You’re Not Broken: A Mock Eval That Will Change How You Practice

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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 Lindsay Kao, 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 Karla. 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 Vestal: 
Perfect. Okay. Let's take a deep breath together. Ready whenever you are, Lindsay.

 Lindsey Kaupp:
Wonderful. Well, welcome, Lindsay. My name is also Lindsay. So hopefully we should remember each other's names for today. And thank you so much for coming in today. I really appreciate it. And also thank you for filling out all of this paperwork. I do understand there's quite a bit, but it's so helpful, both for I find for the client yourself as well as for me to kind of help us prepare and prioritize a little bit how we're going to spend our time today. So thank you so much. Before we get started, I always want to let people know that I'm really impressed with the fact that you came today. I know that this can be an intimidating appointment, and I really do understand because I have been in your shoes as well. So thank you. The other thing here is, Lindsay, is that I want you to know that in pelvic health, when you're coming into my room here, you know, we're looking over virtually right now. So we're going to spend the first bit of our time just chatting. Honestly, we want to just get to know each other a bit. Feel comfortable. And at any point if you don't feel comfortable, just let me know. I don't get offended ever. This is a vulnerable topic, so we want to make sure that you feel good. And then if we have time in the appointment today, we may or may not, then we'll move on to some physical evaluation. Okay, and we will talk all about what that looks like before we do anything. Is that okay for you? 

Lindsey Vestal: 
Yeah, that sounds amazing. 

Lindsey Kaupp:
Wonderful. So I am a pelvic health occupational therapist. I really love this. I love all my pelvic floor physio colleagues here in Alberta. But I think that we have a little bit of an advantage because we get to see all of the physical pieces and talk about all these physical pieces that you described in your intake. But at the same time, I also spent many years as a mental health therapist. And so I want you to know that anything that we want to chat about today is on the table in this room. Is that okay for you? 

Lindsey Vestal: 
That sounds like I'm in the right place.

 Lindsey Kaupp:
Wonderful. So before we get started, and I start every session this way, Lindsay, so you're going to get sick of hearing me ask this question. You filled out the paperwork, there's definitely some things that I see here that we can work on, you know, how often we're going pee, there's some issue potentially with prolapse. And then I see that sexual activity has decreased a bit. But I want to hear from you, what do you hope to be better or different by coming here today? 

Lindsey Vestal: 
Yeah, thank you for asking me that. I don't think I've been asked that before. I'm a farmer, and I have, I do a lot of physical activity. I am constantly out there. And I have to tell you, like, I don't exactly know what prolapse is. But this feeling that I have down there, this heaviness, like, it is going to cost me my livelihood. Like, it does not feel good to be out there, moving this heavy equipment and have this pressure. So I really hope that we can do something about this because my family is depending on this.

 Lindsey Kaupp: 
Absolutely. That's amazing that you're a farmer. So thank you for that. That is not easy work. I'm really curious. Can you tell me just a little bit more about you, Lindsay? Like, who do you live with? You're farming.Do you hold another job off the farm? I know many people often do. I see you have two kids. Are you running around to activities? Like, what is a typical day in the life of Lindsay look like? 

Lindsey Vestal: 
Yeah, yeah.So I mean, definitely the farm consumes me. I took it over after my parents passed away. And so, you know, my partner, she's really the one who keeps the house running. So she takes care of the kids. She's running them to activities. She's an amazing cook. She takes care of all of that. I am really out there, honestly, like 12 hours a day, taking care of the farm. It's my family lineage. I feel very connected to the land and my work. If I have time, I really like reading. So, you know, I'll usually when I get off the farm, I'll come back in and curl up with a good book, you know, kiss my kiddos goodnight. And that's it. That's really a day for me. 

Lindsey Kaupp: 

I love that. There you go. Well, I am so excited to work with you. I don't know if you're aware, but on April 3rd, I'm actually presenting to the Farm Women of Alberta in a conference exactly on these pieces. So I hope you can help me a little bit with that as well. I want to make sure everything's really relevant. And that's true.

 Lindsey Vestal: 
I saw a smile come on your face when I said I was a farmer and I was like, I bet Lindsa’s up to something. 

Lindsey Kaupp: 
Absolutely. Wonderful. All right. So right now it is March and like I'm, I'm aware of what's happening in farming, but I'm not super great about it. I'm a town kid. So with March, we're coming into seeding. So I'm assuming you guys are grain farmers, not cattle, cattle ranchers. Yes. Wonderful. So lots of time in the machinery, if I'm hearing that correct. Okay. So we've got the seeder, different things like that. Are you guys working with older equipment or newer equipment out on the farm? 

 Lindsey Vestal: 
It's like, it's cool. Okay.

