Chew on this: How Eating Disorders and Healthcare Disparities Show Up In Pelvic Health with Rachel Ohene

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Transcript

Lindsey Vestal I'd love to introduce my guest today. Her name is Rachel Ohene. Rachel is the founder of Liberate Pelvic health with a special interest in social justice, sex, positivity and trauma informed care. Her path to specializing in Pelvic health began while working on an acute eating disorder unit at a local hospital. While it's currently very rare for a rehab therapist to specialize in eating disorders, OTs Functional Lens offers a valuable emerging perspective to the field of eating disorders. A couple of years in, she started to suspect pelvic floor dysfunction for many of her clients on the eating disorder unit. This is what inspired her to pursue her first continuing ed course in pelvic floor rehab. Rachel's thirst for advancing knowledge and skills within the Pelvic health practice area has been insatiable ever since. Although she never aspired to have her own practice, fete redirected her career when Rachel's nervous system could no longer handle working full time in an environment where health care inequalities were clinically perpetuated and seemingly insurmountable. With her strong values and social justice, Rachel directly bills Medicare and Medicaid to make pelvic health therapy more accessible to adults who are older or experiencing low income. I can't wait for you to hear our conversation today. New and seasoned OTs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But 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. Rachel, I am honored. I'm honored to have you on today's podcast. Thank you for joining me to talk all things OTs and Pelvic health. 

Rachel Ohene Yeah, it's a pleasure to be here. 

Lindsey Vestal So I don't think I've actually met an O. T who specializes in eating disorders before. And it's it's it's it's fascinating. And I'd love to explore that a little bit more. And, but I'd love to especially explore and I'd love to learn more about how you in your own career kind of saw that connection between eating disorders and pelvic health. 

Rachel Ohene Sure. Well, I'll talk about my journey in general in eating disorders. I was the second OT hired in to this medical stabilization unit for eating disorders, and the first O.T. was particularly interested in mindfulness and in weighted blankets. And I loved studying occupational science in school. So when I came in and got trained up, I was really interested in carving my own path by gravitating towards those professional roots in the arts and crafts movement and structuring more creative interventions as a way to help these clients reduce their preoccupations with more maladaptive eating disorder behaviors and thoughts, and replacing those with activities that could or could keep their hands busy, could create a sense of self. And those interventions were really fun. And it was really I really loved that piece of my career. I'd also just finished up my 200 hour yoga teacher training. And so I incorporated a lot with yoga to support digestive motility and connection to your body and just very gentle, mindful yoga interventions to support meaningful participation in the hospital setting and to start to explore in a functional and applied way, maybe start to challenge some of the over exercise behaviors that a lot of the clients had. And then we also did group while we were there. And so it was the only group available. It was all room based therapy at this hospital setting. But then oftentimes they would transition to residential or step down to residential treatment where they'd be in groups all day long. So kind of using that exposure just right, challenge our approach. We really advocated to the multidisciplinary team about the importance of having group to just do that exposure. And that was actually the first place where like the first kind of light bulb moment where I started to realize that there was maybe some tonic for dysfunction happening, because in that one hour programing throughout the whole week, I just noticed there is such difficulty for these clients to hold their flatulence. And I even had a client to me one time say that they really wanted to come to group, but they weren't going to come because they were embarrassed because they knew that they were going to fart. And yeah, so that kind of gas incontinence was really the first thing where I'm like, this is one hour out of the week. So if clients aren't able to hold their farts in this social environment, that makes me think that there might be something happening with the pelvic floor. And then I started to really see that there was such an aspect of urinary urgency. And I did a lot with ADLs, with this population here. So I did a lot with activity, endurance or safely getting dressed in fall prevention. And and when I was working with people on these areas, I started to see fecal smearing on some of people's underpants. And so all of that really started to spark my curiosity and to ask more questions and ask questions. I started really understanding the lived experience of these clients who a lot of them had been into treatment for years, in and out of treatment for years, and no one was really asking on these questions. And so that was enough for me to to start to get really curious about sub specializing in pelvic floor. So I did Herman and Wallis's level one and biofeedback, which gave me enough tools to really start intervening. And so that's kind of how I started to uncover pelvic floor dysfunction within the eating disorder population. 

