Treating IC: Understanding Cystoscopies and Bladder Instillations

It's finally here - Cohort #2 of the IC course is now open!  Can't wait for you to level up your treatment of patients with IC with all the information you need.  Understand the role of a cystoscopy and bladder instillations in the medical management of IC patients is just one of the important things to know about the condition.

As rehab providers, we're on the front lines with our patients.  We're the ones they spend an hour each week with.  We hear about their ups and downs and we have the best perspective on the entirety of their care.

But that means we have to know our stuff!

In this 'sode we discuss the procedures themselves, the risks and benefits and how to counsel your patients when they ask you questions.  We believe you should be the quarterback of their IC team and understanding their medical options is critical for this.

IC Course - Cohort #2

If you want to level up your treatment of patients with IC, make sure to join us for Cohort #2 of the IC Course (now open today - doors close on Thursday!).  We go through everything you need to know about the condition to provide the best care for your patients.

We also get really practical.  There's hands-on demonstrations on both a model and live patient showing the specific techniques we recommend.

And for this cohort, you'll get $50 off the course and a LIVE Q&A to get any questions answered!  Register before Thursday (2/22) to join us!

About Us

Nicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.

Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 500+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them!  

Get in Touch!

Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).

Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

Transcript

Speaker 1: 0:02

In the last 10 years, our field has gone from an unknown specialty to a household name. This brings unprecedented opportunities, but we need to rise up to meet them and give our patients the care that they deserve. In order to help others get better, we need to be better. 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. Join us as we rise together. 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.

Speaker 2: 0:53

Hey guys, welcome back to another episode of the Pelvic PT Rising podcast with Jesse and Nicole Cozine. Hey Nicole, hello, exciting day today, nicole, doors are open for cohort number two of your IC course. This is going to be awesome.

Speaker 1: 1:07

Jesse always gets excited on these days and I have like massive anxiety because I'm always like, ah, does anyone cares? Anyone think this is going to be as good as I think it is Shoot, so, but it is awesome. And so the IC course is fricking bomb and it's my jam and it's been just a passion of mine for so long. And the IC course is like kind of everything that I know about interstitial cystitis distilled down into one comprehensive how to treat folks with interstitial cystitis course, so pretty excited to share it with you all.

Speaker 2: 1:42

Yeah, doors are open now. For the next three days we are registering guys for this cohort number two. So you'll get $50 off. You'll get access to a live Q&A and then, obviously, all of the great material. You get lifetime access to that, all of the updates, all the newest stuff. If you guys have already been through, you also get access to all those new updates and stuff. Yeah, so make sure to head over to pelvicptrisingcom slash IC. You'll get some frequently asked questions there. You will get a certificate of completion. You can submit that for CEUs if you'd like, for 13, 12 or 13 hours. Demonstrations labs on actual people, on models, on Cynthia.

Speaker 1: 2:21

Cynthia, you guys you know how we have to like buy those models like the vulvar models and the rectal models and stuff like that from places Like I think ours is from tickle me kitty or something like that Tickle kittycom.

Speaker 2: 2:35

Tickle kittycom, they're still sending me emails. Guys, that was a mistake to put my real email address in there. So, yes, half of my inbox is from ticklekittycom. And then our employment attorney comes in the other day for meeting at the office. He'd never been down there before and literally on his way to Nicole's office to meet, there's like one of these like butt first in the air, sex toys, just sitting there. He's like, okay, well, your retainer just went up.

Speaker 1: 3:01

Yeah, he was like this is like an HR nightmare. I was like, yeah, I guess it kind of is, if you look at it like that and you're not in our field. Anyways, those models do come with names, which is objectively kind of weird, but they do, and so one of them is Cynthia's and there's a Scarlett, I think that we have.

Speaker 2: 3:19

Yeah Well, scarlett was the name on the box. I actually named Cynthia, which makes that weirder.

Speaker 1: 3:24

Yes, very weird. I didn't know that. I thought it was.

Speaker 2: 3:26

Cynthia, well, she is.

Speaker 1: 3:28

This is absolutely out of control. I can't believe we're doing this on air.

Speaker 2: 3:32

Well, you find out something new every day, and it called oh, just kind of told us to do as part of the call the employment attorney be like scratch that, that was weird.

