1: That's what you do. I've worked with some physical therapists
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  Speaker 1: who do like a little bit of everything and they
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  Speaker 1: can't specialize on just that one thing because they don't
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  Speaker 1: have the time to commit or the practice they're in
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  Speaker 1: wants them to see patients doing all different things. So
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  Speaker 1: I think that's really cool.
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  Speaker 3: Yes, it's super fun.
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  Speaker 1: Yeah. Now I've worked with patients who have... basically ones
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  Speaker 1: with pelvic pain, vaginismus, and endometriosis. So walk me through
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  Speaker 1: how you handle patients that come to you with something
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  Speaker 1: like pelvic pain, for example. I know they use a
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  Speaker 1: pelvic dilator, but for some of the listeners, they might
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  Speaker 1: not know what that is.
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  Speaker 3: Sure. So I kind of take an approach. So any
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  Speaker 3: type of like pain, right? Our body has a response
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  Speaker 3: to it. And, you know, thinking on my side of
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  Speaker 3: like the physical rehab of it, typically with pain muscles
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  Speaker 3: like to clench down. And it's just a protective mechanism.
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  Speaker 3: That's what I kind of tell all my clients. I'm like,
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  Speaker 3: it's just your body's doing what it's naturally wants to
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  Speaker 3: do to protect you. So a lot of that is,
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  Speaker 3: and also the nervous system a little bit as well,
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  Speaker 3: of course. So with pelvic floor therapy, you know, we
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  Speaker 3: do a lot of nervous system down regulation. So making
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  Speaker 3: sure we're able to stimulate the vagus nerve. I don't
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  Speaker 3: know how nerdy I should get with all of this.
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  Speaker 1: We have a lot of pharmacists, healthcare professionals. So the nerdier,
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  Speaker 1: the better.
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  Speaker 3: Okay, perfect. So a lot of pelvic floor therapy, I
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  Speaker 3: do a lot of breath work as well. So making
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  Speaker 3: sure we're able to actually get a nice deep breath.
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  Speaker 3: So we are stimulating the vagus nerve to really tap
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  Speaker 3: into that rest and digest nervous system. which then again
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  Speaker 3: is also going to help with any just muscle tension
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  Speaker 3: that maybe somebody's having. Um, and of course, specifically kind
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  Speaker 3: of going more.
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  Speaker 1: To like pelvic floor.
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  Speaker 3: So those muscles that sit right in the pelvis, um,
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  Speaker 3: that's causing like pain with intercourse or pain with like
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  Speaker 3: endometriosis or menstruation, things like that. Um, again, those muscles
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  Speaker 3: sometimes like to tighten down or just certain ones like
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  Speaker 3: to tighten down. So going in there and either doing
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  Speaker 3: manual therapy, using things like the dilators that you mentioned
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  Speaker 3: or a pelvic wand, um, those are sometimes approaches that
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  Speaker 3: I'll take with those clients.
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  Speaker 1: Yeah, and it's my understanding that they can take, they
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  Speaker 1: purchase the pelvic dilator, they can bring that home, do
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  Speaker 1: exercises at home, and then do also pelvic floor exercises
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  Speaker 1: at home. Because when I've worked with some patients, I
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  Speaker 1: kind of hold them accountable and say, okay, have you
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  Speaker 1: used your pelvic dilator this week? You know, have you
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  Speaker 1: done your exercises kind of thing? Yes, absolutely. Yeah, no,
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  Speaker 1: I think that's great. And it's so hard, you know,
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  Speaker 1: sometimes with this pelvic floor plan, floor pain, it can
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  Speaker 1: a lot, some of it can stem from trauma. So
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  Speaker 1: in your experience, you know, what have you seen with patients?
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  Speaker 1: Has it been physical, mental, both?
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  Speaker 3: I think all of the above, you know, and your
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  Speaker 3: body kind of presents it similar, similarly anyways, sometimes, you know, um,
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  Speaker 3: but definitely both.
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  Speaker 1: Yeah, no, absolutely. I know because Sometimes I'll refer a
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  Speaker 1: patient out, you know, if they have the vaginismus, for example,
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  Speaker 1: or pain during intercourse is is starts with the brain instead.
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  Speaker 1: You know, I find that very interesting. And then I
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  Speaker 1: know some physical therapists refer out, you know, we'll have
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  Speaker 1: them work with a therapist, psychotherapist also to to go
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  Speaker 1: over that.