Lindsey Vestal Got it. That's incredible. Thank you for sharing those observations. And also just your frame of reference a little bit. Your interest in occupational science and sort of creative interventions. I also didn't realize that about your Uber yoga teacher training background. And I can I can really sense that you were very present with your clients. And I think the thing that really stuck out the most to me and in what you just shared, Rachel, is how no one was asking these clients questions. And we know that to be true around Pelvic health topics, but I can definitely see it after hearing you talk about eating disorders too, and how those two things are connected, and that by holding space and allowing clients or empowering clients to explore and be curious about their own bodies and holding space by asking questions that you're really allowing them to perhaps just more deeply understand some of what's going on that others may have hand waved or perhaps didn't offer hope for being able to get to the other side of that. So this is a little bit more of a direct question. I mean, I appreciate so much you sharing your experience, but in in your own, I guess. Journey through connecting these two areas. I mean, just to be to be very upfront about it, how are they connected? How is pelvic floor dysfunction and eating disorders connected? 

Rachel Ohene Well, there's a lot of interconnections, really. You know, some of the building blocks of public health therapy that we're that's kind of like the one on one lenses of intervention is intra abdominal pressure management, diaphragmatic breathing. And then pelvic floor and core muscle coordination strengthening. Getting full range of motion of those structures. And so let's consider how eating disorders may impact those areas of function. Now, we know that medically in eating disorders, these clients often carry a co-morbidity or a symptomology of decreased bone density gastroparesis or a slow transit constipation. So functionally, the way that I saw that really showing up was chaotic posturing, decreased postural awareness, maladaptive posturing related to body image disturbance. You know, some people really wanting to hide their body or hold their body a certain way to reinforce feeling smaller. You know, there's a lot with generalized weakness, decreased body awareness, decreased motor coordination and a lot of shallow breathing. So, you know, one of the biggest things that I really saw, too, was behaviorally as well as that posturing piece. When I would see a lot of belly gripping, which is stuck in the stomach. So due to body image disturbances, people behaviorally are changing that entrapped low pressure management system. And that is going to interrupt pelvic floor functioning. So and then you play into you look at strict food and exercise routines. I saw a lot with urinary incontinence. They kind of stress incontinence related to overexercising and then continually continuing to, you know, just be disengaged with their body and with the cues of their body. And then just in general, there was a there was a weakness of the pelvic floor. So that stress incontinence was happening. Yeah. And then I also saw I also see a lot of occupational interruptions in their lives. You know, difficulty with bathing, difficulty with sitting tolerance. Also like maladaptive sitting positioning because of potential pain at the initial to veracity voracity with the extended sitting depending on if people are really malnourished and then a lot with functional cognition. You know it's it's in the literature that people with eating disorders are more likely than the general population to experience sensory avoidance or sensory sensitivity. So then how does that play in to pelvic floor dysfunction while people are going to avoid activities that are going to be overwhelming to their nervous system? And then people are going to also have a sensitivity to. So maybe they're going to have like increased urgency sensations because in general, that's the way that their body processes like sensation. 

Lindsey Vestal This may be a challenging question to answer because every client is different. And, you know, we're really treating, you know, the story and the person in front of us. But if you were to think about it and generalize, would you say that clients who come to you with eating disorders and pelvic floor dysfunction as a whole tend to be overactive or underactive? I have some super exciting news for you. O.T. Pioneers ensured a pelvic floor therapy is opening for enrollment January 13th through the 17th, 2025. This is your chance to dive into a 100% online course with lifetime access. You'll get five group mentoring calls with me and two free months. Inside our off social media private community Pelvic OTP's United. Plus, we're hosting an optional in-person lab in Cleveland on February 21st and 22nd. Please come join over 1500 other OTs who have already taken the leap. I can't wait to see you inside OT Pioneers Enrollment January 13th through 17th 2025. 

Rachel Ohene I would say hypertonic with. Yeah. Yeah. I like hypertonic. With also with weakness. But I will say, too, I don't typically go to pelvic floor internal interventions with these clients for at least the first ten visits. I really find that there's so much to be doing. So I'm not actually assessing your pelvic floor. And you know something, for me that's really important. I identify as being a pelvic health therapist because I really love incorporating that. There's so much more than the three layers of muscle in the pelvic floor that contribute to public health. And so I think that the work that I'm doing with eating disorders really just goes to highlight that there's so much with distress, tolerance, body awareness, increasing the range of motion of the core, working on thoracic mobility. There's so much and then so many wonderful outcomes that we have to pelvic floor dysfunction without having to do assessment of the pelvic floor muscles. And that's what I typically find. It's not that I won't do internal work. I just I typically find that I can get really great outcomes along the plan of care before we necessarily get there. And being a trauma informed therapist, for me, it's really important to break out of that. More like ortho specialty approach to pelvic floor therapy, which is to always or like to consider a complete evaluation if we do the internal assessment. I really love to build rapport, and if someone can't conceptualize breathing into their pelvic floor, then I'm not going to do internal work on them. 