Speaker 2: 3:41

So, anyway, but Cynthia is featured prominently in the course is where that came from, because you're demonstrating actual techniques and being able to get really practical on the PT side, as well as the medical management, as well as supplements, as well as everything else that people need to know in order to guide their folks Some of which we're going to talk about today when it comes to cystoscopies and bladder installations and how to talk about these with your patients, how to guide them and counsel them, and what they do and what they're helpful for. So, nicole, let's just dive in for those who aren't really aware or who have heard the term but don't really understand it what is a cystoscopy?

Speaker 1: 4:18

Okay, so hopefully most people know, but we're just going to go over it anyways. So we're all on the same page. A cystoscopy is a diagnostic test that a urologist will do. That puts essentially a camera up the urethra and they can actually see the bladder lining and so it can diagnose all sorts of urologic disorders. And we used to think, and it used to be stated, that you could see bladder wall pathology that caused interstitial cystitis. That's what we used to think. Now we know that you can see things like Hunter's lesions on there with a cystoscopy camera up looking at the bladder where you can actually see ulcerations in the bladder lining. And now we know that a cystoscopy is not needed for diagnosis of interstitial cystitis, and that is not my opinion. That is from the AUA guidelines of most recently 2022. But that has been in the guidelines since they first came out in 2011.

Speaker 2: 5:20

So basically then, a cystoscopy can and should be done to potentially to rule out other things, but remember, I see as a diagnosis of symptoms a diagnosis of exclusion. So in the absence of things like bladder cancer or seeing actual Hunter's lesions, or seeing something else physically wrong which 90 plus percent of people with IC symptoms don't have, then that's what the purpose is. So that's one of the things that I think people are a little bit confused about and urologists will still use this language, unfortunately is oh, I'm waiting for my cystoscopy so I can see if I have IC.

Speaker 1: 5:55

It's like that phrase, that sentence, like literally does not make sense, does not compute. That's not true Now, whether that's the patient misconstruing what the doctor said, whether that's the doctor actually not knowing why they're doing a cystoscopy, or the doctor just using that language to the patient so the patient gets it. We don't know when the patient comes to us and says, like I'm waiting for a cystoscopy to see if I have IC. But as public rehab providers and practitioners that treat these folks, we need to know that that sentence does not make sense.

Speaker 2: 6:27

Right, so you can help your patient and advocate there Now bladder installations, similar kind of procedure, right? And if you're still talking about like a catheter of the urethra and into the bladder, but this time they're actually trying to put medication directly into the bladder.

Speaker 1: 6:40

Yeah, so it's medication, usually a bladder, what they call cocktail, so it's like a mixture of medications. They instill this liquid up into the bladder and then the patient is supposed to hold their bladder as long as they possibly can, and then they'll pee it out. Those combinations are usually heparin and lidocaine in today's day and age right Heparin lidocaine, sodium bicarb is like the cocktail of things that is most frequently used and really has the biggest, the most evidence for.

Speaker 2: 7:09

Something you'll also see old school is DMSO dimethyl sulfoxide which is the very first thing. It was approved for IC back in 1973. That is the sign that your person is like way behind the times.

Speaker 1: 7:21

Yes, totally and fun fact, Jesse, what is your connection to DMSO?

Speaker 2: 7:27

Well, this is a kind of a long story, but I hold a couple of patents related to DMSO that we worked with, but one of the things that's interesting about it is the S, and DMSO is for sulfur, so the body metabolizes this and it comes off with this just absolutely disgusting smell, and so one of the things that we had to do was to try to mitigate that smell so people could actually use it Like it would just stink up like an entire ICU when we were doing clinical trials with this. So one of the patents I hold is on a filter that takes out that noxious smell. Yeah, it works like pretty well, but we actually had to set up stuff where we'd pump things through, send it through the filter and then some poor test dummy which was usually me was on the other end of it, being like hey, how bad does this wreak? Scale of one to 10?, and so you know when you got that wrong. It was an incentive to get this correct as quickly as possible.

Speaker 1: 8:20

Yeah, that was so you got a little insight into Jesse's past life before he sat at the front desk at Public Sanity. I was doing that stuff simultaneously when we were just starting Public Sanity.

Speaker 2: 8:34

So fun fact about Jesse, yeah a little walk down history lane there. But the other thing about installations, just going back to like the lidocaine, heparin sodium bicarb mixture there, is that usually they're prescribed in a set of six. Right, the urologists would say, come in and do these six times, usually like once a week, but I mean just pathologically like they should work. If they're going to work, they should work pretty much immediately.

