Origin's
The stories of our lives often define us. Listen to these interviews and learn how and why people navigate their lives.
Origin's
Navigating New Paths in Pelvic Health with Dr. Reshma Salvi
What if the pelvic floor issues many women face postpartum weren't just unfortunate side effects to endure but instead common challenges with effective solutions? Join us as we speak with Dr. Reshma Salvi, a Doctor of Physical Therapy who has made it her mission to shift the narrative around pelvic health. Originally from Mumbai, India, Dr. Salvi shares her journey from her initial training in physical therapy to earning a Doctorate in the United States. She sheds light on the misconceptions surrounding pelvic floor health and argues why these issues, while widespread, shouldn't be accepted as the norm. Through her work, she aims to empower women to recognize the importance of seeking treatment and reclaiming their well-being.
Our conversation also explores the limitations of traditional, insurance-driven healthcare models and highlights the transformative power of personalized care. Dr. Salvi has chosen to break away from the constraints of insurance to offer transparent pricing and individualized, one-on-one sessions that truly cater to the needs of her patients. By doing so, she ensures that each person receives comprehensive education and resources—key elements often missing from standard practices. Discover how Dr. Salvi's approach, including flexible options like virtual care and home visits, is making pelvic health therapy more accessible and effective for everyone. This episode is packed with insights for anyone curious about how personalized healthcare can revolutionize the treatment of pelvic floor issues.
Dr. Reshma Salvi , PT , DPT , CAPP
Core and Beyond Physical Therapy
Reach out to me via
Email : pelvicpt@coreandbeyond.com
Call @ 2489337207
My name is Brian Grenadier and this is the Origins Podcast. I want to welcome everybody. I'm interviewing today Dr Reshma Salvi. Did I say that correctly?
Speaker 2:You did All right good.
Speaker 1:And she is a doctor and she's amazingly specialized in a very specific type of therapy and I really think that this is going to help a lot of folks, and so I really wanted to bring you on to the show to explain to people who you are and what you do and how you help people, and I thought this was going to be the best vehicle for getting that message out. So we're here.
Speaker 2:Yes, absolutely. Thank you so much for this opportunity. It's a great way for me to go over who I am and what I'm doing and just get that awareness.
Speaker 1:I love it. I love it. So where are you from originally?
Speaker 2:So I am originally from Mumbai, india. Mumbai is located west coast of India, so I was born and raised there, yeah, and I did my bachelor's in physical therapy from India as well. I graduated in 2007 with a bachelor's degree, and then we were trying to figure out you know what's next. So I got married.
Speaker 1:Well, that was what was next.
Speaker 2:Yeah, and my husband is also a physical therapist, so we thought we both could do something together. And then a lot of our friends were exploring, you know, further education in US, australia. So I came across this program, exercise Science, at Oakland University. So I came to US in 2009 to pursue my master's in Oakland University in exercise science and kinesiology.
Speaker 1:Got it, and so you are now Dr Reshma Selvi.
Speaker 2:Yeah. So then you know, I was doing my master's and I was preparing for a license exam to become a physical therapist and work as a PT here in the US. So meanwhile they were transitioning. They want all the physical therapists in the US to get this doctor of physical therapy degree.
Speaker 2:So I'm not a medical doctor, I'm a doctor of physical therapy. And why it's important? Because they are trying to make PT as part of the primary care. I mean, I'm going to go a little bit off route, but there are a lot of conditions which people really don't even need to see medical doctor. They can just come to PT. So they want all the PTs at the same level. That's why this doctorate program. So I completed that just before COVID started.
Speaker 1:Perfect timing to start your new career.
Speaker 2:Yeah, I finished it, and then in two weeks COVID started.
Speaker 1:Got it Well, at least you were done enough to finish online. And that's interesting how the medical business is going, because um pas are becoming a big deal now, whereas when I was younger there was I don't I never even heard of a pa, and now you can do a lot of the things that a doctor does without the full medical degree, um, which a lot of people, that's all they need. Like you go into a urgent care, you're seeing a pa most of the time, right, not a, not a MD, um, so that's phenomenal, though that so you're. So you finish your thing just before COVID. You are Dr Reshma Selvi. Covid happens. What happens next?
Speaker 2:COVID happened and, uh, I was working at outpatient, very high-paced outpatient clinic and we were closed for six weeks. So you know there was a lot of things going on and I'll go back a little bit. So during my PT bachelor's degree we had women's health and pelvic floor. So I had that exposure. But then, with MS in exercise science and doctor of PT degree, the career and education, it went a little different route. But I always wanted to pursue something related to women's health because I felt a lot of women were underserved in certain areas and at that point I was PT for like almost 10 years so I was seeing a lot of patients with different issues.
