Below the Belt: Equity, Access and Advocacy with Missy Lavender

Show Notes:

• Missy Lavender on Linked In
• Missy Lavender's "Below the Belt" book
• Renalis on IG
• Renalis on FB

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Transcript

Lindsey Vestal Oh my goodness. It is such a passion project of mine to have been able to speak with Missy Lavender. Missy Lavender is the author of Below Your Belt How to Be the Queen of Your Pelvic Region. It's a pelvic handbook for girls. I found this book about seven years ago, and it truly changed and energized me around how it could approach educating my clients on some of the most basic adult driven aspects of their life. It was a joy to be able to talk with Missy. She is an entrepreneur, an innovator, a researcher, an author and patient advocate for Pelvic health in that really comes across in our talk today. She's particularly passionate around persons assigned female. Her passion stems from her own journey after a difficult childbirth and search for the right care team, which she did end up finding. She has started two companies to bring equitable, accessible programs and products to people so they can be healthy below the belt and to get the right care faster. Missy is an avid hiker, a cyclist, a traveler and a Yogi. She lives between L.A. and Lake Geneva, Washington, and has two emerging adult children and a Portuguese water dog, Libby. I do apologize. The sound quality is a little bit different than normal in my podcasts. There is some background noise, but I sat at the edge of my seat with everything Missy had to share, and I'm sure you will as well. 

Intro New and seasoned OTs are finding their calling in Pelvic health after all, what's more adult than sex, peeing and poop? So here's the question. What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are Pelvic health. OTs I'm your host, Lindsey Vestal and welcome to the OTs and Pelvic health podcast. 

Lindsey Vestal Missy, Thank you for being a guest on the OTs for Pelvic health podcast. It is beyond a pleasure to have this conversation with you today. 

Missy Lavender Thank you, Linsey. I'm so pleased to be here. 

Lindsey Vestal Yay. Well, I have to start off with a question that is kind of how I know you and how I know your work, and that is by reading the Below your Belt A Pelvic health Handbook for Girls. I read this book about seven years ago. And Missy, I have to say it was one of the most refreshing books about Pelvic health to this day that I have ever seen. It has beautiful illustrations. It was written in such a relatable and approachable way. And after devouring this book from cover to cover, I immediately redid all of my handouts from my Pelvic health clients as kind of a direct result of the inspiration and the impact that your book had on me. And even though I was seeing adults in New York City, it really showed me that Pelvic health education could be fun, it could be relatable, it could be energizing. And so thank you for that. And in in regards to the actual book itself, it really illuminates, I think, public and private conversations around sex education and frankly, just straight up body literacy. And I have a feeling that this is a pretty strong passion for you. Missy, can you tell with us tell us a little bit more about how you came to writing this book. 

Missy Lavender Absolutely. First of all, Lindsey, I'm thrilled, first of all, that you bought it. And considering you mostly deal with adults and that you read it and had such positive reactions to it, we were very proud of that book. It won five independent book publishing awards and was definitely a labor of love. And it started out because I had a ten year old at the time, and I was confounded by this pathway that we hear Adult Women's Express about how they didn't know their bodies. Why didn't anyone talk to them about this when they were younger? So we had gotten a grant to develop a related digital product, and we thought there's a market of people that we want to reach, and those are the people that have really aged children who are going to be going through menstruation for the first time, but who also potentially could have sort of pelvic health disorders like fibroids and and waitresses who might have an moment reading a book like this to their child. So if you notice it, it's strategically written so that it's meant to be read to a child by their grown ups. And we're hoping that that then generates kind of a double moment for the reader and then and then the child to read it same time. So my ten year old was my inspiration. She was mildly horrified that I was writing a book on letters, which was what she knew me as, was like somebody who is focusing on bladder health. And then when she had her own period and we went through the book and talked about how she would know if she was getting her period and and some of the things that were in the book. She was quite excited that and that her mom was writing this whole book. And she said

Lindsey Vestal Oh my goodness, I love that. I have to tell you, Missy, that I have a ten year old right now myself. And so, so much of what you said resonates me with me. And she also thinks of her mom as someone who talks about, you know, bladders and vulvas and all of the things and at this point in time, I'm probably not in the cool category. So I do hope that day is coming. 