Speaker 1: 8:59

Well, and that's what a lot of the studies showed that we looked at when we were researching the book and the course and stuff, if installations are going to work right just by what Jesse said, like logically and also in the research, then your patient should see a significant improvement in symptoms after the first one.

Speaker 2: 9:18

Right, it's not like there's ever somebody who's gone through six rounds of lidocaine, numbing agent, injected in their bladder and then it was sucked for the first five and then the sixth one. They got a ton of relief, like that doesn't even make sense.

Speaker 1: 9:30

It doesn't make sense, it doesn't happen it doesn't.

Speaker 2: 9:33

If your dentist was going to take out one of your teeth and had you come in and numbed you up six times every week for six weeks in order to do it. It's like, but that's not how lidocaine works.

Speaker 1: 9:43

Yeah, it's just not Right Totally the half-life of all the things. So it's just that's what we need to understand about it and that's what we're going to talk a little bit about how to talk to patients about it. But we need to understand that from like just a scientific standpoint and what it says in the research, because a lot of times some urologists are not as up to date as we can be. Now, going back to that real quick, I'm just going to flip back to scistoscopy. I think a lot of people that come in and we can villainize, I think, a little bit of what physicians are saying and doing and we need to just take a half a beat back and I credit Taryn Hallam for this because I feel like she really helped me when she said something at Pelvicon one time that to not villainize the physician all the time.

Speaker 2: 10:31

Right, there's all, all the time right 98 97%, but you're right. So whatever, I'll give Taryn credit for introducing two and a half percent of compassion in you no, we're great, totally so.

Speaker 1: 10:44

Anyways, here's the thing they have reasons why we hope. We have reasons why they really need to cross their t's and dot their i's right with their algorithms on what they're actually looking for, what they actually do need to rule out, to definitively say, oh, these symptoms and this patient's history and family history, which is stuff that we don't necessarily go into all the time, we need to make sure that we're ruling that out, to make sure that we can definitively say you don't have those things and therefore have interstitial cystitis.

Speaker 2: 11:24

So there are reasons to point out, though, to Nicole. It's like sometimes it just is what's next on their list. Like nobody likes if going in and a patient comes to you with something that feels like a bladder-centric thing to a urologist like they're don't like having to say, oh, there's nothing I can do for you, or just go. It's like, no, there is something like cool, here's the next thing that I, as a urologist, can do.

Speaker 1: 11:47

It's medication or installation yeah, you know I was talking to a really prominent interstitial cystitis doctor. His name is Dr Moldwin. I sat with him on the interstitial cystitis association board for a long time and I was able to talk to him quite frankly about a lot of this stuff and how frustrated I was at some of the local urologists in my area and how they treat interstitial cystitis. And I was like you know, in my younger days is when I was just starting pelvic sanity and I was like, oh, dr Suck, they're not looking at the guidelines, what the hell. And he was like, hey, nicole, he was like you know, just so, you know he's so nice, he's like, just so, you know, like sometimes all they're doing is saying what's next that they can offer patients?

Speaker 1: 12:22

Like we only have a certain amount of things that we can offer somebody, especially if they're not going to go down a surgical road and, by the way, most of those physicians are surgeons, so not that they want to do surgeries or stuff like that, but if we're not going to do any sort of procedures, then the next thing that they can offer is you know, let's make sure, let's rule this out let's offer medications, let's offer installations, like that's what their job is, and so I think sometimes in the pelvic rehab world we can villainize their process because they're not referring to us frequently and it well, I think that's a valid sort of knock on their process. We can't also extrapolate that into oh they suck as a physician because we don't also know that end of their job right.

Speaker 2: 13:09

So if you're thinking that, though, this also helps to inform how you counsel patients to ask because I think that might be as a patient person at me, one of the fundamental misunderstandings there is that the urologist says, hey, I can do installations, and the patient hears, oh, we need to do installations, it's really important, that's going to help me. And that may not be at all what the person was saying, and I loved how Dr Molderley is talking about that. Right, this is just what I can offer you. But if you are saying that and somebody's scared and they you've got a white codon, that becomes almost something that has like the force of law to folks. So when you talk about this, nicole, I know you go into this on how to counsel your patients to get better outcomes, to ask better questions, and I love this little framework that you have, but you think about your people coming in.