Speaker 2:So it happened to be that perfect time that I was introduced to this pelvic health academy through American Physical Therapy Association. So APTA has orthopedic pelvic health, different academies and they do very hands-on, thorough training. So I started, you know, with that path and loved it and loving it. I started practicing as I was taking courses and labs. There is just so much to do and I still feel like I need to take this class, this course. It's a huge demand, huge need and I love it.
Speaker 1:I love that, you love it. But I find it interesting too, because I have never spoken to another man who says I need to deal with my pelvic floor and women. I mean, when I've done CrossFit or I'm married, you know we have a child, you know my wife is just like. Well, pelvic floor issues are just what comes along with it that nobody talks about and no one tells you about. When I was doing CrossFit, like all the ladies would run out to the bathroom before we started because they knew that if we're jumping up and down, they're going to pee themselves and it's. It's really a thing that people just sort of accept and go. Well, this is just the byproduct of having children. But when I spoke to you before, you said it doesn't have to be that way.
Speaker 2:That's right. So, yeah, I mean that's what I heard growing up. I mean, after you have a child, there are certain things just come with it. So it's common. But now we are realizing that there's a lot of research going on, there are a lot of people working in this field. Just because it's common, it's not normal and there are a lot of possibilities to seek treatment. And that's why a huge part of this work is bringing that awareness that somebody like me exists where you can go discuss your issues and actually resolve them.
Speaker 1:That's pretty impressive, because I think most women I mean like I'm a man, I don't know, what do I know? But from talking with my wife and talking with other women in the yoga world, you know this is just yeah, it's just normal, like something to suffer with, and I love that you actually have solutions for some of these problems. That's, that's really phenomenal. What so? Who is your ideal patient? Who comes to you? What do they come with? And then what do you? What do you hope that they leave with at the end?
Speaker 2:Yep. So if you don't mind, I have this model of pelvis. I want to just take a couple minutes to explain and then I can explain the client.
Speaker 1:Okay.
Speaker 2:So this is the pelvis, this is the spine, the lumbar spine, these are our sit bones and these are the pelvic bones. So this portion at the bottom, so basically the portion we are sitting on, is the pelvic floor. Pelvic floor muscles start in the front, at the pubic bone, and they are just like a hammock. They attach in the back to the tailbone. So these muscles have a huge role in supporting all our organs reproductive organs in women and males, and your bladder and the bowel, all that. So it has a supportive role. Secondarily, because of the location of these muscles, these are very close to the genitals, so it plays a huge role in sexual health. So basically anybody who is having issues from bottom of the rib cage to the knee, everything in between, can be treated with pelvic floor physical therapy. And I'll elaborate a little bit more. There are typically three categories we commonly see. Number one is pain. We all know about low back pain, hip pain, so people go to PT, chiropractor, injections, pain medications and some people feel really better with it. But sometimes the pain is vague. They have tried everything and it hasn't helped. Most likely there is pelvic floor involved and because the location of the muscles, general physical therapists or even doctors. They are not trained to evaluate and palpate these muscles. So number one is pain, any pain, like I said, bottom of the rib cage to the pelvic area, or even it can radiate all the way to the knee. Second is weakness in the pelvic area, or even it can radiate all the way to the knee. Second is weakness in the pelvic area or your core, which happens typically after the surgery, like hysterectomies in women, hernia surgery or pregnancy. It's a natural process, but people forget that it still affects women's body. So all these things lead to weakness in this pelvic muscles and that results in leakage or unable to control bowels or impaired sexual health. I mean, I can talk for hours, but just basic terms. So, and the third thing is tightness in the pelvic area. So this is what is the hardest part, which people don't understand. Everybody knows Kegels.
Speaker 2:So if you start leaking bladder or somebody says, oh you, you know, I do pelvic floor exercises, but a lot of times these symptoms are coming because of the tightness and weakness plus there are. You know, the muscles are in multiple layers, so one side can be tight, the other side can be weak, so there is a different combination. There is never one thing. There are always multiple things which link to the symptoms. So tightness can feel like difficulty avoiding bladder or chronic constipation.
Speaker 2:When people are taking stool, softener medication, fiber, exercising, still nothing is helping because that opening is so tight. And these are issues which are sensitive. So people feel embarrassed. Some people feel, oh, I don't even want to discuss with my husband, that's where I come in, I can talk about it, I can listen to them and I can go to the root cause of what's happening. So pain, tightness, weakness somebody can have all three of them. Someone just has a pain factor, someone just has a pain factor, someone just has a weakness factor. So that's why I focus on this one-on-one individualized consultation and evaluation Got it and for some of these things, what is an expected outcome?