Missy Lavender That's right. Well, it was funny because she had gotten her period and was really, really stressed out about it, but because we had had these conversations, you know, she asked to stay home from school and have a tampon practice day because the next day they were going to be swimming. And of course I was kind of taken aback that she wanted to go right to tampons. But of course, I had done the same thing at 14, not at up to 11 at that point. But she she had just this general comfort with her body that I knew was different for me, especially growing up Catholic in a in a family that really didn't speak about these things. So I think this is probably one of the biggest gifts we can give our respective children, especially our daughters, is being comfortable enough to have the conversations with us about what's going on for them. 

Lindsey Vestal I couldn't agree with you more. And that's another thing we have in common, is that I actually grew up Catholic as well. And so I think that's that's part of the comfort and passion that I have or. I'm talking about these topics because I just think that it really kicks off such advocacy in ourselves. And going back to what you said a moment ago about your intention for the book with these double moments, right? So this and I can't tell you how often I hear about the notes that I support who are specifically working in the pediatric realm where you can kind of see this look of contemplation come over the parents face and then there's a side conversation around, well, goodness, I didn't know these things are normal. Is there is there help for me? And so the optimism and the hope that we can spread by this education has such an incredible ripple effect in you agree with you more. It is 100% the best gift that we can that we can give the younger generations and our children. 

Missy Lavender Yes, I agree with you because everything that I know from my work with thousands of patients over the years, which pale in comparison probably to yours, is just that constant barrage. No one talked to me about this. I, I didn't know anything. Doesn't normal. It's so therefore, how do you know it's not normal and that that's what we really try to get under in all the work that we're doing. 

Lindsey Vestal So, Missy, your more recent projects really revolve around access to care and really essentially the client journey and pelvic health. And we all know that that this can be a very, you know, complex journey for some of our clients. Would you mind sharing if you're comfortable a little bit about your own journey and why you're so passionate around issues like access to care and cost in Pelvic health? 

Missy Lavender Absolutely, Lindsey. Thank you. This is my favorite question. So, when I had my son 20 years ago and ended up in the in the arms literally of one of the world class best colleges in Chicago, I could not believe all of the statistics coming out of her mouth about how many millions of women look just like me. I mean, I was a 40 year old mom, so that had its own risks. I didn't even know about that. I didn't know about the kinds of things. I chose it in my delivery that put me in her arms and in her office. And I had made some decisions based on no data that contributed to my body then being really kind of a pelvic health nightmare. And then when I went home, maybe a good little MBA was I Googled everything and was just horrified. And the more I dug into it and the more when I was back with follow up care, the same doctor, I'd be like, Where is the data on black women? Where's the data on Latino men? And then it really became an income issue. And I realized that there are so very few resources in the field of pelvic health, whether it's physical therapists, Uruguayans, even urologist. Peters ET cetera. Most of them are are in major metropolitan markets. 80% of specialty care providers are in major markets. And that means if you're in Missoula, Montana, or somewhere where you have to drive 3 or 4 hours to get to care, your ability, for example, to follow Clinton is probably slim to none. If you are a low income person in this in this country, your your health care options are just very, very limited. So everything that this company does now is really to create things that can treat women where they are on people versus assigned female, where they are in their home, and then keep them connected to health care providers who need additional care. 

Lindsey Vestal This is so evolutionary. And I have to ask because this is probably not this is probably not a tool that many people are familiar with in terms of treating a person assigned as woman at birth at home, you know where they are. So that you're right that follow up care and the options are actually available to them. So would you mind sharing a little bit about how that actually works? 

Missy Lavender Sure. So our our first products name is CC. And so CC is a software product that you would refer to as the category is called Digital Therapeutics. So the name tells you something. So it's meant to deliver to a patient and date the course of treatment over her smart device. Or frankly, we're building a computer as well that would mimic the kinds of things you would learn if you were fortunate enough to get to an O.T. or an occupational therapist or a pelvic floor physical therapist in this space. And again, there's about 5000 eligible PTs in this country. So let's just start with that being an access inequity issue. So see basically takes your data from validated embedded questionnaires. And it's and then there's a 72 hour diary. So it's. You mentioned we're starting with a condition called overactive bladder is our first indication that we're addressing. And then from those data, she then starts discussing topics like fluid management, bladder irritants, constipation, pelvic floor specific with pelvic floor for overactive bladder oab, as we call it. And it's in a very user friendly environment. It looks basically like you're chatting with your best girl friend who's a nurse practitioner. So it meant to be kind of a credible medical, approachable voice and also engaging because we want women to have this journey and and feel like it's personalized to them. So we then check back in at the midpoint with another one day diary, and at the end they get a final one day diary and the same questionnaire. But it's all to show progress and encouragement. And then if they need care or when they need care, then see what alerted providers who would then step in and maybe schedule them for additional treatment options. 

