Behind the Intake Form: What Clients Aren’t Saying-Yet

• • Learn more about Level 1 Functional Pelvic Health Practitioner program
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  Facebook: https://www.facebook.com/doug.vestal.5
  Website: https://www.freedomofpractice.com/

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Transcript

Lindsey:
So a little bit of background here. As part of our level one functional pelvic health practitioner program, we always do a series of calls together where we role play and we get comfortable with explaining common pelvic health diagnoses to our clients. We get comfortable with sharing education, which is such an important cornerstone and foundation of our work as pelvic health OTs. And we also mock role play evaluations and the type of art and science that goes into creating a comfortable safe space for our clients that enable them to also open up and share additional concerns that may not have been captured on their intake form. I am so incredibly proud of the students that participate in this. They're so incredibly brave and honestly, they're brilliant. They just blow me away with the depth and just the way they don't shy away from leaning into the OT lens, which is so incredibly special. So in today's episode, I am sharing a recent mock interview that we had in our most recent level one program, which is a five month long mentoring program. This particular student is named Karla, and she is just incredible. I can't wait for you to hear this conversation. She basically had the opportunity to look over a intake paperwork, as well as the Australian pelvic floor questionnaire. And that was the basis of all of the questions and the interaction that you're about to hear today. If this program interests you, you can check out more information about the level one program in the show notes. It does open twice a year. It's incredibly, incredibly enriching and supportive and community driven, and I'd love to have you there. Okay, without further ado, here is my conversation with Carla. 

New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing and poop? But here's the question.

What does it take to become a successful, fulfilled and thriving OT 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, Lindsay Vestal, and welcome to the OTs in pelvic health podcast. 

Lindsey:
Welcome to everyone to our first role playing call where we're really getting into what it's like to speak with clients and be a detective regarding the intake paperwork. I really believe this is where it starts and this is another place we shine. So I'm so excited about today's call. We do have all three volunteers, so thank you so much for being here and doing that. Just to catch everyone up because I would really love, even if you're not presenting today, to be looking at the paperwork and putting yourself in the shoes of the OT. So I'm the mock client. I have three volunteers who are my pelvic health occupational therapists, and I want you to be actively engaged and thinking about what you would say to me and what you would do. That's really going to bring the learning home today, and it's going to make you an active learner in this process. Carla, thank you so much for volunteering to do this. Let's take a deep breath together as we transition here into our mock role playing here.All right, Carla, let's get started whenever you're ready. 

Karla: 
Okay. Afternoon, Lindsay.Thank you for submitting the paperwork that I see you have in front of us here, and I understand that in the paperwork you wrote down that you were having some low back pain, some depression, and also some problems with some of your bowel function, and I just wanted to let you know I thank you so much for filling out this paperwork. I know that it was kind of a long intake form, but it really does give us some really great information. So thank you for taking the time to do that, and we're on this virtual call here, so thank you for taking the time to even just find some quiet space for ourselves, and hopefully this is a space where you can feel safe to talk about some of the topics that we'll bring up. You know, a lot of people don't feel comfortable talking about their bowels and bladder and just the different topics that get brought up when working together, so I just wanted to bring that to light to, you know, thank you for trusting me and, you know, feeling comfortable sharing this stuff together. 

Lindsey:
Thank you. You know, I'm a nurse, and I understand, you know, the value of paperwork, but it also feels really nice to hear you acknowledge that, because it was a lot of paperwork. So yeah, thank you. 

Karla: 
Awesome. So is there any questions that you have for me before I kind of get started asking you some things? 

Lindsey:
No, I'd love to just get into it. Thank you. 

Karla: 
Okay. Okay, great. So looking at the paperwork, it looks like you are having some constipation and some kind of some troubles with your bowel functioning. Does that kind of resonate with you? Is that kind of what the major concern is, bringing you here, or is there anything else? 

Lindsey:
Yeah, I mean, I, it was really interesting, because I thought we were just going to talk about bowels, and when I was filling out the paperwork you sent me, I realized, oh, like, there's some interesting questions about urination on there, and even my intimacy life, and so I didn't know that we were going to be going into those topics, so that, I thought that was really interesting. 

Karla: 
Yeah, yeah, so something that a lot of people don't know about is, I mean, you might, as a nurse, so we'll just kind of go over it again, that the pelvic floor has, like, three primary functions of elimination and holding urine in, and bowel in, and also with intimacy, you know, we have to be able to contract and relax these muscles reflexively to have an orgasm, and then also with just supporting our pelvic floor, these muscles help to support our organs and, you know, our reproductive health and stuff, so there's some different functions that a lot of people don't know about, so these are great topics that we can go into, and so I saw on your paperwork that, you know, you're having a bowel movement about less than once a week, and a lot of it is kind of a very hard consistency. Is there anything that you'd like to share with that? Like, what is your routine like for that, typically? 

Lindsey:
Yeah, I mean, you know, we did a bunch of layoffs at the hospital, and so for me, I'm picking up extra shifts, so it's worse than ever. I'm there five days a week right now, you know, my shifts are 10, 11, 12 hours, and I'm just, I don't have the time. I don't have the time. You know, my patients are really intense. They need me on the floor all the time, and so I was definitely constipated for many years prior to this, but I feel like I finally came to see you because it's just so much worse right now, and I would say, you know, because I'm familiar with the Bristol, so I figured you might ask me about that. Like, I'm like a one and a two most of the time.

Karla:  
Okay, okay. Yeah, so those are, that's great insight already. I love that you know the Bristol stool scale. Like, that's something that we kind of gauge and to look at, so you're already like right on top with that. So in regards to kind of that routine, that's something that we can really work together about because that makes total sense if you don't have enough time to feel like you can relax your pelvic floor and to get those, you know, the breath to coordinate, and you know, we can definitely go into that more. So for the routine, you know, is there, have you ever heard of a squatty potty or being able to put your feet up on different things? Like, tell me about your bathroom setup at home or even at work, like.

Lindsey: 
I was curious about that because on the maternity floor, they do have those stools. That was really cool. I saw that when I was, when I was over there. We don't have it on any other floors, and I don't have one at home. Would that be helpful? 

Karla:  
Yeah, yeah. There's, you can find them on Amazon. They're pretty easy to access, but also if you just have any, you know, you, I meant, I saw in your intake form you have some some kids, so if you can even put your feet up on some small blocks, yoga blocks, or just anything around your house that are to raise your feet up, because that's going to help to relax your pelvic floor to fully empty a little bit, and I noticed in your paperwork also that you are having some feelings of incomplete bowel emptying. Is that something that you've noticed as well? 

Lindsey: 
Definitely. It feels like there's always something there that I could get out, you know? 

Karla:  
Yeah, so just kind of positioning is something that we'll go into more, but that's, that's a great, a great place to start, and we can, we can talk more about breath work and how our breath can really connect to our pelvic floor as well. At work, at work, what's, what's your work schedule? Like, are you working night shift, day shift? Tell me about your work routine. 

Lindsey: 
All over the place, just because I show up when they need me. Typically, I used to do day shifts, but I'm doing a lot of night shifts these days.

Karla:   
Okay, okay, and that's something that our bowels love normal routines and really getting into habits, and so this can be something where if your schedule kind of is all over the place, we need to maybe take a step back and say, what's working? What's not working? Is there a way to maybe talk with your manager or something to maybe get more on a consistent schedule if that's something you feel like you need or want? You know, those are things we can kind of dive into as well. 

Lindsey: 
That sounds great
. 
Karla: 
I also, I just wanted to bring this up because a lot of people don't know this about occupational therapy, but I saw on your intake form that you have a history of depression. I don't know if that's like a full diagnosis or if that's something that you're currently kind of still working through or if you're seeing a therapist about that. 

Lindsey: 
No, but I've been thinking lately that I really should. When I had my children, I did get on postpartum anxiety medication and that was really helpful, but my kids are 13 and 11 now, and I stopped that years ago, but with the changes at work and everything like that, I'm thinking I would, if there's someone you could, you know, refer me to, someone you really like in the area, I would be really open to that.

Karla:  
Yeah, I definitely have some people I can recommend, and you know, if you feel like you need to really dive into that as well, we can, I can refer you, but I also have some specialty training in mental health and, you know, as an occupational therapist, you know, our bowel function really is connected to our mental health, and there's actually, I just read a research article the other day that said that, you know, those with constipation have 48% chance of increase developing depression, and so I'm just wondering how long this constipation has been going on for for you, and did that precede the depression, or do you feel like the depression came on after? 


Lindsey: 
It's a really interesting question and really appreciate that research study too. I would love to check that out. I'm kind of a geek myself about that kind of stuff. Honestly, if I really had to think about it, I think that kind of happened around the same time. 


Karla:  
Okay, yeah. Okay, so kind of just back to the form that you filled out, you know, a lot of what we've talked about is in regards to your bowel function and stuff, but I did notice that you have an occasional leakage with some urination. Do you want to talk a little bit about that? I think it was, you know, maybe when you have a cough or something, is that, you want to tell me more about that? 

Lindsey: 
Yeah, so I mean, basically, like, when I go, there's just like a little bit that comes out because I go, I try to go as often as I can. I'm thinking that'll help feel, release some of the pressure that I feel with stool, so I think I filled out like eight to ten times on the form, and just like a little bit comes out, um, and then, like, I do, I do leak when it's, I'm, like, transferring clients. 


Karla:  
Okay, okay, yeah, that's something that I hear is very common with, you know, well, I can teach you how to manage your abdominal pressure correctly, because sometimes putting that pressure down on the pelvic floor, that can cause some leakage, and, you know, you mentioned you go to the bathroom, like, eight to ten times in a day, and although, you know, typically, we kind of teach people it's about six to eight times a day is, like, the normal, but, you know, that's something where we can, if you feel like it's, if it's interrupting your routine, that it's maybe too much, that's something we can also dive into a little bit more, too.

Lindsey: 
That sounds amazing, thank you. 


Karla:  
Was there anything else that kind of stuck out to you on the forms that I had you fill out that you'd want to have questions or chat about? 


Lindsey: 
Yeah, actually, I wasn't really expecting to talk about this, but I just feel so comfortable with you. I, when I filled out the part about sex, you know, I, I just, I didn't realize the question was there, but I really don't have any sensation with intimacy. My partner and I, maybe once, maybe once a week, we try, maybe not even that, and I just don't know why I wouldn't feel a sensation there. 


Karla:  
Okay, if you're okay with that, I'd like to explore kind of what you mean by sensation, like, are you, I don't know, just kind of tell me what you mean by sensation, like, what is it, something as far as an uncomfortable feeling of no sensation or too much sensation, like, there's just a broad kind of range, like, you want to explain that? 
Lindsey: 
Yeah, it's almost like I feel disconnected. It's almost like, you know, when, when we are doing penetration, I feel pressure, but I remember feeling pleasure. I remember that it used to actually feel really good. And I just feel like I just wanted to get it done. Now, you know, like, let's just get it done and move on and check that box. I don't have a sense of real interest or passion around this. 

Karla:  
Okay. And how long has that been going on for? 

Lindsey: 
Maybe the last year or so.

 Karla:  
And so have you talked with your spouse about this at all? 

Lindsey: 
No. 

 Karla:  
Is that something that you feel comfortable bringing up to him? Or is that something that maybe we can chat about some different strategies to build more confidence within maybe that setting and, you know, feeling safe within that, that environment? 


Lindsey: 
Yeah, I'd love to, I'd love to have some ideas on how I can bring this up. 

 Karla:  
Okay. Yeah. Yes. Is that something you'd want to chat about now or next session? 

Lindsey: 
Probably next session.

Karla: 
Okay. 

Lindsey: 
Yeah. A huge round of applause after this year job as an actress is solidified and it is like definitely I see a future career. No, that is phenomenal. Carla, like what a way to kick this off. You guys put some, put some observations in the comments, anything you want to share with her. I have a whole list of stuff that I want to compliment you on, but keep them coming in. It always feels so good to hear from the community, especially the first volunteer, right? Like that's, it's, it's, it's, it's stressful. It's she was really brave Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already hop onto 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 post it to IG, Facebook, wherever you post your stuff and be sure to tag me and let me know why you liked 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.

Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto 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 post it to IG, Facebook, 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.