Speaker 1:Like a woman comes in and says I've had children and I leak all the time, or I had a C-section or an episiotomy or some of these things. Or a male says I had prostate cancer and now I'm having issues. I'm not asking you what the protocol is, because that's for you, but what's the outcome?
Speaker 2:so the outcome is? Basically it depends on what we find in the evaluation. First of all, what's person's goal? So the treatment is targeted pretty much depending on what's going on and what they want out of the street. But with regular exercises, the techniques we use, the outcomes are pretty good. People have felt significant relief with the pain, the chronic pain. They were told okay, there is no solution to it because nobody really evaluated. So the outcomes are reduction in pain or completely pain-free resolving that leaking issues. People are able to return back to their active life. People are able to return back to running, exercising, improve sexual health. So these are all the great, great outcomes.
Speaker 2:And number one is they are just so much more aware of what had happened and how we resolved it. What are the lifestyle changes they need to do? So they always take away some education which they can apply in their everyday life. And this goes this is what I want to actually speak about is a preventive part of this pelvic PT. I mean people don't have to come to me only when they have issues. I would love pregnant women to come during the pregnancy so they can prevent that tears and episiotomy. With pelvic PT you learn so much before the birth of the baby, about the birthing process, about labor, and they already know what's going to happen postpartum. So the recovery then mental preparation is so much better. So there is a huge preventive role for pregnancy postpartum. You don't have to wait until you start leaking.
Speaker 1:Got it. So if somebody is a doula or a prenatal coach, so to speak, or somebody who offers prenatal classes, those are people you want to meet, also because they can funnel people towards you, who you can help in conjunction with what they're already teaching.
Speaker 2:Yes, absolutely.
Speaker 1:Got it. Now yoga go ahead. I'm sorry.
Speaker 2:Most of the doulas are like. I'm connected to a lot of them and I did get some referrals from doulas about pregnancy prep and postpartum prep, so I'm still in a process of them. And I did get some repros from doulas about pregnancy prep and postpartum prep, so I'm still in a process of connecting with a lot of people.
Speaker 1:But got it okay good that's great yeah and then?
Speaker 1:um, well, that's why one of the reasons we're doing this now. In yoga we talk about lifting your bandhas all the time, and it's specifically, you know, for women they say it's the top of the uterus and for men the space between anus and genitals. There's a pulling up and in and then low belly muscles pull in, a little bit like you're putting on tight pants in just the lowest part of the belly, and it's impossible to keep these things perfectly still throughout the whole practice, but there's an emphasis in it. However, what you're telling me is that for some people, that may not be beneficial because it might be tightening things too much.
Speaker 2:Right. So when you're doing yoga, it's part of that procedure. I would say part of that exercise.
Speaker 2:Yeah no symptoms or they're doing regular yoga and by doing it, any of their symptoms are not getting worse, then it's okay, because every single person is not going to come to pelvic floor pt and get evaluated and then live life. So these things, you know, make sense when they have significant symptoms. A person is able to do yoga, fine, they're able to contract the pelvic floor, able to contract the belly button, but they are suffering with other issues which they don't correlate with the pelvic floor or abdominal. So that's where people like me come in, so it's okay to do it. People like me come in, so it's okay to do it.
Speaker 1:But if somebody is feeling pain while doing that, then that is what something needs to be addressed and since most of the customers clients are women, they're not going to talk to me about, oh, when I lift my bod as it hurts, what should I do? I know that conversation has not happened in 23 years, that's right, but hopefully I can send them to you and say you know, if that person speaks up, Got it. What are some other things that you'd want people to know about you and your practice, if anything else, to help them understand what you do and sort of warmly welcome them in, because it is an uncomfortable conversation for a lot of people and very, very sensitive, I would imagine, because I don't know for whatever reasons and what else would you want them to know?
Speaker 2:So I want them to know that if there is a hesitancy, that if pelvic PT is, right. For me, that's the typical question which people feel, or is this really going to help me? You know I'm having this issue for 20 years. What are you going to do now?
Speaker 2:So, that's why I recommend that, if there is a hesitancy, call me or schedule a call. And I spent 15-20 minutes understanding what's happening and then I explain briefly that this is what we would do and why don't you come for first visit, and that's when I can exactly check and explain and educate and that's when they feel okay, you know what this makes sense, so make that call. I'm happy to spend 15, 20 minutes and explaining before even they make that appointment with me.
Speaker 2:And we call it discovery call. But I had this experience with men, some other PT, a male client and she said I've been talking to him for a couple of weeks but I don't know why he's not contacting you. And I said you know what? Just have him call me. They just feel comfortable when they're talking to someone before walking in that room. They already know that. Okay, this is the one I'm going to see. This is what is going to happen during that first visit.
Speaker 2:So, I am happy to talk to everyone before scheduling consult.
Speaker 1:Got it Well, to me it's. You know, if you have to do an uncomfortable thing but to get results that might last you the rest of your life, do the uncomfortable thing, get it over with and just move on. You know it's like peeling a Band-aid off. Do it fast, just move on um most of the people.
Speaker 2:Uh, after the first few minutes in that consultation they open up yeah, I would imagine it's just that hesitancy to take that move and go to someone or talk to someone.
Speaker 1:Yeah, yeah, usually people make change when they're sick and tired of being sick and tired, and it's sad because you don't have to wait that long to fix something. In this case, you don't have to wait till it's you know. You don't have to wait till it's stage four cancer to go get cancer treatment if you already know you have it. Get it fixed as soon as you know you have it. And if people have this, they should see you.
Speaker 2:Yeah, and I emphasize that because people feel, oh, I tried it a couple visits and it didn't really help. Yeah if you're living with something for the last 10 years, your therapist cannot really do magic in couples.
Speaker 1:Yeah, it takes time.
Speaker 2:Come early.
Speaker 1:Yeah, and is there a top age limit that you go? Well, at certain points I can't help people.
Speaker 2:So there is no specific age limit. Like I said, every patient is unique, but I am connected to so many other clinicians that in two, three visits, if we both feel that this is not really helping, I will know where to send them.
Speaker 1:Got it.
Speaker 2:Pelvic pain medicine specialists, or there are different clinicians urogynecologists, gynecologists and there are so many subspecialties where a lot of times people don't get referred because. So I will provide them with all those resources, but, yeah, there is no specific age limit.
Speaker 1:And is this covered under insurance? How does this work?
Speaker 2:So right now I'm not in network with any insurances and I purposely decided to stay that way, and I'll explain why. I worked as a PT since 2010,. Worked in home health, worked in outpatient, so I am very, very aware of changes in insurance system, changes in healthcare, and I just felt that insurance puts a lot of limitations in terms of time of treatment, number of visits, how the care should be delivered. So if you are a client and you ask me, ok, I understand that as a clinician, you don't want to take insurance because it's going to save your time for documentation, but how it's going to benefit me as a client? So that's the common question I get. So number one for any rehab service, most of the insurances have copay and that copay can be $30 to $45 or even more. Pay can be $30 to $45 or even more.
Speaker 2:Currently, a lot of people have insurance but they have high deductible. So for rehab services, your insurance won't even kick in until your deductible is met. So they are pretty much paying out of pocket. And how the PT places are going to make money is they're going to have you come to three times a week. So you're basically going for a month multiple times a week and still not getting that quality treatment.
Speaker 2:And this is really very important for pelvic health conditions because it takes time. Each visit takes 60 to 70 to 90 minutes because there is so much involved. Now, in a typical PT place, no PTs have that much time because they're calling insurance to get authorization, they are doing documentation, so the amount of time spent one-on-one with patients is going down, and I was one of them before I left my job, so this helps you know this. So, finally, what happens is people don't get the care they really need and the issues are not resolved, and then they feel this is not helpful yeah so with me there is no situation of copay or surprise bill after a couple months that this is what insurance didn't pay.
Speaker 2:So now you pay this. The fees are transparent. I am open to give discount if somebody really needs it and they have a certain budget. The visits are placed according to their convenience and budget. So you come once and you will learn so much, which is worth three visits. So you may not be coming for the next two weeks. Come every other week and then I am able to provide virtual care and home visits which insurance will never cover otherwise, for a general pain or a pregnant woman or a new mom who really needs care, but insurance is not going to approve a home visit for that client. So I want to reduce all these barriers and that's why out-of-pocket or out-of-network cash-based really works for my practice and it is for the client.
Speaker 1:That's wonderful. I've had a couple of shoulder surgeries, I've been through physical therapy multiple times and then before the surgery they're always like oh yeah, take a few rounds of physical therapy beforehand, and it always felt like a racket because I knew I needed the surgery and they knew I needed the surgery. But they made me go through it anyway and you'd see the physical therapist that first time and then afterwards maybe for five minutes, but you were seeing a technician afterwards and you never saw the doctor at all, and that was just sort of how it works. But what I love is that they're going to see you, they're not getting somebody else, and that you're willing to spend the time with them, to answer their questions and to be there for them in the way they need. And you don't typically see that in medicine anymore, unless you're seeing a concierge doctor or something like that. And it's just.
Speaker 1:It's a sad state of our system, but system. But you know it's about money, more about money, less about helping, and the doctors feel strapped by it too. It's not like they want this. Uh, the few that have broken out of the, that system of insurance, and do concierge work or concierge, I'm not sure how it's pronounced Um. I find that they're they're happier doctors and they really feel a better connection to their clients, and the client feels better as well. And but I do also find that, like people come to me, you know, after the physical therapy is over and I'm like all right, so PT is over now.
Speaker 1:Are you still doing the exercises? No, the insurance isn't covering it now, I'm not now. Are you still doing the exercises? No, the insurance isn't covering it now, I'm not going. But are you doing the exercises? Well, and that's always the trap that people end up not healing themselves because even though they've been shown the work, they don't do it. And how do you? How do you? Well, I suppose you know, if you want to keep not peeing on yourself, do my exercises. That's one way to.
Speaker 2:Yeah, well, that's how this out-of-pocket works, because there is no end point Like if we both feel you know what, I have enough information and enough resources to do this on my own. You know what? Let's schedule something next month so they understand that you know what I'm slacking, I'm not exercising, but I have this visit coming up so I can readdress everything, maybe do a couple visits back to back and then maybe slow down again. The number one thing is people don't need physical therapy script to come to me.
Speaker 2:Most of the people have to wait two to three months to see the doctor. Then the doctor is going to write a script and then they will start PT. With this you're eliminating everything. People don't need script, you just come to me. We do a thorough evaluation. And I just want to say this just because I'm a pelvic floor physical therapist, I don't just look at the pelvic floor. The evaluation, the first consult, is pretty much head to toe. I mean, we go through your diet, your lifestyle, your spine, musculoskeletal evaluation, so it's a full body evaluation. Sometimes they come for one problem and they realize, okay, this is the thing I need to really fix first. So yeah, there is no end date, and that was the huge limitation with insurance. I used to have a lot of new moms as clients and my kid is is sick, so I cannot come, and they cannot come for the next couple of weeks. And then that end date is coming closer and your authorization ended. So guess what I have to prove to insurance that you still need more PT.
Speaker 1:With this.
Speaker 2:there is no end date. The visits can be paid depending on what they need, because everybody's understanding level, their compliance, is different. I have patients that are like you know what, I'm just going to come once a week. I want to come here and you tell me what to do. Some people are like you know what, I'll come every other week. This is what works best with my schedule, so there is a lot of flexibility.
Speaker 1:That's wonderful. I love that you can cater to the client's needs rather than the client is just sort of subject to these arbitrary insurance rules and timeframes, because it's really limiting.
Speaker 2:Yeah, it's really limiting because you're spacing out these appointments. If you calculate the expense, this is cheaper because you're not using all the visits in. You know, limited timeframe.
Speaker 1:Right right.
Speaker 2:So you can use these 12 visits over six months and that's what it needs in pelvic PT. You know the your body keeps changing, the amount of stress you have, what's going on in your personal life all that affects. I am there whenever they need me. I love it.
Speaker 1:I absolutely love it. I think that's phenomenal. Is there any last words that you want to convey to people to get them to give you a call?
Speaker 2:yeah, so my clinic is located on jana road between 14 and 15 miles. Uh, the name of my clinic is core and beyond physical therapy. I purposely decided that because I don't want to just limit it to pelvic floor. It's beyond, and then I will share. My website is coreandbeyondcom. That's the best way to reach me. The top of the website that is schedule now tab. Once you click that, there are all different questions and when you submit that form, that comes directly to my email. But, like I said, if somebody wants to know if this is really going to help me, how many visits I'm going to need, my phone number is listed on the website and maybe you can put it in show notes and if there is any hesitancy, text me, call me, email me.
Speaker 2:I'm happy to answer and help.
Speaker 1:I love it. I love it Well. I hope this podcast helps a lot of people find you and it turns into something great, and I can't thank you enough. I really appreciate your time and I'm looking forward to referring people to you and having them come back going. Brian, she was a miracle, Thank you.
Speaker 2:I hope so. Thank you so much. And just real quick, till end of October I'm offering 10% off of my first consult and I hope people can use that and at least get to know me, get to know what services I offer. I also do offer dry needling or low back pain and some of the pelvic floor issues. So yeah, if they contact me I can explain details.
Speaker 1:I love it, dr Selvi. Thank you so so much.
Speaker 2:Thank you so much.
Speaker 1:We'll see you soon.
Speaker 2:See you soon. Thank you, have a good one.
Speaker 1:Thanks, you too.