Lindsey Vestal What type of provider are we talking about? 

Missy Lavender So initially we're going to be targeting specialty care providers. So the same thing I just told you are are accessible to many. But the reality of of OAB or a fractured bladder is that you really can be preliminarily diagnosed by your primary care provider and it can all frankly be done with telehealth. It's with those conditions you just want to screen for some big things like is there pain when they when they're peeing? Is there blood in your urine or do they have recurrent or very, you know, tract infections? Often those would be positive people you would want to see in a practice. But otherwise to be a primary care provider who then prescribe or it could be again at the specialist urologist here again call just or even original hands, which people tend to see more often. 

Lindsey Vestal Well, I have to say, if it's anything like below your belt, this is sense of engagement and personalization. And chatting with your best friend is definitely there. Because I've seen this firsthand with the book I'm actually holding in my hand right now, so I can. I can see that that is also important to you and and a big part of you designing this as well. 

Missy Lavender It's huge. Lindsey. And we have done a lot of usability testing over the years, so we do a lot with we did a lot in our nonprofit days with community health workers, most of whom English was not their primary language, and they actually named her for us, I want to call her, comes up and she touches and connects what they like to see because it sounds like CC, which is great. But we this, this conversational style that she has is really approachable like we were talking about that also plays well across ages and also across socioeconomic levels. So we wanted to have something that again, could, could not be intimidating. We want it's not like you're reading a website or web and it's really, you know, again, something more I would say digestible is also a good word to use because you don't want to just dump a whole pamphlet on someone and say, Here, read this. And that is unfortunate. The standard of care where CC is meant to be. This is a journey over eight weeks of of learning, engagement, encouragement, repetition, etc.. 

Lindsey Vestal Yeah. Yeah. Missy, are there any other aspects that you can think of that put a bee in your bonnet regarding a client's journey in public health? 

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Missy Lavender Yes, I think there's a couple of things and I really get my goat, as we say. First of all, the fact that so many people have told us they brought up these conditions reeking breeding, chronic pain, those are big buckets that we're addressing and renounce that bring them up to their doctor or their health care provider and basically dismiss, well, baby, you're older woman. It's just it's like it's a part of the deal to have a normal uterus leading or to be constantly in the bathroom or to have your falls out of control. These these are issues that are literally militating and isolating and can cause women to fall on the way to the bathroom at night. Sample bring it here. So that really makes me crazy. And the other part of it is the reason we started with the raft of water samples we spend in the category of disorders, $100 billion a year. And all of these conditions, the overactive bladder alone is close to 70 billion of that. And that's mostly indirect medical costs. That's. Yes. And the key to understanding that plus is having early intervention with things like CC that can help a patient before they get so chronic and so controlled that they might need a more invasive, more invasive therapy. So we're really focusing on those patient at the top of the funnel, if you will, and and trying to address them early in their journey. 

Lindsey Vestal Well, I mean, that's so important because we know that that early intervention is game changing for people. And the biggest the biggest issue that we hear as practitioners on the ground is exactly what you said earlier on on our talk today, which is like this idea of why didn't anyone tell me? How did I not know? There are options for this? And what we start to see, especially because as an occupational therapist, I have a strong desire to eat, to really treat the biopsychosocial approach. So to to really think about the role of the nervous system and how things like chronic pain really do add layers of complexity. And have the client found us seven years earlier, which can often be that that average number of how long it takes for a client to find a pelvic health practitioner to really address some of these core issues lifestyle, behavior, habits, roles in routines, functional outcomes, the things that we know really move the needle is often seven years. And so if we can go back in time and actually catch a client in when when just education can play such a key role, then then we're not down that road of, you know, having to address some of these more sometimes complex or more evolved aspects of care. 