Speaker 2: 14:02

You really have like three different types of folks who are going to be asking you questions. One is the type of person who's gotten into your office really early on. They haven't done a cystoscopy or they haven't done an installation, but the urologist is recommending it. They're thinking about it, you know it's on their radar, but they don't really have any direct experience. Then you've got the people who have done one of these before and it didn't work, or it flared them up, or they're apprehensive, or they really don't want to go through that. And then the third group are people who have done it and for some reason it helped, and we'll talk about that in a little bit too. But your conversation with each of those, nicole, is going to be very different, because it's not a one-size-fits-all approach.

Speaker 1: 14:41

Absolutely, of course, as we all know, it depends. And so you know, here let's talk about that first group first. So if your patient comes into you relatively early, this is actually quite common, right? They go to the urologist because they have bladder symptoms. They also independently usually find us because they're searching online and being like, oh, I should go to pelvic floor therapy. So they come to us and then they've gone to their urologist and the urologist has said sometimes, because that's, they're running a good business, they have their cystoscopy scheduled or their next installation scheduled, and then we see them in the midst of that and so they haven't done anything yet, but their urologist has sort of scheduled for them that procedure and they're recommending it.

Speaker 1: 15:25

And so one of the biggest things that I ask my patients is like how do you feel about that? Are you excited to get that information? Are you scared, do you? What's happening within the patient's mind? So that's number one. And then I also want to say do you have to do it right now? The answer is always they don't have to, but it's interesting to to see what the patient thinks oh, yeah, I have to do it right now, or blah, blah, blah, blah, blah. Or in order to do the next thing that he said I could try, have to do this first. So I also want to get out of them. Do they feel like they have to do it and why?

Speaker 1: 16:07

And then sometimes I'm like, well, let's do our exam first. And if, for instance, I see that they have really tense, tight, symptomatic periurethral muscles, for instance, and I know that a cystoscopy is going to go right up the urethra, for an installation would go right up there. You know what I would love for you to go back and ask your urologist hey, is there any reason why we can't wait or postpone this procedure? Now, usually we can postpone the installations, no problem. I'm a little bit more careful with. Can we postpone the cystoscopy? Because the urologist might be doing it for a real diagnostic purpose and not just to rule out other things, hoping that it's negative so you can diagnose interstitial cystitis. But they might be doing it for a reason that I don't understand, and so I want the patient to ask the question is there any way that we could postpone that? What would be the ramifications if I postpone that and do it next month instead?

Speaker 2: 17:09

And interesting right, because a lot of times it's like, oh yeah, there's no right, you get forces them to have that conversation, but almost no patient actually has that conversation without you guys really being able to guide that and give them the confidence to kind of push back a little bit on that. And you know, I love what you're saying to Nicole about if they are going to go through and do something, then you got to make sure that you're not perpetuating this misunderstanding that I see is a bladder condition, because it's not. And if they go into installations thinking that it's going to quote unquote cure them, that's not a great place for them to be and you're letting them continue on in this vein. That is leading them down the wrong path and it's going to lead to disappointment, frustration, a lack of trust in you, potentially right, and so I know you talk a lot about just preparing them for the possible outcomes if they do decide to go forward with something.

Speaker 1: 18:05

Totally and preparing them for what's most likely to happen, right? So if we know and this is not my opinion, y'all this is that we know that interstitial cystitis is not a bladder condition. There's usually nothing wrong with the person's bladder and, especially if they're under 50 years old, the chances that it's actually Hunter's lesions is less than 4%. Okay, so we know that interstitial cystitis is not a bladder condition. It's a pelvic pain condition that has bladder symptoms, and so what I want us to all make sure we're doing is that we're not perpetuating that myth simply by also corroborating and being like yeah, go get that cystoscopy and see if you have IC. It's like, no, we need to know, we need to make sure. Be like oh, yeah, I can see why your urologist might be recommending that. It's interesting to note that the AUA specifically says that cystoscopy is not needed for the diagnosis of interstitial cystitis. So another great question to ask is like why, for me, do you feel like I need to have a cystoscopy at all, and why do you feel like I need to have a cystoscopy now? Those are two great questions, and if they still proceed to that, we can also be like what we're hoping for and what we're expecting is a completely clear and negative result. That would be the best outcome possible, right?

