Dr. Alex Hill, Pelvic Health & Oncology Physical Therapist

Pelvic health is often overlooked, especially in cancer care.  Dr. Alex Hill shares invaluable insights and practical strategies for addressing common issues like urinary incontinence, sexual dysfunction, and constipation. Join us in this enlightening discussion about the tools of the trade, types of pelvic floor exercises (Spoiler: It's not just Kegels), and why you really should not hover over the toilet when you urinate.

Short bio, website, and all social links for Dr. Alex Hill.

Be sure to follow Dr. Hill on her YouTube channel at
https://www.youtube.com/@oncopelvicpt and on Instagram at https://www.instagram.com/oncopelvicpt

Links mentioned in this episode:
Find a pelvic health or oncology-trained physical therapist
Find a lymphedema trained PT through Lymphology Association of North America (LANA)
 

Transcript

Leah: 0:00

Hi, Tina.

Tina: 0:01

Hi, Leah.

Leah: 0:01

So today we're talking with Dr. Alex Hill, who on Instagram is known as OncopelvicPT, and we cover a lot, I think, in this interview.

Tina: 0:14

Yeah, who knew there was so much to talk about, about pelvic health. We talked about sexual health and issues around that, sexual dysfunction, urinary issues, like incontinence or retention of urine. We talked about kegels and I learned a few things like, I never knew there was something called a reverse kegel.

Leah: 0:32

I know, no. Oh.

Tina: 0:34

That's news to me. And there are times when you can do too many kegels. Didn't know that either.

Leah: 0:41

Or when kegels aren't indicated.

Tina: 0:43

Mm hmm.

Leah: 0:45

Yeah, plus a ton more. I mean, this is, yeah, this is a plethora of information, I think, that

Tina: 0:54

A plethora about the pelvis.

Leah: 0:56

It's a plethora of pelvic information um, that I think so many people will benefit from.

Tina: 1:03

Yeah, whether it, is cancer related or not, because she also does see people with other conditions. we talked a lot about. cancer related, cancer treatment related issues, and she also talked about pregnancy and other occasions when this comes up.

Leah: 1:16

Right.

Tina: 1:17

Yeah, so follow us wherever you're listening to us right now, and uh, let's start the show. I'm Dr. Tina Kazer, and as Leah likes to say, I'm the science y one,

Leah: 1:26

And I'm Dr. Leah Sherman, and I'm the Cancer Insider,

Tina: 1:29

and we're two naturopathic doctors who do integrative cancer care.

Leah: 1:33

we're not your doctors. We're your

Tina: 1:35

This is for education, entertainment, and informational purposes only.

Leah: 1:39

Do not apply any of this information without first speaking to your doctor.

Tina: 1:42

views and opinions expressed on this podcast by the host and the guests are solely their own.

Leah: 1:46

Welcome to the Cancer Pod. Okay. So today we have a very special guest, with us today is Dr. Alex Hill. She earned her doctor of physical therapy at the University of Florida and completed the women's health physical therapy residency at Duke Health. Alex is a dual board certified clinical specialist in women's health, and Oncologic Physical Therapy and a LANA, LANA, certified lymphedema therapist. I got that right? Okay. She is presently a physical therapist in Jacksonville, Florida, specializing in pelvic health, oncology, and lymphedema rehabilitation for all genders. In addition to her clinical work, Alex has multiple peer reviewed publications, is an active member and leader within the American Physical Therapy Association, has presented at national and international conferences, and is passionate about providing inclusive and empowering education on pelvic health and oncology rehab through her business, Oncopelvic PT. Welcome

Alex: 2:53

Thank you so much. I really appreciate you having me on.

Leah: 2:57

now, you're somebody that I've been wanting us to talk to for a long time. So I'm glad that we were able to finally connect.

Alex: 3:05

Well, I've been wanting to talk to you for a long time, so this is perfect.

Leah: 3:07

Well, great. Okay, let's just turn off the cameras and let's just talk. Um, So I, I think 1 of the things, and I was. kind of going over beforehand, Tina and I met and I was talking about one of the things I really love about your Instagram page is how inclusive you are. you cover so much in the oncology, pelvic, physical therapy realm, but you, you truly do remain inclusive. And I just think that is, that, that's, that's so needed.

Alex: 3:42

Yeah, thank you. And that's really one of the, the pillars and missions for me just with everything that I do. and especially, you know, I have a board certification in women's health. physical therapy, but it's really a misnomer because within that specialization includes men's health and oncology, which is kind of how I got into these two specialty areas. and when we look at the research that's available for, You know, lgbtq plus individuals for BIPOC individuals. These are areas that are really lacking in the research and then leading to disparities and gaps in care for our patients. so for me, it's just so important to, you know, just take that extra step and make sure that the content is as we can get it.

Tina: 4:28

Yeah, so maybe we should start with, what is your specialty exactly?

Alex: 4:33

So my specialty is pelvic health and oncology and lymphedema. So those are kind of my three specialties. Areas'cause within lymphedema, the majority are cancer survivors or people living within beyond cancer. But I do work with people who have no history of cancer and have lymphedema or lymphedema related conditions. So those are my primary areas within pelvic health. It's not just pelvic cancer related. I work with people just who are. Recently had a baby and now they're dealing with urinary leakage with prolapse where the organs are starting to descend down. I work with, people who are having sexual dysfunction with, people who are transgender going through gender affirming care. So it's very varied amount of diagnoses that I work with which is why I say again, that kind of women's health is a little bit of a misnomer. And I'm in the outpatient setting. So, you know, in a clinic where people come to see me, weekly or, twice weekly basis.

Leah: 5:27

So you were saying that it was women's health that kind of brought you to Oncology as your specialty. how, how did that come about?

Alex: 5:37

Yeah, so um, it's kind of funny. I, I. I had heard about and knew a little bit about pelvic health and oncology rehab when I started PT school. But when I first started, I thought I wanted to get into geriatrics or neuro. And so in my first clinical rotation and in our clinical rotations, we work with a a physical therapist and we work with patients directly. And my clinical instructor was out for a couple of days. And so. I wanted to know what the pelvic health therapist did behind the doors all day. It was just this kind of you know, Wizard of Oz kind of thing. Like, what are they doing behind the doors all day? Like, how are they helping people? And so I shadowed with them and the therapist that I shadowed with did pelvic health and oncology together. So that was, for me, they've always been, there's always been an overlap. And so that includes. Again, not just pelvic cancers like gynecological or colorectal or prostate cancer, but also breast cancer survivors who have hormone therapy and now they're having pain with intercourse, for example. And so that's kind of how I got into those two areas and it was, for me, just so Exciting and incredible to be validating what people are going through, especially during their cancer journey, but also like just how much of an impact you can have on a single session with educating on, just simple things or dietary things like some of the, a lot of things that you guys talk about on this podcast and giving people those tools to be empowered, I thought was just so incredible. And so I knew I had to get into these areas.

Tina: 7:12

hmm.

Leah: 7:13

And that's one of the things that I love about referring patients to physical therapy in general is that they are given tools to empower themselves. And then part of what I think we do is remind our patients, you were given tools, you know, are you doing them because it's not, it doesn't just, and I know this from personal experience, physical therapy doesn't just work if you only do the exercises when you're in physical therapy,

Alex: 7:38

Yes. Works best when you're consistently doing them.

Leah: 7:42

right? Right. And I think, you know, from the patients, I know that that Tina and I have seen, it is not talked about the after effects during or after they've received radiation therapy to their pelvis or, sexual issues that come up from cancer treatments across the board, oncologists tend to dismiss, you know, dismiss it like, well, that's, collateral damage. You know, that's. know, I guess let's, should we start with sexual health? I guess, because that really, that we haven't covered that yet. We've been waiting to get experts on board. But yeah, I mean, sexual health is so overlooked, I think is only now kind of being talked about. What kinds of things do you offer your patients who are coming to you with sexual dysfunction, either from the hormonal therapies that they're taking or from things like surgery or radiation?