Missy Lavender Right. And the other side of this is especially your overactive bladder. What most people fear is the information and somewhat rationally, but also because some of the earlier medications and space and some crazy things like this and the whole class of them are being studied right now because this is potentially for dementia in 11% of the patient population. They actually go off the meds. So people take you with all those jobs, but they're cheap and they're readily available compared to other medications in the space. Are expensive health issues in your view? So if you're going to go tools in the patient, you need to take every patient in Ireland, take one or more expensive ones right now. If I didn't know that Jesus was teaching me the things you just did, referencing these behavioral therapy subjects, I didn't know that my patient is being nearly successful. I'm 100% competent, and that's because I've made choices. I know what your actions are. I know the ones I want to the message, the volume, the timing of those. I chase them with water and do all the things I have to do to defend myself. But I have to take the medication and it works perfectly. So I know all things take the same medication that I guarantee you I have results. And that's another reason that we see this important as a supplement to the medications. There's data that shows that behavioral plus medications and more than just the medicine. So that's a place that we like to see that. 

Lindsey Vestal Absolutely. You had mentioned I'm sorry, the. I didn't hear it very clearly. But earlier you had mentioned three conditions that Renalase is really passionate about. I believe you said pelvic pain, overactive bladder. And if I heard you correctly, what was the third one? 

Missy Lavender So we like to think of when people are talking pelvic health disorders. We talk about making meeting chronic pain. So I actually started with a CC that is focused on coaching a mom of a pretty child around with someone not normal in that situation. It's basically the digital version of the document. And we received an SBIR, a small business innovation research grant from and I actually felt that we had a research study with no question, this study was very positive, but we didn't have a commercial track for that product. So we then did a huge amount of customer discovery that's really overactive bladder patients, the providers that were really screaming for solutions. So. Over our waters and precipitation. We have a second version CC that's focused on the stress version next. So meant to be very much with primary care patients and then people and people in finance. That's because it's such a debilitating condition for many, many, many other issues as well. And then chronic pelvic pain is definitely a long term roadmap. 

Lindsey Vestal Amazing. So next is the stress urge mix. 

Missy Lavender Yeah. The stress of that what we call a urinary incontinence CC or obviously CC is actually a disability study with the University Hospital here. And right now it's part of a very different type of medical care offering. I have not asked you once what that does. Let's see what our overactive bladder patient wants. The first one that we're getting once a year achievements. 

Lindsey Vestal That's incredible. Well, I know that I'll be watching with bated breath to see how all of this develops. And I am just so inspired by I'm so inspired by your approach and your optimism and just the great care you're taking to really consider all the aspects of making this really crucial aspect of health care so much more accessible, unapproachable. 

Missy Lavender Thank you. And I want to say, one of the things that drives me is. You know, we can't. We have to form a business around this for it to work, Right? So trying to figure out who is going to pay for behavioral therapy has been really challenging for us. And what's really clear is that there's a road to reimbursement that's happens in other conditions like mental health, addictions and social, etc., is very translatable to behavioral therapy for bladder health. And so as a company, we're taking this very strenuous for equity clearance as a way to then come, let's say, first year. We also makes it more operational plans for the providers to responses because they also get paid to talk about things in their sex codes for these products. But it's a very complicated and intentional part of health care right now, and we're excited to get to know. 

Lindsey Vestal Well, I'm going to list in the show notes where where our listeners can find you. Of course, I'll link to Below Your Belt as well as Renalis. Is there anything else you'd like to share with our listeners? Additional resources. Way to stay in touch with you. 

Speaker 2 I would say, you know, find me on LinkedIn. We also have social media like everyone else within the audience. Yes, that's true. And we have Instagram and Facebook page and those we specialize in certain pretty certain little trials, which we will be doing later this year. Modifications. 

Lindsey Vestal Okay. So I'll definitely also include in the show notes the LinkedIn as well as the Instagram and Facebook handles. 

Missy Lavender That would be awesome. 

Lindsey Vestal Such a pleasure, Missy. Thank you for all the innovative work you're doing and really enjoyed our time together today. 

Missy Lavender Thanks. Take care. 

Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast.