9. Dysautonomia and EP's not actually exercising.

This week's episode dives into 2 juicy topics:

1. POTS as a presentation of Dysautonomia
2. Nic's controversial LinkedIn post about why EP's should be exercising.

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Transcript

SPEAKER_00 0:00

Welcome to Remote Control EP, the podcast. I'm Nicola. And I am Courtney, and we are here to have the real and the raw conversations about clinical practice, business, and what it means to be an EP because it's time that we took control of that conversation. We would love for you to like, subscribe, and share it with all of your EP networks. The more, the merrier. We are going to kick off today with our physiology fact of the week. One of your favorite parts of the episode. And Court, I believe you are sharing something with us today. Yeah, I'm going to share a little bit about POTS or postural orthostatic tachycardia syndrome, which to be honest, I have a really hard time remembering all those words every time I uh explain it to people. I just call it POTS. Yeah. And they're like, what does POT stand for? And I'm like, something about postural. Yeah, it's a lot better at remembering it, but it crosses over heaps with my endo clients all the time. Um, so you know, just wanted to share a little bit of things I've been diving into. I think it's really highlighting a bit of depth of knowledge, which is one of the topics that we've talked about on the show a couple of times, and something both Nick and I are really passionate about with the EP world. So I'm going to share a little bit about it, uh, something that I didn't really know a lot about. Uh so pots is actually just one way that dysautonomia actually presents itself. And POTS can have several different phenotypes, depending on what is actually going on with the body. So I've written a couple of notes here, so I don't forget because obviously this is still new to me, this information. But we have hypovalenic pots, which is related to just not having enough volume of blood getting back to the heart and the brain. And it's really probably the most common presentation with hypermobility. Then we have hyperadren hyperadrenergic pots. See, I've got the right pronunciation, uh, which is where the hormones actually respond really dramatically to changes in blood pressure when you stand up and cause not just the heart rate to rise itself, but also the blood pressure. And then there's also mast cell activation syndrome-related POTS, which is triggered by the general activation of mast cells throughout the body. So POTS is often just seen as a marker of general disorderonomia, where it's more of a symptom. So if we are only going to be targeting the POTS, we often miss a lot of the deeper cause of the problems. So POTS can be caused by a host of other things that actually affect the central nervous system. Uh, things like chronic fatigue syndrome, concussions, trauma, the severe loss of body weight can all be reasons for POTS. But then when we have another recurrent phenotype, which would be the vascular compression syndromes or something, such as um Mae Turner syndrome and nutcracker syndrome, which I have not yet looked into, but apparently they're a thing, which all affect the blood return in the body. This can also result in POTS. So that it's um I'm coming to realize that it's not just like pots is a thing, it's actually like a present presentation types of dysautonomia. Yeah. So pots is just like the general kind of heading of dysortonomia, and there can be all different types. Yeah. Right. How on earth did you find this information? Because I feel like anything I've ever read about pots is like just tells us pots, and then there's like protocols you follow for people with pots. Yeah, yeah. Crazy, right? Because like you just do like super hunter pro and slow progressive movement. And I think like um, I actually have a new course coming up on her education with Stuart McDonald, who is an absolute guru in disordernomia. And he was actually teaching me all this stuff. I asked him about a client who has no POTS diagnosis at all, but she has this really weird fainting issue that happens with no, like we've been picking up on patterns now, but she's like, I don't meet any of the criteria for POTS and I don't get random heart rate changes at all. I just ever every now and then I just get this weird fainting that happens. Um, and so I was like, this sounds very like it sounds like pots, and I don't really know enough about it. So I rang to you and I'm like, mate, I need like I I'm gonna ask you a question about this. And he was like, Yeah, this is what I wanted to teach and talk about because pots is actually so in-depth that I could do like hours and hours and hours on this in terms of like dysregulated people and it's dysautonomia rather than actually just pots, and if we're not treating things properly in our EP world, so I was like, let's sit down and have a coffee and plan this course. And so as he was teaching me all this, I was like, oh my god, mate, this is like This is wild. Now that you've said this, I'm like thinking of a client who years ago was having random sync syncope episodes, like randomly fainting, and no one could figure it out. Now she has a POTS diagnosis, but there was like five years where we just didn't know what what was happening. Now I'm like, oh my god. Yeah, well, this particular patient of mine, she has really severe fatigue, really severe. And so we've now started to like like I've been educating her a little bit on like as I'm learning stuff from Stu, I'm like, hey, I've just been learning this stuff about POTS. She's also got endo and she came for endo in