Alex: 8:38

Yeah, so I think, I think that's a great question. And there was actually a study that showed, you know, 60 percent of cancer survivors have some type of long term sexual dysfunction. But only 25%, so only a quarter of them are actually getting help. And so that's something that like I always try to tell people is like, one, you're not alone in this, like, you don't have to suffer in silence or think that this is just, you know, you have to live with this. But to like talk to your medical provider like you said, like it's becoming more common for medical providers on the oncology team to talk with their patients about it. But a lot of them either aren't comfortable, or they don't know who to refer to, or they don't know what type of treatment to recommend. So I think that there's a lot of gaps with people getting the help they need, which is why I love addressing this and, talking about this on my platform so much. So in terms of physical therapy, it's really going to depend on what, the type of treatment they had, what type of symptoms they have, and then most importantly, what are their goals? So if their goal is penetrative vaginal intercourse, for example, that's going to be very different from penetrative anal intercourse or non penetrative intercourse. There can still be ways to be intimate with your partner without having penetration. And I think just giving people that That knowledge that we can redefine what sex looks like for you is so important, especially if they've had a mastectomy, where now they've lost part of their body that they used to utilize with sexual activity. So some of the things that will do so, especially for radiation in the public area, like you mentioned, Leah that's probably 1 of the more common referrals that I get. So, if they have pelvic radiation, what that can do long term is basically cause a scarring and fibrosis of those tissues. So they can get. Firm, they can get hard and what that leads to, especially with Penetrative intercourse is it leads to pain. It leads to difficulty with penetration, bleeding, discomfort, dryness, and so we can instruct people on how to use dilators or trainers. So these are devices that are either like hard plastic or silicone dilators to help retrain the muscles and to help with decreasing that sensitivity, improving the mobility, especially if there is fibrosis. So that's probably the most common thing that I'll get referrals for. Um, But also on the flip side, so if somebody has a penis and they are having erectile dysfunction, there are also things that we can help people with with that if they've had radiation or hormone therapy or prostate cancer surgery, something like that. So we can instruct on. pelvic floor exercises or kegels, which they're commonly called to see if we can help improve blood flow, help improve the erectile tissue teach them different strategies or devices that they can use for that as well. And then we were talking about breast cancer survivors or really anybody who has a vagina and is on hormone therapy or they're, they've gone through menopause. Those tissues get so dry. They get really fragile. They don't get as flexible. And so we can recommend things like vaginal moisturizers something that's still a topic, but there's more research coming out about it is actually the use of vaginal estrogen for breast cancer survivors and to address pain with intercourse or even recurrent UTIs, which can happen after menopause as well. So a lot, I think I've gotten completely off course with what your question was, but really um, pelvic floor exercises, different strategies, tools, devices um, and the dilator training are probably the The primary things that we'll do as well as different exercises like stretches, mobility, especially for the hip muscles, if they have had radiation, the hips are really tight, that can be helpful too.

Tina: 12:30

Yeah, for anyone who is a medical provider out there who's listening to this and you're seeing patients who have had cancer or treatment for cancer asking is important. You know, asking about their sexual health, asking about their pelvic health, and in a review of systems kind of way. Because I think that it's hard for patients to overcome this, the cultural or social hurdles of bringing it up themselves. But if, asked, they probably will be honest. So I think I just want to urge everyone to like put that on their to do list because we are taught to ask about certain things in every appointment. Maybe this should be on the list.

Alex: 13:05

Yes. Open the door to talk about sex and that

Tina: 13:08

Mm hmm. Mm hmm. Mm hmm.

Leah: 13:11

as, as a cancer survivor myself, when I would follow up at the cancer center, I was given like a, an iPad with you know, Do you have these? You know, symptoms going on and there was always a question about sexual health and I would answer it and It wasn't usually addressed even though there was Whatever it was that I wrote, you know there there is this kind of uncomfortable thing or if it was discussed it was kind of in a use it or you or lose it kind of way and You know, and so I am glad that there are more people like yourself who are talking about it. there are doctors who are talking about you know, urologists are talking about the use of, hormone therapies. You're super open about talking about dilators and I know your Amazon store, you have this whole Collection of, you know, of options for people, all of them, you know? And so um, yeah, we definitely need more people like you out there. Um, Because you, yeah, there, there's no, you know, you're, you're talking about these things that are so in some mindset, you know, taboo, to discuss and you're talking about it the way that it should be talked about, you know? You know, like you're, you're, you're, you're talking to your, you're, you're talking to your bestie and you're just, I don't know. I, I love your posts. That's I always tend to fan fan girl, but it's, it's true. I learned so

Alex: 14:40

But this is, but this is what we should be doing.

Leah: 14:42

exactly. And I and I feel like your posts have made me more comfortable bringing things up with patients as well. Cause I know that I'm also, you know. Depending on, where my patients are from or what their backgrounds are, you know, it is kind of awkward to kind of bring these things up, but once you get people talking, they start talking.

Alex: 14:58

Yep, if they're being referred to me for something that's not sexual health related, One, again, like, you said, Tina, like, it's in my systems review of sexual health. But I always also ask them, is it okay that we talk about your sexual health? This can be a common concern among people who have gone through, you know, XYZ treatment. do you want to talk about it? So I, I ask them, I open that door, but I also give them permission to be asking about it. Because if they're coming to see me for, you know, You know, shoulder pain or neck pain from their head and neck cancer. I'm like, Hey, but also how's your sex life? Like, they're going to be like, what the hell? Like, where is this coming from? You know, but if we approach it in a way and asking patients, is it okay that we talk about it? It's so much less like in your face. Let's talk about sex. Right? So I think that's really important as providers for anybody that's listening is like how you bring it up is going to be really important, but I think we can also say that for the patient. I feel like the amount of advocacy that people need to do on their behalf in their health care. And I heard that sigh, Tina, right? and especially like. during their cancer journey, it shouldn't be a battle to feel heard in health care so I give people tips on, okay, how to, how should you bring this up? So, like, if you fill out that distress thermometer, that iPad questionnaire, take a picture with your phone, so that you have it in front of you with your doctor, your medical provider, so you can say, Hey, you know, we didn't talk about this. I actually marked this. Can we talk about it? Or come to your appointments. With that list of questions or concerns, especially if it's something you're not comfortable talking. about, like sex, or maybe you're having leakage and you're peeing your pants, right. It could be anything. But if you come to the appointment with that list in hand, that helps to kind of prompt you and give you a little bit more of a template than, 15 minutes. All right. No evidence of disease. You're good. Move on. I'll see you in six months kind of thing. if you come with that, that can be so helpful to start that conversation?

Tina: 16:58

Specializing, just quickly, it just reminded me of a question. I know you're doctorate in physical therapy. Is there a certain initials behind the designation that people should look for, for oncology specialized or pelvic floor specialty or what would guide people to someone like you?

Alex: 17:14

The good thing is there are more of us that are treating both pelvic health and oncology. Um, It's still hard to find somebody. For the board certification, that would be a W. C. S. So women's health clinical specialist. However, our professional organization I think maybe four or five years ago actually did away technically with our designations. To make it not as confusing for people to understand what are all the alphabet letters soup after our name. So that can make it a little bit tricky. But WCS is going to be kind of the top line like board certification. PRPC is another certification that, Is showing a very advanced proficiency in pelvic health for oncology, because this is a newer specialty and specialization. We did not get any letters because this was started after they did away with the designations.

Tina: 18:10

Okay.

Alex: 18:10

so again, that's a little bit, it's a little bit tricky. I would say more pelvic health therapists crossover into oncology. Then oncology therapists crossover into pelvic health just because of pelvic health. We see again like prostate cancer. We see the colorectal, right? So there's a little bit more overlap. So B. More likely to have success finding finding a pelvic health therapist that does oncology. There are a couple of websites, that I can give out. And if you want to put them in the show notes, but there's a couple of different places that, I always go to, to try to find somebody and you can actually look by zip code. You can look by specialty specialization, like, that kind of thing. so that can be really helpful too.

Tina: 18:50

Okay. We'll put that in our show notes for sure so that the listeners can, find, when, when we introduce ideas or solutions to a problem, I like to, you know, give them the last bit of

Alex: 18:59

How to do it.

Tina: 19:01

Yeah.

Leah: 19:03

Yeah, especially because not every cancer center is like that. Or, you know, community hospital may not have these resources. And so being able to give patients a way to find someone themselves so they can get their doctor to make a referral if that's needed wherever, you know, they're living, that'd be great. Let's take a quick break. And when we come back, we will continue our conversation with Dr. Alex Hill.

Tina: 19:28

All right. I have one question. You had a post that had to do with four reasons you're not emptying your bladder. Can you go over that for us?

Alex: 19:36

Yes, absolutely. So first I want to preface this with it is totally normal to not completely empty your bladder. So I'm gonna start with that. However, you should be emptying your bladder most of the way. So the average bladder holds between four and six hundred milliliters of urine, so half a liter. So think of like a half a liter LaCroix or Pellegrino, whatever your flavor water is and so you should be emptying, you shouldn't have more than a hundred milliliters left in your bladder. So if you go pee and then you sit there for a little bit, you're on your phone. I was just having this conversation with the patient earlier. She was sit on her phone scrolling through TikTok. She was sitting for like 10 minutes. She's like, but then I peed again. That means I'm not emptying my bladder. Like, oh honey, your kidneys continue to produce urine. So if you sit there for a while, long enough, like everybody's going to empty a little bit more. So, so this post is more for people who really are constantly feeling like they're not emptying their bladder. They're having to strain to try to get the urine started or to finish the stream. They leave the bathroom, they're having to come back because they feel like they're, they're not empty and then they do actually have half a bladder full of urine. So for those, the primary reasons that people can not completely empty their bladder appropriately. is one, if their pelvic floor isn't relaxing completely. So the pelvic floor muscles, there's muscles that wrap around the urethra, where the urine comes out from the bladder. So if those muscles are tight and not relaxing like they should, that urine's not going to be able to come out completely, or a little bit can get stuck in the urethra. You go to stand up, you have a little bit of dribble. So first is the pelvic floor muscles aren't working correctly. We can retrain that in pelvic health rehab and, and address that. The second reason would be pelvic organ prolapse. So this is where the organs start to drop downward, kind of into the vaginal walls. So the bladder drops down, the, the uterus drops down, or the rectum drops down. So if the, if those organs are dropping down, it, especially the bladder, it's going to change the position of the bladder and urethra. So you can, almost kind of kink it. Kink that urethrus that you're not completely emptying. So when you move, so like I'll recommend for people to like rock back and forth or change your position if you have a prolapse to help change that anatomical position to empty the bladder better. The third, and this is very, very common nowadays is that you're basically. you know, especially with a lot of us, like our job, we don't have a lot of time between, you know, meetings or appointments or that kind of thing. Or we've got kids at home and we're just rushing and trying to get as much out and then we go run out and have to do something. So, the more that you rush or what I call power pee, you're just like pushing to get it all out and then move on with your day. That's not allowing you, one, to relax your pelvic floor, two, to completely empty your bladder. So you really need to sit down. I really mean sit down on the toilet. Even if you're in public, put your toilet paper down, sit down. Relax the pelvic floor and take your time. So it's going to help you empty more as well. And then the fourth reason is going to be different types of medical conditions. So for example, somebody with a prostate, if you have an enlarged prostate or the prostate is getting larger, that can kind of block that, flow of the urethra. Um, There could be obstruction of the urethra. So there are medical conditions. So if you try those first three tips, you're still having issues. You've got some other underlying medical things, always talk with a medical provider.

Tina: 23:06

That's great. Yeah, I, I don't know about, I don't know if I can comply with that one where you sit on a public toilet, even if you put the paper down. I

Alex: 23:12

Why? Why?

Tina: 23:16

It's so close to the water.

Leah: 23:18

Alex did a post on, on this a while ago and it was life changing, absolutely life changing where she gave permission and so yeah, that whole squat and hovering thing, which I've heard people talk about, like, oh, this is so good. It builds your quads and all of that. No,

Alex: 23:37

exercise, not while you pee.

Tina: 23:40

All right. Well, okay. Okay. I'll tell you what my real issue is. Are these darn toilets that go flushing before you're ready for it to flush. And if I'm sitting on that thing and it's flushing underneath me, I'm not doing it. There's no way, no way.

Alex: 23:56

That does make it a little, I have had some times where I'm, I'm peeing and then it starts to flush and I close up, nope.

Tina: 24:05

See?

Alex: 24:07

But the more you can sit the better, because as you're, as you're squatting down, right? Like, and for anybody listening, go ahead. And if you're able to get into a squat position. And you'll feel your pelvic floor kick in. Your pelvic floor muscles are stabilizing muscles. They help to make sure that you don't pee and poop and pass gas when you're not supposed to, right? So if you're squatting and then your brain's trying to tell your pelvic floor and bladder to empty, you're sending it opposing signals.

Tina: 24:36

All right, we'll see.

Alex: 24:38

You're gonna think of me next time you go pee.

Tina: 24:41

Yeah, I don't know.

Leah: 24:44

At Target, I'm like, okay, Dr. Hill said

Alex: 24:50

love it. The only time that I tell people it's okay to squat to pee is if you're like, out hiking. And even then, I have very specific strategies on like, okay, you're gonna hold here, this is how you like, strategies.

Tina: 25:03

Oh, wow.

Alex: 25:04

there's also a little funnel that you can get to, a little pee funnel for if you have a vagina.

Tina: 25:10

Well, when you're peeing in the woods, can't you just go all the way down

Alex: 25:12

Exactly!

Tina: 25:13

Yeah, that's fine, right? A full squat.

Alex: 25:15

Yeah! Would you like to do That I've had, I've actually had some people and they'll do that, like, on a public toilet because they don't want to sit on the toilet. And so they'll put their shoes, like, they'll stand on the toilet and then squat down into that. That really deep squat and go pee that.

Tina: 25:29

That could be a good compromise because I'm farther from the toilet water, right? Alright, that's all I care about. That

Leah: 25:36

I would be afraid of slipping if my foot goes in the toilet.

Alex: 25:40

toilet. gymnastics,

Leah: 25:43

That's why everyone has to work on their full squat, because you never know when you'll need it.

Tina: 25:51

could do.

Alex: 25:53

Mm-Hmm.

Leah: 25:54

So, um, one of the, one of the things that I would refer my oncology patients to physical therapy for, you know, pelvic rehab is for incontinence. And typically while they're waiting for their appointment, I'll talk to them about Kegels, but there's so much more than Kegels. And that's a mystery to me. So, can you talk more about, you know, what is entailed and supporting that pelvic floor and to help patients with incontinence, because it's, not only the gynecologic cancer patients, it's the prostate cancer patients, but it's also just, you know, somebody with lung cancer who talks about their incontinence has always been there and then they don't want to talk about it because it's not cancer related, but I'm like, it is because it's quality of life related.

Alex: 26:45

Yep, absolutely. and I'm really glad that you brought that up because in, People who are listening, you may see polarizing views in social media from different influencers of like, Kegels are the devil, and like, these are the worst things, and they're so villainized for no reason. Like, kegels are fine to do. it's all a kegel is, is a repeated pelvic floor contraction. Think of it like your bicep muscle doing contractions. That's all it is. Where we need to be mindful when we tell people to do kegels, Or if we, you know, somebody's watching a YouTube video on how to do Kegel exercises, is that Kegels aren't also for everybody. So if they have urgency incontinence, or they have trouble emptying their bladder fully, and that's why they're having leakage, we may need to actually relax the pelvic floor and do a reverse Kegel. And work on that coordination before we actually have them start strengthening their, their public floor. So that's the 1st thing we always want to do is determine, like, what type of leakage you have and then go from there. So, in terms of interventions, honestly, 1 of the number 1 things that I always address is constipation. I don't care what type of leakage you have, if you have constipation, it's likely having some type of impact on you leaking. Um, So you think about the amount of stool burden that you have. All that's pressing on the bladder, or if you're straining really hard to get that stool out. that's also making the pelvic floor weak, you're having issues with then holding the urine, right? So constipation is always one of the first things that I address with folks. And then besides the pelvic floor exercises, um, or kegels, it's going to then be also strengthening the core muscles. So their abdominal muscles, their glute muscles working on breathing and getting good coordination. So something that's common with, a lot of different types of cancer treatment with stress, with anxiety, which we know is very high during, you know, especially during active treatment, is people tend to restrict their breathing, because they're, they're stressed, they're anxious, everything's kind of tight, and so when people aren't getting those full breaths, that's impacting the movement of the diaphragm, the muscle that helps you breathe, and the diaphragm and the pelvic floor move together. So if you're then holding your breath a lot or tightening things that can also put a lot of pressure on the pelvic floor and cause pelvic floor dysfunction as well. So, again, like, 1 of the 1st things they do is work on breathing with people. So. Even if you're not doing kegels, don't be constipated and breathe 2 big things that can be really helpful for people. But we'll also make sure that there we're doing functional things. So you know, I've had people where, depending on their profession, like, those are things that we need to work on. So, if you are leaking as you're, revving up a lawnmower, we're going to mimic that in the clinic with a TheraBand and work on your breathing and your core activation as you do that. movement. If you're leaking as you're jumping on the trampoline with your kids, then we're going to work on, you know, a jumping progression. So we try to make sure that it's very functional to what their goal is.

29:48

I love that.

Leah: 29:49

It's something that makes so much sense. And it's like, why isn't everybody doing that? You know, like, like how is it affecting your life? And let's, let's modify it. Like, that's wonderful.

Alex: 30:00

yep, exactly.

Tina: 30:02

I've never actually even heard of the diaphragm and the pelvic floor being so, so intimately related.

Alex: 30:09

Yes, it's, it's fascinating. You know, even looking at, you know, lung condition, like lung cancer, cystic fibrosis, where there's just not a lot of lungs, lung expansion, COPD, if there's a lot of coughing, like that stress and strain on the pelvic floor even with smoking, cause the, the breathing pattern is opposite of how you would normally breathe. And so even that can impact how the pelvic floor and diaphragm move together. It's, it's really fascinating. Yeah.

Tina: 30:37

Interesting.

Alex: 30:38

I've collaborated with um, some speech therapists before if I'm working with a singer or somebody who's having voice or speaking issues, and they're trying like, so hard, like, so effortfully to like, try to talk and that's causing leakage. So we'll collaborate together and work on that too.

Tina: 30:55

So I guess we were talking about this and Leah and I were discussing, is there such thing as too many kegels? from what I hear you're saying, there is, right? if your issue is relaxing and then you're doing the opposite.