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  Speaker 3: Yeah, absolutely. There's definitely like a mental side to it
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  Speaker 3: as well, especially if it's been going on for, you know, years.
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  Speaker 1: Yes, for sure. As far as any products that you
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  Speaker 1: would recommend, like with other certain pelvic dilators that you,
• 7:17
  Speaker 1: since we're on that topic of pelvic dilators, things like that,
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  Speaker 1: any that you recommend patients use or.
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  Speaker 3: You know, I don't get anything for saying this, but, um,
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  Speaker 3: I typically just kind of stick with intimate Rose. Um,
• 7:30
  Speaker 3: they're pretty trusted, a well-known brand. There are other brands
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  Speaker 3: out there, but, and that's kind of how I tell
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  Speaker 3: clients to, again, I don't get free commercial for them, but, um,
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  Speaker 3: there are brands, but that's one that, you know, has
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  Speaker 3: been around a while and has a good reputation. Yeah.
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  Speaker 1: I like that too. I've, I've seen that. Um, I've
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  Speaker 1: seen that one. Um, I've recommended, I forget what we'll
• 7:52
  Speaker 1: call Dr. Laura Berman has one as a sex therapist
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  Speaker 1: that she recommends, but, um, yeah, there's different ones out
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  Speaker 1: available for sure. Um, and then I can include all
• 8:03
  Speaker 1: of that. What I'm going to do is I'm going
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  Speaker 1: to include all of that in the show notes and
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  Speaker 1: like your practice info also. Um, Now, I know we
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  Speaker 1: just had the loss of Miss Dolly Parton, which I
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  Speaker 1: am very, very sad about. And she struggled with endometriosis,
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  Speaker 1: which I did not know that.
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  Speaker 3: I didn't either.
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  Speaker 1: And she was talking about how she went through like
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  Speaker 1: a whole depression in her life at one point. And
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  Speaker 1: I have to, I forget, I think it was a partial,
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  Speaker 1: I think it was a partial hysterectomy that she had. Um,
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  Speaker 1: but how do you handle your patients with, um, with
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  Speaker 1: specifically with endometriosis? I know there's a lot of unknowns
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  Speaker 1: with that and there's still a lot more coming out,
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  Speaker 1: but that whole thing with Dolly Parton made me think
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  Speaker 1: about it. And I think it's cool that she actually talked,
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  Speaker 1: started talking openly about it to make people aware of it.
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  Speaker 3: Yeah. So again, so with like pelvic floor therapy, you know,
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  Speaker 3: I'm treating the symptoms, right? If someone's coming to me
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  Speaker 3: for endometriosis, of course, I don't have the cure for that.
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  Speaker 1: Right. Yeah.
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  Speaker 3: You know, I'm treating the symptoms. So, you know, dealing
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  Speaker 3: with that pain, maybe the lower abdominal pain or the
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  Speaker 3: pelvic pain. So giving them some good movements, maybe we're again,
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  Speaker 3: going back to the breath work.
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  Speaker 1: Yeah.
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  Speaker 3: Just almost giving them, sorry, giving them tools for their
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  Speaker 3: tool belt. So when their symptoms do try to flare up,
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  Speaker 3: you know, how can we address that?
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  Speaker 1: So they're more manageable.
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  Speaker 2: Yeah.
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  Speaker 1: And I know it can vary with patients, but what
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  Speaker 1: is the timeframe? Does that look like you typically, what
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  Speaker 1: is your average patient? Are they with you for about
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  Speaker 1: a year? Is it six months? What does that usually
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  Speaker 1: look like? It also really.
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  Speaker 3: Depends with how frequent, you know, they're able to see
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  Speaker 3: me also, whether that's my schedule or their schedule. Um,
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  Speaker 3: you know, I kind of give the vague, like four
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  Speaker 3: to six visits, however you want to sprinkle those out.
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  Speaker 3: But again, that's super generalized, and that's going to be
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  Speaker 3: different for each client, truthfully. Yeah.
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  Speaker 1: Is it covered on insurance typically for people?
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  Speaker 3: So Happy Pelvis is just a cash-based practice. I've only
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  Speaker 3: had a couple clients ever try to submit their super bill,
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  Speaker 3: and I don't think they've gotten reimbursed. But I'm not sure.