 Lindsey Kaupp: 
So it's not GPS driving itself. Wonderful. All right. So that's really great to know, because what we want to think about is some of those obligations aren't going to change, right? So though we haven't even jumped into the pelvic health piece yet, is I really want you to kind of keep in the back of your mind, where are some opportunities for you throughout your day that we can make, you know, small, tiny little tweaks, changes, or even just put some attention to something. So I like to say that I am the worst client. If you give me 20 minutes of exercise in a day, I'm not going to do it. So everything that we're going to focus on here, if that's okay with you, we can do in 30 seconds to two minutes, because we know how that day is going to shift back and forth. Right? So for example, and this is just going to kind of open that, I hope open that kind of opportunity up for you, is with machinery, especially that old machinery, we have a lot of vibration, right? So we want to be thinking about, you know, as I'm getting in and out of the tractor, how much time am I spending in the combine? What's happening? Do I have to manually hook up the seeder? Or like, do I have kind of hydraulics? So we want to look at opportunities to use the education and the strategies that we will get to over top of that. Because when I think about it, when I look back here, Lindsay, you're born in 1980, right? So we're going to pretend we're both 29 still. And it's taken this long for some of these things to show up. So we also know that things might not turn around just immediately. But if we can sprinkle little things through the day, and I call this my confetti method, totally trademarked, right? It is actually. So if we can sprinkle it through the day, then we're going to have that opportunity where we're not thinking about our pelvic health all day, but we are absolutely impacting it in a positive way. Does that make sense for you? 

Lindsey Vestal: 
Yeah, I mean, that sounds perfect. Because honestly, like I've gone to PT before for a knee injury, and they wanted me to do like 30 minutes of exercise. I felt awful. I just didn't do it. 

Lindsey Kaupp: 

Yeah, me neither. And I work in the physio clinic. So it's okay. Right. And I understand you have the half hour drive in half hour drive out, we have all of these other obligations. So let's build it into our day, right? Yeah. What I didn't hear was what you love to do for fun. So I want to make sure I don't skip over that you yourself and your partner. Is there anything you're involved with that you love to do? 

Lindsey Vestal: 
Not really, honestly, like farming. We used to go out dancing together, but we don't really do that anymore. 

Lindsey Kaupp: 
So sorry, I missed that. 

Lindsey Vestal: 
You used to go out. We used to go out dancing together, but we don't really do that anymore.

Lindsey Kaupp: 
 Yeah. Amazing. 
What type of dancing did you do Lindsay? 

Lindsey Vestal: 
Line dancing.

Lindsey Kaupp:  
Line dancing. Good old Cadillac Ranch. Perfect. Awesome. So is there anything else that you think I need to know kind of about you, your daily life, kind of the obligations and stressors that are going on for you in your life before we jump back into what you came for the pelvic health piece? 

Lindsey Vestal: 
I just really hope that we can do something about this because you know, my partner and I, I'm so embarrassed about what's happening down there that we have not been intimate. I just, I feel, honestly, I feel shame. Like I just, I don't, I don't know what's happening. I'm worried about obviously our livelihood and then I just don't feel attractive. So I really hope that those things can shift for me.

Lindsey Kaupp:  
Absolutely. Thank you for sharing that. That is not easy to say, right? And I think that when we can kind of really name some of those things like the shame or that maybe I'm not feeling as attractive as I previously did to my partner, kind of gives us a really great starting point. Hey, then we know this is where we're at now. What are we going to do about it? Yeah. And I feel like you've done taken a huge step already just by making this appointment, coming in and, and looking at like, what can I do? Yeah. So kudos. That's amazing. So if it's okay with you, Lindsay, I just want to kind of go back to this paperwork that you filled out. I made some quick notes and there was some kind of some major, not major, that's the wrong word. That's Monday, Monday time coming out, even on a Thursday. So there's a couple of different opportunities, I guess. The thing that I love about pelvic health is that even when there's multiple things that might be bothering us, oftentimes when we work on one, we benefit a lot of different things. So knowing if we pick a priority here, we're not just dropping the others off. You know, we're not going to not come back to them, but we are likely going to see progress in other areas or just make our, our progress down the road on different issues easier. So if I had to kind of list out a couple of things that from the paperwork, I'm noticing you, you're having some difficulty with is that number one is you talked about that heaviness, right? And we mentioned, you're not quite sure what prolapse is, right? Those cattle farmers, they all know we don't let them touch prolapse because they treat that very differently on cows, right? So prolapse is going to be one piece and we can come back to that. The other thing I noticed is that decrease in sexual activity, right? Yeah. So let's come back to that as well. And then urinary frequency was the other thing that really quite stood out to me. So when you mentioned that you're going pee 15 times a day, is there a bit of a pattern to that? Like I like to bug my nurses and my teachers that in the morning, they pee, pee, pee, pee, pee, hold for eight hours and then pee, pee, pee, pee again, right? Being out in the field, what does that look like for you or open the shop? 


Lindsey Vestal: 
Yeah, I mean, I just kind of pop a squat when I need to, I'm just out there, you know, by myself. And so I think it really started when I felt that heaviness. And so I don't know why, but I just it always feels like I can go. And you know, just check drops come out, but I still do it because it does relieve some of that pressure there. 

Lindsey Kaupp:  
Absolutely. So I love that you've already tied that back. So that frequency and that feeling that we need to go that urgency, being tied back to that heaviness. So I want to come back a little bit to you kind of the structure of the pelvic floor, the functions of the pelvic floor, right and the pelvis itself. So I have this fabulous little guy that somebody gave me. And so what I want you to think about is the fact that the pelvis is right here in the middle of the body. And sometimes it seems obvious, but we we just overlook it, that everything is connected top to bottom through the pelvis in the middle as a connector, right? So this big bony structure in the middle is strong, it's really great to support our organs, it helps us with elimination of bowel and bladder, and also is tied into that sexual function, which you've already alluded to, right. But something we want to think about is that anything that we do up the chain from the pelvis, and anything that we do down the chain from the pelvis can really impact things. So I might ask you some questions that seem a little bit weirder, or not relevant, but we're going to bring it back to the pelvis. 

Lindsey Vestal: 
Okay.

Lindsey Kaupp:   
So with that prolapse, a prolapse is the descent of our organs within our pelvis. And so when I say our organs, I'm talking about our bladder, I'm talking about our uterus, or the vaginal canal, or I'm talking about the rectum. And they kind of stack one to the other to the other. So when one descends a little bit, the others descend as well, typically, maybe a little bit doesn't have to be a lot. And one thing I want you to really hear from me is that anytime there is, you know, we feel that bulge, I would be a little bit concerned, too, I'd be like, what is this, but our distress level from our prolapse, and the actual physiological change or how much it's moved, aren't always the same. So I want you to hear me really, really clearly here is that as much as the change might be happening, our distress can be a lot or a little. And it doesn't matter if that correlates with the actual movement. 

Lindsey Vestal: 
Okay. 

Lindsey Kaupp:  
Does that make sense? 

Lindsey Vestal: 
Yeah, I yeah, I really appreciate that.

Lindsey Kaupp:  
Especially since I noted on your on your intake that you have a history of depression. Is that still something that you're currently working with working on? 


Lindsey Vestal: 
No, but I probably should because I definitely I don't feel much joy these days. 

Lindsey Kaupp:  
Fair. There you go. Absolutely. We all do with more joy. So when with when we're working with prolapse, I want I really want to reassure people. prolapse is very common. I think there was a study came out recently, and I'm not as great as my colleague Carla at citing stats here. But that almost 40% of women who have never had a child and I mentioned or I saw that you have to write and that never had a child have some degree of prolapse. So these are 20 year old women, I believe in the study, and 40% of them had a degree of prolapse. The beautiful thing about prolapse is that when things come down, they can also go back up. But what we want to really focus towards is what are those activities in your daily life that might be creating some pressure to bring that down? Right? One thing I can think about being five foot tall trying to climb up into a tractor is trying to grab on and then haul my body up into that tractor, right? It's like a pretty much like a pull up every time I go. So I'm really curious, if you think about one or two things in your day, where do you start to feel that heaviness? Is it kind of when you're out in the field? Is it later in the day? Or is 

Lindsey Vestal: 
it definitely later in the day, you know, I wake up feeling pretty good. And I'm thinking, oh, things have shifted. This is a new day. And then as my day continues on, I'd say probably around lunch, it's when I start to feel it. And then I just can't get my mind off of it as the day goes on. That's it. Like, that's all I'm thinking about. And of course, I can't tell, is it getting worse? Because I'm thinking about it. Is it, you know, I don't know what chicken and the egg, but and then the rest of the evening, that's all I'm thinking about. 


Lindsey Kaupp:  
Absolutely. So I think that I want you to hear that's really normal. If there's something that's changing, and that we know is maybe not, quote, unquote, what we want, right? Then absolutely, our brain wants to fix things. It's a fixer. It either fixes or it ignores typically, right? So I'm really curious what your brain is saying when you notice that. Is it a this is happening again? Or is it like, Oh, my gosh, I'm falling apart. Like, what is that inner dialogue? When you notice that bulge, 

Lindsey Vestal: 
that my body has let me down, that I'm here to carry out my family's work. I'm here to make a living for my amazing children, and my partner. And am I going to be able to do that? Am I going to be able to continue that life? And so I feel like it's let me down. 

 Lindsey Kaupp: 
What else would tell you, Lindsay, that your body is letting you down? 