Alex: 31:06

Yes, so that would go for, you know, if you have urgency, if you have pain, like pelvic pain, coccyx pain pain with intercourse, pain with any type of sexual, component like orgasm or, you know, penetration, anything like that um, those are all things that we typically need to relax for. Constipation, trouble emptying your bladder. We need to relax. But even too, like You know, especially with prostate cancer, Kegels is like the number one thing that's recommended and there's different protocols anywhere from, 30 a day to 100 a day. But at the same time, like, you think about if you're doing that many, bicep curls or that many squats, like, your legs are going to be jello, right? So I've had some people that do. A hundred, 150 kegels a day and like, awesome, like you're strong, but also you're leaking more because your muscles are just pooped out so you can do too many kegels. Yeah.

Tina: 32:02

Mm hmm. So what is a reverse Kegel, because you mentioned that.

Alex: 32:06

Yes. So a kegel and if you're listening, I want you to go ahead and try this and y'all can do this too. So, a kegel is pulling in either the, you know, penis or the vagina and you're pulling in the rectum as well. So you're pulling them up and in kind of like an elevator. And then you're relaxing them back down. A reverse Kegel would be then, Okay. the elevator's at the ground floor, now we're gently kind of pushing it down to the basement. So you're lengthening it. So think of it almost like a stretch for the pelvic floor. So Kegel's pulling it up and in, reverse Kegel is dropping it and kind of bearing down a little bit. Not straining and pushing hard, but just like kind of gently nudging it out.

Tina: 32:44

Okay.

Alex: 32:44

I can see that you're trying it, Leigh. I can see it, I can always tell when people get this like far off look like, I think I got it. Could you get it.

Leah: 32:56

I got it. I got it. And if anybody is like drives by me and we're stopped at a light and I'm making this face, what's going on.

Alex: 33:07

It's that sensation. Like almost like you're just about to like quietly pass gas. Like, it's just you're just kind of nudging into it. You're not forcing that that muscle down.

Leah: 33:17

So is there, is there anything else um, in the oncology realm that you provide for your patients that you want to share? If there's any specific things that you would dress that might. Not come to front of mind,

Alex: 33:34

A couple things. So, and these are things that like that all oncology providers would would rehab providers would address. So, chemotherapy induced peripheral neuropathy. So, you have that change sensation, maybe even weakness in the hands that can be common with chemo. Balance issues are common with that. We also see a higher rate of sexual dysfunction. From chemo and if they have peripheral neuropathy with that. Um, Deconditioning, which is really common. Cancer related fatigue, I think, is significantly under addressed. People are told to just rest, take a nap, sleep, take coffee, have these stimulants, but really we know in the research, the number one thing to combat it. And to mitigate it and try to reduce it and improve it is exercise. So that's another thing. And then with lymphedema. So I'm a lymphedema therapist, but what most people would do is lymphedema for the arm uh, lymphedema for the breast, lymphedema for the legs, but I also specialize in head and neck cancer and a lot of people don't realize that you can actually do the lymphatic massage inside the mouth. So if you have swelling in the mouth or the tongue, you can do that. And then I also do uh, lymphedema management for the genitals as well. And that's, again, is something that is, often overlooked. It's not screened a whole lot. People think it's normal. So if something feels full or you're, having more swelling, that can be addressed. And I don't think a lot of people realize that.

Leah: 34:59

and that would be the result of either radiation or surgeries, typically,

Alex: 35:05

Yep. Yep. Most commonly. Yep.

Tina: 35:07

Yeah. And I know that, I think we've talked about this before on the podcast, but lymphedema is one of those things that the sooner you get to a physical therapist, the better.

Alex: 35:15

Yes, yep. And really with what's called the prospective surveillance model. So essentially we try to get people in to the providers they need, including rehab before they even start treatment. So like time of diagnosis, you see a whole laundry list of people. And then what's important is then we follow up with you. So especially with lymphedema, we have people at the facility that I'm at, we have them get assessed for lymphedema. We do all their baseline measurements before they start treatment and then especially after surgery, then we'll do a reassessment and then we'll periodically remeasure to track for lymphedema. So like you said, the earlier that we can catch it, it's a heck of a lot easier to manage than if it's, to progress more.

Leah: 35:59

is that standard of care to see patients prior to radiation or surgery and then follow up with them throughout.