Lindsey Vestal Yes, yes. Yes. Yes, yes. You're speaking my language. I love that. So if you are sometimes seeing a client ten visits or really emphasizing nervous system regulation and deeply considering that trauma informed approach and not going directly to the hands on work, can you give us an example of of some of the things that you're doing with your clients? I'm particularly interested in learning a little bit more about some of the sensory work you may be doing and or nervous system work. 

Rachel Ohene Yeah. So while with the eating disorders, I typically do a lot of therapeutic rapport building in the beginning and really like the occupational storytelling, I think that one of the huge benefits that we have as OTs and what is like the delineation between psychotherapy and occupational therapy that's working in it by in that behavioral lens, I think that it is more of that active listening in occupational coaching and not so much doing like the processing work. So to me, doing a lot of occupational storytelling and really understanding who someone is through how they occupy their time and then trying to find ways to support more health, promoting occupational use of time versus yeah, trying to process things like doing like trauma informed processing, psychotherapy. That's really where I start in building rapport and interacting with these clients because they're going to be a lot more comfortable to talk therapy from their experience working with more folks in the multidisciplinary team. That being said, I do like to start by assessing posture and breath as well and just kind of starting to build some body awareness and see how they respond to that. Sometimes I find that as I've grown as a pelvic health therapist, it's been really challenging for me to learn how to make modifying the wake up with accessible because breathing we breathe every day pretty unconsciously. So then when you start to try to change that, when it's so intrinsically tied to our survival, it can be kind of insulting to tell someone that they're breathing wrong. And so that's when this huge area of growth and personal exploration to really explore how to get people to be really well regulated in their experience, but then to also have curiosity and to have these little experiences of feeling things slightly differently. And that can take a lot of time. And I really try to create space of it being kind of fun and it being kind of stepping out of the comfort zone a little bit and reflecting on what they know notice in their nervous system. As we were doing that, I find that a lot of times when we say take a deep breath, if that feels like tension in the chest, you know, then that's almost sending a mixed message because it can feel like hyperventilation to the client or to the nervous system. So really kind of teaching people and working very, very, very great it and. Learning these things is where I like to start. So yeah, so I found that with the sensory processing I got used to when I was working on the eating disorder unit using the sensory profile. And so I do like using that with some clients to just kind of show that to help to decrease the internalization that there's something wrong with them or weak with them. But to start to bring in the environmental piece and how the environment can be overwhelming to their nervous system, which can make it challenging to engage in the things that they need and want to do. And so I like getting that score. I love sharing literature with clients. And so especially since people are really interested in the literature and so we'll do the profile, we'll see that their score is in line with what the research says, I think. And I remember I was like quarterly collecting this data when I worked at the hospital and maybe, you know, 40 to 50% of clients were in the top 2% of the population on the sensory profile for sensory avoidance and sensory sensitivity. So that's exponentially higher than the general population. I think that that's pretty profound, actually. So knowledge is power and then finding ways to help to take out the internalization of of what sensory processing impairments can create for people and then starting to have like meaningful sensory experiences that help the nervous system, say, regulate it and practicing that in session. And that's the greatest approach to, you know, it's like, can we experience it in our session and reflect that? That did feel good to someone's nervous system then can we kind of give a homework assignment to incorporate that outside of our session and then come back and reflect on it and work ourselves? That's what everybody loves to do, right, is to work themselves out of a job so someone, their client is fully sufficient with what's explored in our sessions. So yeah, so that's how I've been using sensory processing. I'm not that most definitely Of my several coworkers that I've worked with over the years of O.T. and eating disorders, I have probably been the least interested in the sensory processing, mostly because I kind of really went more the public health realm. But in general, that's how I'll use that information. And I do a lot with chronic pain, behavioral interventions for chronic pain. And so I'll do the CSI, the central sensitization inventory and the pain catastrophizing scale. And I find that that knowledge can be really powerful, too, to start to realize that it's not someone's fault, that it's really, really hard to deal with introspective things happening in their body related to an eating disorder and going through eating disorder recovery. 

Lindsey Vestal Yeah. Yes. Yes. There's so much to reflect on here and just what it would be beautiful. I just want to pause and say what beautiful connections you've made in terms of the introspective piece for clients of yours that maybe share eating disorders and pelvic health issues or have one or the other, or maybe just have like the chronic pain piece that you were talking about, because it really does come back to shifting that sense of safety, that sense of feeling like you belong in your body and and the safety that can the lack of safety that sometimes we take on as a way to protect ourselves. And so that slow, step wise graded approach of getting feeling safe again in the body is that is that step towards healing. And so I mean are Rachel of the connections that you've made and really glad you're on the podcast today. 

Rachel Ohene Is Yeah it's great to be here and be chatting about it. And you know, one other modality that I haven't mentioned that I do work with quite a bit with this population is, is visceral manipulations and abdominal massage. So I do do a lot of work with more of that soft tissue release. And I find that working on some position will release around the rib cage as well as my attach to release throughout the abdominal cavity, especially around the stomach because that early satiation and gastroparesis and slow transit constipation is such a piece of what's happening for these clients in their gut motility. So I do do a lot of manual therapy with this population and a lot of reflection. So really helping someone to kind of help with some of that sensory processing of pain. So it can be really scary to the body when someone has been controlling what they eat. As their modality of keeping their nervous system regulated so that when someone feels really uncomfortable and fall, then there's a big aspect of hyper attention on that. So really and then and then kind of attaching to that. So really by really assessing what someone's distress and discomfort is in their body and then doing the modalities and then having them reflect and oftentimes their anxiety decreases and oftentimes their discomfort decreases. And then really celebrating that as a piece of what I do as well. 

Lindsey Vestal Yeah, Yeah. So that's so important. So, Rachel, someone who's myself who hasn't hasn't considered eating disorders with my clientele, how can you tease working in public health who maybe may be sharing our conversation today on the podcast? How can they start to screen or just maybe be curious around their own clientele as to whether or not eating disorders could be part of their experience? 

Rachel Ohene Yeah, that's a really great question. You know, I think that it's really helpful to perhaps pursue some continue education, to understand, to get a basic understanding of what eating disorders are and what they look like. One big thing I've been I've had a couple of meetings with people recently and I've really been talking on this topic of how a lot of new moms experience disordered eating and a lot of a lot of adolescent women go through disordered eating patterns, whether it's diagnosed or undiagnosed as part of their coming of age process. And so when people become new, when people become parents or when women become new moms, oftentimes that can kind of going back to controlling what they're putting in their body, you know, people can kind of revert back to to that way of being when so many other aspects of their life are kind of out of control or out of sync and taking on that new occupation of being a mother. So so, yes, I think it's really valuable to ask questions like of that postpartum patient. How is it going? How how is self, how is what are your eating routines look like? What are your exercise routine looks like? How are you feeling in your body? Are you comfortable in your body? How are you feeling with the changes in your body? What is your body image? You know, what is the relationship to your body image right now? Because I think we've all really seen that, that that can be a really challenging thing for for a postpartum client. And I think it's also really important, something that's really wonderful about the eating disorder industry at large is that they are very used to being kind of thought into the concept that it takes a village to support a client along with you sort of recovery journey. So oftentimes like a staple team is going to include a dietician, a psychotherapist and a doctor. So that's really great. One thing is, is that they're not typically going to be thinking about bringing a public health therapist in. It doesn't mean that they're not open to considering into learning about how public health therapy could possibly help. So I think by networking in your community, if you have an interest, you know, and I talk to the Disorder Center, people are coming to me all the time that are so interested that I was not working in eating disorders and or students were. So I definitely know that there's a huge interest in the occupational therapy field to better understand and better work with eating disorders. And I think that if you're a public health therapist interested in working with eating disorders, get out there and, you know, take this information from today's podcast and go to the literature and see what's there and then start networking in your communities so that you can be a referral source to each other. 

Lindsey Vestal I love that. That's fantastic. Rachel, if it's okay with you, I'd like to shift the conversation a little bit now. I mean, I could spend another four hours talking about this with you, but there is some other important topics that I was really hoping to cover with you today. And at the beginning of our talk today, I shared your your bio and your background with our listeners. And one of the things that really stood out in your bio is the fact that you're really passionate around social justice. And in fact, it was one of the reasons you started your own private practice called Liberate and Love. To hear a little bit about your journey, about why you started your private practice, and how did you know that it was time to go in that direction? 