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  Speaker 3: I've just tried to stay out of the insurance world.
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  Speaker 1: It's sad. It's really sad. I know it's so sad.
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  Speaker 1: And then with patient care, a lot of times like
• 10:22
  Speaker 1: with hormone replacement therapy for women isn't covered. They have
• 10:24
  Speaker 1: to pay out of pocket. Like it's usually, it's usually
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  Speaker 1: the case. Yeah. And, and. Unfortunately, it's I hope we
• 10:33
  Speaker 1: get our country and the world gets better at it
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  Speaker 1: with with women's health and more funding for that, too.
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  Speaker 1: And for the practitioners, you know, because it's not easy
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  Speaker 1: when you have to bill when practitioners do have to
• 10:45
  Speaker 1: bill insurance. Like we're at the mercy of the insurance
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  Speaker 1: company for reimbursement. It's frustrating. Right.
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  Speaker 3: And, you know, and with pelvic floor therapy, I take
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  Speaker 3: a very like whole body holistic approach and insurance doesn't
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  Speaker 3: always love that. You know, they want to be like, Oh,
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  Speaker 3: you need to be treating like in this instance, right.
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  Speaker 3: The pelvic floor, like, why are you going out to
• 11:04
  Speaker 3: the breath work again? You know, like that's too far
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  Speaker 3: away from where the symptoms are happening. Um, there's that
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  Speaker 3: whole caveat too. Um, but there's, you know, I'm sure
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  Speaker 3: there's ways around it and all that good stuff. But again,
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  Speaker 3: I just try to not have to worry about that.
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  Speaker 3: I want to be, you know, focused on my clients
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  Speaker 3: and give them that individualized care. Um, sometimes insurance can
• 11:26
  Speaker 3: kind of dampen.
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  Speaker 1: Yes. How long is the session usually you have? Is
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  Speaker 1: it an hour?
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  Speaker 3: So I do the initial evaluation, which is about 90
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  Speaker 3: minutes just to give us enough time for a good
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  Speaker 3: history debrief. Um, and then also, you know, doing the
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  Speaker 3: evaluation physical exam and And then follow-up sessions are typically
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  Speaker 3: about 60 minutes. Okay.
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  Speaker 1: That's good to know. And then if anyone is in
• 11:48
  Speaker 1: the Cookville area and looking for treatment, just so they
• 11:51
  Speaker 1: all know too, but this is like, I feel like
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  Speaker 1: this is a whole branch that a lot of people
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  Speaker 1: don't know about. So I think it's really cool.
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  Speaker 3: Yes.
• 11:58
  Speaker 1: Yes. And so to shift a little, you are an author.
• 12:02
  Speaker 1: So I want you to Talk about your book that
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  Speaker 1: you have.
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  Speaker 3: Yes. Yes.
• 12:08
  Speaker 1: Yeah.
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  Speaker 3: I have a pregnancy and postpartum pelvic health guide. I
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  Speaker 3: actually did that as part of my student led project
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  Speaker 3: at the very end when I was in graduate school
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  Speaker 3: and kind of had tweaked it since then.
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  Speaker 1: But yes, I do have that.
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  Speaker 3: So that just kind of gives some good tips and tricks,
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  Speaker 3: very pelvic floor specifically for the pregnancy and postpartum population.
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  Speaker 1: That's so amazing. Good for you. And is that available
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  Speaker 1: on Amazon or.
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  Speaker 3: Are you able to- Honestly, I just kind of have
• 12:38
  Speaker 3: it locally and can ship it to you personally.
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  Speaker 1: I love that personal touch. That's great. What has your
• 12:47
  Speaker 1: experience been working with other, have you worked with other
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  Speaker 1: therapists or sex therapists before with patients? What does that
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  Speaker 1: usually look like if you do?
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  Speaker 3: You know, like the population that we're talking about a
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  Speaker 3: lot of, you know, that pelvic pain client. Absolutely. You know,
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  Speaker 3: I love when the clients come in and they're already,
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  Speaker 3: you know, involved with some like mental health therapist or
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  Speaker 3: a sex therapist or have used them in the past
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  Speaker 3: for these similar symptoms. Because like we've touched on already,
• 13:16
  Speaker 3: like there's such a mental side to the physical side also.