Alex: 36:08

It's more, it's, it's very well established in breast cancer. The, the vast majority of cancer centers, this, this model is in place. Whether it be efficient or not is the, is the whole other question. There's, you know, especially in the U. S. healthcare system wise, like we're very reactive. So when we're trying to get insurance coverage for some of these things when people don't have impairments yet, that can be an issue. But I would say for breast cancer for sure starting to become more, more common and within cancer centers for like prostate cancer The, the pelvic cancers as well. I work primarily with, solid tumors. So I don't do a lot with the blood cancers, but in terms of solid cancers, that's kind of what the trend is right now. We're trying to improve that across the country, but slow and steady right now.

Tina: 36:59

Mm hmm. Mm hmm. Back to that whole self advocacy that you mentioned.

Alex: 37:03

Yes. exactly. Yes, I can't tell you how many people I've had that have like, oh, I saw this online or I, you know, Saw this from American Cancer Society. I heard this on a podcast I should be coming in here and I like had to keep asking my provider for a referral. So I think More providers are are aware of it and the benefits of it but it's still like you said just kind of having to advocate for yourself and recognizing that You can get started on things before you start treatment, right? Like, we can improve your bowel health and your bladder health and your sexual health and your pain before you start treatment. So you're starting off on a better foot, Right. You think about any other orthopedic surgery, hip surgery, knee surgery, they get prehab, right? Like, they get exercises, they get all this stuff, but then when we talk about cancer, like,

Tina: 37:50

Mm hmm. Mm

Alex: 37:51

You know, or even pregnancy, right? I mean, that's a whole other thing, but you know, we, we need to be getting people in sooner for the help that they deserve.

Tina: 38:01

hmm.

Leah: 38:02

Yeah, I, I feel a lot of that is well, that's what happens, you know, well, that's just a result, like, that's just, it's just going to happen, whether it's pregnancy and like, you're going to have a little incontinence and, you know, like, that's just, that's kind of, need to move away from that for sure.

Alex: 38:17

Yeah, absolutely.

Leah: 38:19

Is there anything else that you want to talk about before we end? Before we end this, I don't want to end this conversation. I'm so glad to have you here that I like, I want to keep picking your brain, but is there anything else that you want to, you want to talk about?

Alex: 38:37

I mean, trust me, I could literally talk for hours about? this, but I will say no for now so that I can try to boomerang back onto your podcast again.

Tina: 38:46

Oh, nice. Nice.

Alex: 38:48

I mean, there's so many. I mean, even looking at. Like adolescent young adult, right? Like a lot of, like, especially colorectal cancer. Like, we're seeing that in younger populations, but we're still lacking in research in this age group. You know, between 18 and 39, they're either grouped with historically pediatrics or older adults and like, they have their own distinct needs. So, I mean, there's, there's so many gaps in care in ways that we, as providers and researchers can really address to do better for our patients. But you know, again, if you're a survivor, if you're a caregiver, like, just know that there's help available. It's just a matter of finding and asking for it.

Tina: 39:25

hmm.

Leah: 39:25

Well, I definitely want to mention that you do have a YouTube page, which is a great resource. For patients out there, and so we'll put the link in the show notes to that, as well as to your social media, your Instagram. Are you on TikTok as well? Or do you

Alex: 39:43

Yeah, Instagram is my baby. It's like where I do everything and then I'll cross. Oh, like Instagram's my baby and YouTube, I am on TikTok and Facebook too.

Leah: 39:55

Okay, so we'll put all the links in the show notes so people can find you if they're not already following you. And um, Yeah, I don't know. I, like I said, I could, I could pick your brain forever and I'm so glad that we were able to pin down a date and do this.

Alex: 40:15

Yes, me too. Thank you again so much for having me on. Like I, like I said, I've been really looking forward to this. for a while.

Tina: 40:23

Well, and there's a really good chance, Alex, next time I urinate in a public bathroom, I will think of you.

Alex: 40:29

That is, I love when, I love when people tell me that, like, I thought of you when I pooped. I thought of you when I, I when I peed, and I'm like, that's all I want to know. Like, that means I've done my job.

Tina: 40:43

Yes. Thank you so much for sharing your expertise. It's really been, it's been a learning experience, so thank you.

Alex: 40:50

my pleasure. I love you. I love you. I love

Leah: 40:53

Thanks for listening to the Cancer Pod. Remember to subscribe, review, and rate us wherever you get your podcasts. Follow us on social media for updates. And as always, this is not medical advice. These are our opinions. Talk to your doctor before changing anything related to your treatment plan. The Cancer Pod is hosted by me, Dr. Leah Sherman, and by Dr. Tina Kaeser. Music is by Kevin MacLeod. See you next time!

Alex: 41:22

Thank you so much. This is the best podcast. Woo.