Rachel Ohene Well, you know, I worked within systems job until one day I couldn't anymore. And, you know, I definitely came from a family system that valued working for a paycheck and having job security. So, you know, I didn't really come from a background of entrepreneurship, and that was really, really scary to me. But I came to a point in my career as an occupational therapist kind of off of the coattails of Covid and then of Black Lives Matter movement, of really seeing clearly the disparities in care and having a hard time working in a system that wasn't shifting fast enough to create meaningful change, to provide equitable, equitable care across the entire population. So, you know, I had a bachelor's degree in communication, and I loved giving presentations throughout graduate school, but I found myself having more and more anxiety about even giving a client update at a weekly team meeting. And yeah, I had a a near panic attack before giving one of my last presentations. So I really went through this experience of having my own perceived discrimination. And, and yeah, and I just had a pretty big psychological crumble and I ended up taking a mental health break. I ended up spending months, you know, not really sure if I could pick up working with my license again. But during that time I was I couldn't stop studying public health and and studying trauma. And I remember I would gobble up your ATM power hours and and there were a lot of free conferences on trauma at the time. And so I was like really studying and really understanding when I was doing my own work to explore the internalized oppression that I was experiencing. And yeah, I just kind of at one point just decided I wasn't going to bow out that way. And I kind of got out of this free state and decided that, you know, it was worth taking a chance of seeing if I could do private practice and be really aligned with my value system and actualizing that I system through the work that I do and the approach that I take. And that was the birth of Liberate Pelvic health. 

Lindsey Vestal She's so aptly named. 

Rachel Ohene Okay. 

Lindsey Vestal That's that's beautiful. Thank you for sharing all that with us. I'm sure there's many people joining us that can relate to what you've experienced and incredibly, incredibly inspired by that drive. When it was time, when the time was right for you to kind of recognize that a shift needed to happen, taking pause for that and then moving forward with with actually creating liberate. So congratulations on that. Rachel, what are a couple topics regarding health care inequality that are really, you know, are most important to you at this time? 

Rachel Ohene Well, you know, I think that wounded healer, the Koran archetype, I definitely consider that that definitely resonates a lot with me. And so two of the biggest area of health care inequities that I personally resonate with is women's health and bipoc health. I'm a biracial person. My father's from Ghana and my mom is a Caucasian American. And I identify as a cisgendered woman. And so I think as public health therapists, we're pretty well versed in understanding the disparities in health care between men and women because there's such a strong component of women's health in the lineage of this specialty area. So that's definitely a place that I'm really interested in. And then with my own experience of just kind of seeing racial disparities in care, I've done a lot of work in exploration about understanding Bipoc health and how that is an inequality in health care. Yeah. So I think it's important with with this topic to really understand like what is discrimination in health care? And one definition that we can rely upon is that it's negative actions or a lack of consideration that's given to an individual or a group that occurs because of a preconceived or an unjustified opinion. So one example that we're that's kind of a little bit more commonly accessible or or that's commonly explored is the example of the woman with menstrual pain that goes to, to a health care provider with complaints of that menstrual pain. And it isn't necessarily going to be fully explored because it's normalized by the society that that person lives in. And also there maybe not going to even go because it's been so normalized and their system. So it may take them years before they even really bring up that they maybe are functioning for a couple of days out of the month because of their menstrual pain. But we're conditioned as menstruating people to think that that's just normal when in actuality, that is very common, but it's not normal. So that's kind of one example. And then, you know, something that we know is that maternal death rates are exponentially higher for bipoc people in America as well as other Western cultures compared to their Caucasian counterparts. And we also know the literature also depicts that bipoc people are less likely to know about pelvic floor dysfunction and resources and how to address it than their Caucasian counterparts. So that's one area of disparity of care that's in the literature that that I'm really interested in addressing. And something that's been really wonderful about working in the eating disorder space is that there's been a lot of work in the last few years to highlight how there's a disparity of care within eating disorders and supporting people in bipoc bodies. And I think that in public health we're a little bit further behind in being able to identify that or talk about that or know where to start. 

Lindsey Vestal Speaking of which, Rachel, what are some things that we as voters can do to be more aware and to help these issues? 

Rachel Ohene So I think as our tease, along with all health care professionals, it's really important to do the personal work around anti-racism. I think that people with all different levels of melanin in their skin, whether that be that they're brown or pink or pale or tan, live in a racialized body. And there's a call to action right now, an invitation to do this anti-racism work. There's this perspective that it will take hundreds of years to heal our our white supremacy society and the implications that that has on our population at large, because it took hundreds of years to get here. But actually, it doesn't have to if people are willing to do the work around it. I think of it similarly to kind of the concept of herd immunity. You know, if more people do the work to take a stand to be anti-racist, then we'll be closer to having it be more widespread and it will infiltrate our society more so. You know, I think one of the things that happens or one of the things that's happening right now is that this topic is falling on the shoulders of people of color to provide the education. And so we need more allyship of people that are in different lived experiences, including the racialized white person, to really be an ally and really do this work so that it can be more of a collective effort to become an anti-racist society. I think it's really important and doing the anti-racism work to understand how internalized oppression and perceived discrimination, what that can look like to someone's psyche as well as to understand a little bit about how white guilt and white fragility can really be a piece of someone's psyche. So I think it's really valuable and it's really important right now for our society to understand others perspective. There's been a lot of othering that's been happening in our society at large over the last decade or so. And so I think it's really important to understand the lived experience of someone else and have curiosity of that. And so if someone's in marginalized identity, whether that be because of gender or sexual orientation or skin color, they can have an experience of internalized oppression or excess or perceived discrimination is really important to explore. There's really amazing research out there that can explain that psychological processing that happens for someone that's in marginalized identity. And on the other side of that, there's this concept of like privilege, guilt or privilege fragility or sometimes it's called white guilt or white fragility. And what that looks like is that people that are in a place of privilege kind of bear the collective responsibility or take on their collective responsibility for the harm which is resulted from historical racism and treating people that belong to other racial groups. And so with that, there can become this place of, yeah, I've just like because it's not congruent with someone's opinion of themselves. There can be this nervous system dysregulation that happens and kind of a fight or flight response where there's just a lower distress tolerance to be in it and to hold. Space for it. And so there's an avoidance of the topic. And so I think it's really, really important to understand that, you know, for the most part, I'd say most people at their essence are good, yet there's a lot of pain and avoidance that's happening right now. And when this comes down to how clinical biases play out and consciously, because people haven't done this anti-racism work, there's a lot of harm that's being done because of not having the tolerance to really kind of go on this decolonizing journey on a personal and a professional level. 

Lindsey Vestal My question at this point, listening, listening deeply to you talk is like, what is one concrete thing that we can do today as as human beings, you know, as I'm a Caucasian, cis, gender female, like, what is one thing I can do today? If this is something that I feel like I want to move forward on, that I want to be an ally for the people, the people in our society. 

Rachel Ohene So I think one thing that can be really valuable for people to do is to just be curious and just start to explore what is anti-racism. And so even just doing a quick Google search and understanding that concept and, you know, if you work in more of a systems job, being an advocate for doing anti-racist work within that environment, I think it's really, really important to be an advocate for getting formalized training within our systems at large. And I think if you are a private clinician or if you're working in a systems and you're just really interested, if you resonate with being in a a privileged identity or a privileged body, then, you know, in for at least from a race construct, then reading white fragility could be really, really powerful. And I haven't personally read that book, but I do know a lot of people that identify as being Caucasian, that have read that book, that have really gained a more in-depth knowledge of the importance of being able to work on the distress, tolerance for holding the pain versus avoiding the pain and not internalizing that they caused the pain, but understanding that it's the environment that they exist in. But the pure avoidance of the topic perpetuates the pain. 

Lindsey Vestal That's that's a great recommendation. I'm going to link to that book in the shownotes. I'm also going to link to your website and any other ways that you are open to connecting with the other Ot's in our community about the vast variety of things that you've shared with us today. Rachel I've really appreciated the eye opening topics and journey that that you shared with us today, that you've not only been on in your own life, but that we have the ability to share conversation with you today about and just kind of continue our own journey of making connections for ourselves and for our connections and for our world at large. 

Rachel Ohene Great. Yeah. Thank you so much. And yeah, it's really I've loved stepping into public health therapy and just how much dialog goes goes on around being better clinicians. And I think that that's one thing that in O.T. and working in more of a classic you know really like siloed or more traditional role it feels like we get so pigeonholed. So it really is such a privilege and thank you for all the work that you've done to help to empower and just create a space for sharing so many different approaches to doing this work. 

Lindsey Vestal Thank you, Rachel. 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.