Lindsey Vestal: 
I mean, probably the birth that I my first kid, it didn't go as planned. And that was the first time I really felt that, you know, I ended up getting that emergency c-section. And I would say, when I think about that sentence, and when I say it out loud, right, because I've never said it out loud before, I immediately think about my birth, that that is that is that same feeling.

Lindsey Kaupp: 
Can you tell me a little bit about that birth, Lindsay? 

Lindsey Vestal: 
Yeah, just, you know, it didn't go as planned. It was like a 42 hour experience and ended up in a c-section. And I couldn't speak up, you know, there was no opportunity for me to voice my opinion, my partner got ushered out of the room, I really wanted her there. And next thing you know, we had this beautiful baby, but it's just I wanted a natural birth. So it was it was quite different than that. 

Lindsey Kaupp: 
Absolutely. I'm sorry, you had that experience. And that wasn't what you were, what you were planning and hoping for. Right? Yeah, absolutely. If we come back to that birth, I want to kind of just move things back and tie that back to prolapse is that, when did we start to notice some of this heaviness and bulging? Has that been since birth? Has that been later on? I just want to kind of get a timeline of things. And then we will come back to that birth and talk a little bit more around, you know, what may have changed for you there? 


Lindsey Vestal: 
Yeah, I would say, honestly, you know, I don't know if it had anything to do with the birth or not. Because really, the symptoms started about a year ago. And that my oldest kid is 13 now. So yeah, I'd say it's really exacerbated the past year. Also, my period has gotten funky this past year. So I don't know if I'm in perimenopause or what, but that would be the only other thing that's really happened this year for me. 


Lindsey Kaupp: 
Okay. And while we're kind of on that timeline train, um, has anything about your bowel or bladder habits really changed in the last year? You know, do you find yourself having to go pee more? Do you find yourself I noticed that you mentioned that you are using finger pressure daily to help empty your bowels, which great strategy way to figure that out. But something that potentially we, we could look at doing less as we are able to move forward with that prolapse. So has anything changed in the last year with those bowel or bladder habits? 


Lindsey Vestal: 
I'm drinking less for sure. I'm drinking less water for sure. And I'm probably I used to have maybe a glass or two of wine a week. I'm probably you know, I get back in and I'm just so upset about that pressure that I find myself I'm probably drinking a little bit more wine than I used to. 


Lindsey Kaupp: 
Yeah, absolutely. I can understand that. For sure. With less water coming in, you know, potentially your quality time with your partner may have looked different in the past. And you mentioned that that's changed drastically. Were they going out to do dancing, you know, partners running around with the kids, different things. And then as well, you know, having that as you described shame around decreased sexual kind of intimacy, right? And that quality time together. Yeah. So I'm curious with water, how much water are you currently drinking? 


Lindsey Vestal: 
Probably drinking, honestly, like two cups, probably like two to eight ounce cups a day. 

Lindsey Kaupp: 
Awesome. So we're still having some water intake. That's fantastic. Great job. I'm really curious. That's gonna be one of those funny, weird questions that I told you about. Are you sipping your water? Are you gulping your water? 


Lindsey Vestal: 
Right when I wake up, I just gulp it. I'm so thirsty when I wake up, but that's that's really when I drink. 


Lindsey Kaupp: 
Okay, amazing. So absolutely. If that's something that slates that or slakes that thirst for a little bit, let's keep doing that. But something that I always found was kind of a cool little fact is that how we drink our water really matters. So if we're drinking two cups, and that wasn't to change, we could even just get some improvement out by sipping the water versus gulping. So after that first time that we gulp, maybe we want to look at taking out to the field with us, you know, a Stanley or a Contigo cup, that's going to let us just sip water through the day. Is that something that you do at this point? Do you take it a coffee cup or a water or anything with you? 

Lindsey Vestal: 
No, no, but I could do that. 


Lindsey Kaupp: 
Absolutely. So when we gulp that water, we typically output six times as much. So when you think about that, and how many times we're going pee through the day, plus that heaviness and that prolapse, I'm kind of created a couple little things where we're going to go pee fairly frequently. Right? So if we can take out just one of those Contigo cups a day, fantastic, right? Any extra water is good water. But we do want to make sure you're getting the benefit of it, right? If you're going to put in the work, you get to get the benefit. So if that's that every time at the end of the field, you take a sip, right? You can put up a good old sign at the end of the field if you want drink water. Right? Because otherwise, we just get going with our day. Does that make sense for you? 

Lindsey Vestal: 
100% Yeah, that was phenomenal. Lindsay, let's give her a huge round of applause. What a stellar morning. Oh my gosh, this is incredible. Let's put some love in the comments, please, in the chat for Lindsay. That was phenomenal, phenomenal.

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.

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