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  Speaker 3: So having those two together just works really well. So
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  Speaker 3: I can almost really stay in my scope and they
• 13:27
  Speaker 3: can stay in their scope. So it blends really well.
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  Speaker 3: I honestly haven't done a ton with like therapists, like
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  Speaker 3: meeting up or phone calls, but I just feel like
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  Speaker 3: I haven't had those clients where maybe they're actually seeing
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  Speaker 3: that therapist actually in that moment, maybe it was something
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  Speaker 3: previously or it just hasn't lined up perfectly like that.
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  Speaker 3: But that is a really... good opportunity.
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  Speaker 1: And I would, I think so too. I mean, when I,
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  Speaker 1: I remember when I had a physical therapist, it was,
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  Speaker 1: she was a physical therapist I was working with. She
• 14:02
  Speaker 1: thought it was great because there weren't a lot of
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  Speaker 1: people that were doing just that or the other side
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  Speaker 1: of it where they're getting referrals from like an OBGYN,
• 14:10
  Speaker 1: but like, there's no other communication after that. They just
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  Speaker 1: refer you. So there's no collaboration and And it's nice
• 14:17
  Speaker 1: that you have your own practice where you can take
• 14:19
  Speaker 1: the time to do that if necessary. I think that's
• 14:21
  Speaker 1: so important. I think this is a whole field of
• 14:26
  Speaker 1: medicine that is often overlooked or dismissed when women go
• 14:31
  Speaker 1: to the OBGYN. And I think what you do is so,
• 14:33
  Speaker 1: so important for that. Especially, you know, on the postpartum
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  Speaker 1: end too. I think every single female after they have
• 14:42
  Speaker 1: a baby, they're just kind of, and you've gone through
• 14:45
  Speaker 1: this on a personal level, you know, they're kind of
• 14:47
  Speaker 1: rushed out, you're thrown into having a baby, uh, you know,
• 14:52
  Speaker 1: and you kind of forget about you. And I think
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  Speaker 1: that it should just be part of the discharge protocol
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  Speaker 1: for a patient to who's had a baby to have
• 15:04
  Speaker 1: some type of therapy, you know, just to check in
• 15:07
  Speaker 1: with a mental health professional, um, at least one appointment
• 15:12
  Speaker 1: with someone like yourself, because there's a lot of things
• 15:15
  Speaker 1: going on after that.
• 15:16
  Speaker 3: Right.
• 15:17
  Speaker 1: You know, um, do you feel that you, do you
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  Speaker 1: get a lot of women who, who, where it's, it's
• 15:24
  Speaker 1: just happened or do you feel like it happens a
• 15:26
  Speaker 1: little later when they go to you after? Yeah.
• 15:31
  Speaker 3: Um, you know, I had to, I've had a handful
• 15:33
  Speaker 3: of clients, you know, that I've actually seen me during
• 15:35
  Speaker 3: pregnancy and then they return, you know, postpartum, which is
• 15:38
  Speaker 3: really sweet. Cause I usually bring their baby as well,
• 15:40
  Speaker 3: of course. Um, but I do always tell my clients
• 15:43
  Speaker 3: to a lot of the stuff that you like. So
• 15:45
  Speaker 3: perfect world, right. They see me during pregnancy and then
• 15:47
  Speaker 3: postpartum as well. Um, but a lot of the stuff
• 15:50
  Speaker 3: that they'll learn during pregnancy is applicable postpartum. It just
• 15:54
  Speaker 3: feels a little different, looks a little different. Um, So yes,
• 15:59
  Speaker 3: I definitely see clients postpartum. Um, you know, I would
• 16:04
  Speaker 3: say 50, 50, truthfully, if they're like close to that
• 16:07
  Speaker 3: six weeks roughly, or if it's months down the line
• 16:10
  Speaker 3: and they finally, you know, have found time for themselves again.
• 16:13
  Speaker 3: And then they come to see me and you know what?
• 16:15
  Speaker 1: No shame either way. I know.
• 16:18
  Speaker 3: I know.
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  Speaker 1: It's like, you only have so much time. I mean,
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  Speaker 1: I know there's a big, a big controversial trial right
• 16:24
  Speaker 1: now happening with someone who's had postpartum. And that's, it
• 16:28
  Speaker 1: is serious. You know, I think people don't understand how
• 16:32
  Speaker 1: serious it can be until they see things like that
• 16:34
  Speaker 1: happen where, you know, it can, it's just mental health
• 16:38
  Speaker 1: is everything. It's, it can be incredibly sad for sure. Yeah. No,
• 16:44
  Speaker 1: I think that's, I think your book idea is great.
• 16:46
  Speaker 1: I think that's amazing. And I love that you did that,
• 16:50
  Speaker 1: like when you were in school and it's a.
• 16:54
  Speaker 3: I think it was probably best that way. Even just
• 16:56
  Speaker 3: continuing education now, I'm like, oh, I had more time
• 16:59
  Speaker 3: actually in school and that was my whole focus.
• 17:03
  Speaker 1: I love that. Now, is it just you at your
• 17:09
  Speaker 1: practice or you have other clinicians too?
• 17:12
  Speaker 3: At the time, at this moment, it is just me,
• 17:14
  Speaker 3: but in the works of having someone join me, which
• 17:17
  Speaker 3: will be an upcoming announcement, maybe in the new year.
• 17:21
  Speaker 3: So exciting.
• 17:25
  Speaker 1: And for those listeners, I have been into Dr. Apple's office. It's,
• 17:30
  Speaker 1: it's a beautiful space. Cookville is like, so charming and cute.
• 17:35
  Speaker 1: I love, I love Cookville and it's just such a,
• 17:37
  Speaker 1: it's like a little hallmark town. I love it. Um,
• 17:40
  Speaker 1: and I think you have a very nice, warm and
• 17:42
  Speaker 1: inviting space too, which I think is so nice for
• 17:44
  Speaker 1: people as well. You know, thank you.
• 17:46
  Speaker 3: Yeah. And I offer it to like a free consultation
• 17:50
  Speaker 3: either on the phone or you can come into the office,
• 17:52
  Speaker 3: you know, if you want to just ask questions before
• 17:54
  Speaker 3: you feel like you're you know, signing up kind of thing.
• 17:58
  Speaker 3: I always try to offer that because I, again, I
• 18:00
  Speaker 3: know this topic that we talk about is not the
• 18:03
  Speaker 3: most comfortable. And so just kind of getting those questions
• 18:06
  Speaker 3: answered beforehand can kind of be a, just a comforting
• 18:10
  Speaker 3: thing for some clients.
• 18:11
  Speaker 1: So. Oh yeah, absolutely. And, and it's, yeah, it's a
• 18:15
  Speaker 1: touchy subject and some people feel really shy about it,
• 18:19
  Speaker 1: you know, and, and it takes them a while to,
• 18:22
  Speaker 1: to want to go to see someone. So I think that's,
• 18:26
  Speaker 1: I think that's really great. Like what you're doing is
• 18:27
  Speaker 1: just so special. I love it.
• 18:30
  Speaker 3: Super fun. Like I said, I always tell my clients,
• 18:32
  Speaker 3: I'm like, these four walls have heard it all. Like
• 18:34
  Speaker 3: you're probably not the first one kind of thing. So
• 18:37
  Speaker 3: trying to make it as comfortable as possible.
• 18:39
  Speaker 1: Oh, I love that. Well, I will definitely be putting
• 18:42
  Speaker 1: all of the info for your practice in the show
• 18:44
  Speaker 1: notes and your book info. So if anyone, you know,
• 18:47
  Speaker 1: obviously that's not in Cookbow, you can ship it out
• 18:49
  Speaker 1: to them.
• 18:50
  Speaker 3: Yeah.
• 18:51
  Speaker 2: Yeah.
• 18:52
  Speaker 1: And then what is your, and you have an Instagram also?
• 18:54
  Speaker 3: Yes.
• 18:55
  Speaker 1: Okay. Okay. I'll put that on the, on, in the
• 18:58
  Speaker 1: show notes, everyone for everyone also. Um, yeah, I just,
• 19:03
  Speaker 1: I'm so happy that we're able to connect and I
• 19:06
  Speaker 1: hope that maybe in the future we'll have some mutual
• 19:08
  Speaker 1: patients also, but I really, for those of you in the,
• 19:11
  Speaker 1: in the Cookville area, Putnam County, it's, it's a really
• 19:14
  Speaker 1: great office space that Dr. Apple has. So thank you.
• 19:17
  Speaker 1: I highly recommend it. And to all our listeners out there,
• 19:24
  Speaker 1: thanks for tuning in and everyone have a great day.