Speaker 1: 19:28

If we find something, that's gonna be usually not great because that's gonna mean like, oh, all these symptoms are actually caused by something way more severe and we actually expect it to be negative. That's like the definition. It's in the absence of any other situation that you have IC, right, and so what we need to also do is that, no matter what we find on cystoscopy, our pelvic floor therapy plan of care does not going to change. That's the biggest thing that we need to make sure people understand. That may change your medical treatment, but it's not gonna change what we do here. So if that's the case, if you're gonna go through with the cystoscopy and it's scheduled for randomly like February 20th, I wanna see you two or three days after that Schedule with me right afterwards. I wanna know what they found, I wanna know what's happening and I want to make sure that your little urethral muscles around there are can get treatment right afterwards, right, and so that's the kind of stuff that we need to make sure we manage expectations.

Speaker 2: 20:29

So that's for somebody who really is a little bit net neutral on doing this kind of stuff. If they've done it before, we get this a ton. I even hear this at the front desk People who have done it before or are doing installations now and it's not working or it's flaring them and they're almost looking for you or for somebody to give them permission to like push back on this. They don't want to do it, it's not working. They don't feel like that's really their issue, but they're stuck in the middle of three of six installations and feel like they have to finish the course out.

Speaker 1: 21:04

Yeah, this is where freaking understanding the research like really helps. Like, hey, if you can say with confidence, if you were going, you know, help them to see. Like is there anything that was changing with it? Right, make sure that we're accurately like talking about symptoms, what symptoms were you most hoping to have? Help with the installations? Cool urethral burning great, did it help? No, is it worse? Maybe right, so we can definitely be like okay, so we definitely don't feel like it's helping. Now you've done three of them.

Speaker 1: 21:34

The research shows that if it was going to help, it was gonna be helpful in the first one, the very first installation, and so maximum two. And so you can say that. And you can say the thing is is that there's nothing that tells you you have to continue. There's nothing wrong with that. It's not like an antibiotic where you're stopping treatments early and that's bad. You can just not do it. You can always go back to doing them if you really wanna revisit this. Like nothing about the course is magic right, except for that someone told you to do it at the urology office, so we can help them to have those conversations and advocate for themselves.

Speaker 1: 22:19

This is hurting me. I'm worse when I'm doing this. I don't wanna do it and it doesn't need to be worse because it's actually causing damage. It's not that. It's not that, even if the procedure itself is actually not painful, because a lot of times it'll be like, oh, the actual procedure is fine, but man, it just really burns afterwards and it's like but their nervous system might be the reason why that's happening.

Speaker 1: 22:43

Right, they might be scared going into it. They might be clenching their pelvic floor for days afterwards. They may have tried to hold their bladder because they're holding the installation and that could have caused the symptoms and the medication's totally fine. So we just need to give them permission to stop if they want. We need to reframe to them why they're doing it, because it's remember, even if an installation is going to be done, we'd still need to be perpetuating. The truth about IC is that it's not a bladder condition, so it's going to be very interesting. If it works, that's going to be weird. If it works, it's not a bladder condition. What does that mean? Does it mean that there's decreased inflammation because you also have things like heparin? What is the actual mechanism and the other reasons why it can be helpful, versus perpetuating the myth that it's helping the bladder lining?

Speaker 2: 23:38

The placebo effect works 30% of the time. Every time and especially I don't know if you guys have, you guys probably get. Do you guys do this like kind of research stuff in PT school? But there's definite evidence that the placebo effect gets stronger and stronger the more invasive or difficult the procedure is. So the placebo effect for a fake surgery, for example, is actually significantly stronger than the placebo effect for a fake pill. Does that ever get?

Speaker 1: 24:03

covered? Oh, I mean, I don't know. I went to PT school so long ago. I don't know, maybe it does, it should be. I mean, that is a real thing right.

Speaker 1: 24:11

So and that could be why installations are working is because it's like the person thinks it's a bladder issue and they're getting their bladder treated, and that's also fine for them to think for a while, and then we also need to show them that there's a lot of other things that we need to address and that, yeah, and that interstitial studies isn't a bladder condition, there's nothing wrong with the organ itself. The organ is giving symptoms, but it's not. There's nothing wrong with it so diseased.

Speaker 2: 24:38

Right. So that brings us to kind of our three big takeaways there, and that's exactly where that goes. Nicole, your first point is that the pelvic floor aspect of what you're doing doesn't change with all this stuff. This is independent of anything that's going on at the urology office.

Speaker 1: 24:51

Correct and I would highly suggest that you continue to have a frequent visit with your patient as they're going through all this stuff, so you could help to mitigate some of the issues of patients, you know, hearing something wrong or misinterpreting what the physician says, or you know they get to spend two seconds with the doctor, they get to spend an hour with you. So it's really important that you communicate to your patient like, hey, I know that you're doing all that stuff at the urology office and that's great and fine. However, I need still need you to also come here, whatever your clinical honest opinion is. For us it's usually once a week, as you're going through all that stuff and we will make sure to address all these pelvic floor things and see how you do after each of those procedures and be able to help you manage a flare. If one of those procedures happens to flare you, we can still be really valuable during that whole process.

Speaker 2: 25:41

Yeah because that is your second point here. Right Is that you have a role to play in preparing the patient for the procedure and in putting the pieces together afterwards if it does cause a flare or those muscles to tighten up.

Speaker 1: 25:52

Yes, 1000%.

Speaker 2: 25:53

And then, finally, the last thing you had on here, Nicole, is our kind of third takeaways. What you're doing is really just empowering them to ask their own questions, giving them the tools to advocate for themselves and refusing to perpetuate this myth that there is some disease process in their bladder.

Speaker 1: 26:10

Yes.

Speaker 2: 26:11

And that is so important to I mean, we just have seen it the people who have been down that road or who are so now convinced and holding on to the idea that there's something wrong with their bladder. I still remember we had an out-of-town patient who came in, who was literally what was it from? Like 1984? The picture of her bladder from 1984. That was handed it to the front desk. What the hell. And this was 30 years ago.

Speaker 1: 26:40

Yeah, and we talk about this type of person in the intersocialistitis course, but I'll just go a little bit and share a little bit about that here. That person that is clutching a scistoscopy result from 30 years ago, saying this is my bladder like, has so much ingrained fear and just wrong information, and all of their actions and their identity is wrapped up in this photo, and so I really that is not the person that you are going to have the conversation. Hey, you know what? Your bladder actually doesn't have any pathology going on. Did you know that what you've been, your belief system over the last 30 years and your entire identity is actually false? You can't say that.

Speaker 2: 27:27

Right, but what you can or should have, somebody should have caught this earlier, because she actually went to PT before as well.

Speaker 1: 27:34

Yes, and that's the result if you don't debunk this myth, stevan, yeah, and like chip away, so she had that person who didn't tell her that 30 years ago.

Speaker 2: 27:44

And now you're dealing with the consequences and it's really hard. You talk about in the course how to communicate that well and how to chip away at that, but I mean, that's what you're protecting people from, is you know? By not having these conversations, you allow that to exist and that's what that creates. 30 years from now, we have an out of town patient at pelvic sanity.

Speaker 1: 28:03

Yeah, well, and seriously like that person had not just seen one pelvic PT, she'd seen multiple pelvic PT's and she had seen very prominent pelvic PT's as well. And the thing is is that I get that that's very difficult to do, and especially in an out of town setting where you're just like, wow, I can't even get into that with you, but I happen to be able to see this person because she lived at least driving distance away and so I saw her frequently and it was difficult, but we started to chip away at her belief system and it was hard and that created tears and questioning her life choices for 30 years. And so, yes, that is not something that you can necessarily just lead with and say it once and then be like, oh, don't you get it, person you know. So all of it's really complex to deal with it. But I do want you to understand that you do have a role to play in not perpetuating this myth, especially when we know so much now about interstitial cystitis, what it is and what it isn't.

Speaker 2: 29:05

So if you guys want to be amazing at treating IC and doing better for your IC patients, you can go right now, 50 bucks off the course, live Q&A, lifetime access, certificate of completion, all of the good stuff. Go check it out. There's some FAQs there, but if you have any questions about it, let us know. It's at pelvicptrisingcom. You've got three days to grab it. So don't be the procrastinator who writes me on Friday and says, oh my gosh, I'm so sorry, somehow I missed it and we just have to say, well, there'll be another cohort someday, right? So don't be that person. If you're going to do it, go ahead and grab that and we can go from there. So I'm sure you guys will love it. If you have any questions, please reach out, let us know. We always want to keep this conversation going.

Speaker 1: 29:49

And let's continue to rise.