chronic pain, but her fatigue was the problem. And she was like, I'm scared to exercise because I get random fainting and I don't know when it happens. And I'm like, okay. And the that was not actually the problem. Like, she wasn't coming to me for the fainting. And so um, when we started to talk about things, she's like, actually, when I've got really, really bad fatigue, it's it causes I then faint. And she was like, for example, she was playing basketball, and basketball would be fine playing basketball, and like an hour or two later, she would faint from from from it. She would just faint at home. And then that sort of improved with her fatigue, but now she gets it, now she's noticed this pattern related to the fatigue side of things, and she's had previously a chronic fatigue diagnosis. And so I was like, Oh, and he was talking about how like these things can cause these phenotypes of pots, but not always the same. Like, she doesn't have blood pressure issues, really. Yeah. And she doesn't have like she's not like sitting there going, oh, my heart rate's at 150. That's weird. Like she never had that. Um, so anyway, he is bringing out a course. It is actually going to be super in-depth. We're going through all these different phenotypes, all the different strategies and prescriptions, and what we actually do with it. It's very in-depth. It is very thorough, but it is insanely like insightful. And I feel like when I read it, I was like, this is what physiology is. This is how you go to a GP and you say, Hey, did you know that all of these presentations are different phenotypes? We use different strategies and different prescriptions for that. And like, not just, oh, you just lay down and then go upright with them. Like, I feel like that's just like the general prescription that most people with pots probably do. Um at the baseline. So correct me if I'm wrong, but that was definitely my knowledge. Yeah, sign me up, and maybe we can have something in the control room that's like a little taster of this. I know. I was like, Stu, you need to also come into the control room and do like a quick lunch and learn with us. Um he was like, How do I even teach anything? Like, there's so much to cover. And I'm like, we just start with like a little bit of highlight stuff because there's so much depth to it, um, which is which I feel the same way too. So anyway, his course is gonna be uh launching in September, I believe it is. We're doing like a week three weekends of like deep dive, um, which is really cool, all virtual. So I've got like a bit of a wait list started for people that are interested in it, but mind blown. Every time Stu, I don't know, like every time he talks about stuff. If anyone's done anything of Stu's or um even just like following him on LinkedIn and seeing all these posts and stuff, I'm like, this guy knows his shit. Oh, I know. I'm like, I feel like an idiot sometimes to talk about women's health, and I'm like so fine with it. But his um he has the trauma course out already on the platform, which is like also fantastic, but his knowledge is just so far beyond so many other people that I speak to, in a sense of all of this like invisible illness stuff. So anyway, that's where I learned it from. And I was like, I'm sharing this on physiology fact of the week because I would 100% guarantee most people are like, what phenotypes of pots? Like, well, I feel like I work a lot with pots, and I've never heard that presented in that way, or any PD that I've done has never touched on any of that. Yeah, so technically you work with people with dysautonomia. Wow. All right, changing language now. Yeah, but anyway, so that's the physiology fact of the week, everyone. Wow, wow, wow, wow. Now, today's actual topic, actual topic info. Also, quickly, before we keep going, if you want to join the lunch and learn wait list in the we're doing lunch in the control room, it is in the show notes. We haven't got a date yet that will be launching this. Um, we're both planning, but uh stay tuned because it's coming. Yeah, join the wait list weekly, 30-minute PD. We dive into like super practical physiology prescription on physiology. It's all application, no fluff. It's like 20 minutes on your lunch break, 10 minutes to ask questions, like super short and sharp and to the point. Um, join the wait list. But what we're gonna get into today is actually a post I recently put up on LinkedIn, and it's gone off. So I thought it was a good conversation to have with everybody that's not in my LinkedIn network, um, and just bring it to the table a little bit more, talk it through. Um, so the post that I wrote was it said you need to exercise to be an exercise physiologist. Uh, not occasionally, not I used to exercise consistently. The thing that you spend all day telling other people to do, that is the bar, that is the job. And I didn't think it would be controversial. I I comment on it because I was like, I we've had this conversation before, like, how many EPs actually meet the recommended guidelines that we're prescribing to people just for general health and well-being, really, outside of the city. Yeah, like two days a week resistance training and 150 minutes of moderate intensity activity. Yeah, uh it's actually one of the first things when I do goal setting with my students on day one. Uh, the last question I ask them is So, how do you currently meet physical activity guidelines? And most of them look at me blankly and I'm like, okay, let's workshop this. You are committing to doing that while you're on placement with me.

SPEAKER_01 10:54

That's just so crazy.

SPEAKER_00 10:56

Yeah, it is like actually mind-blowing how many students that I see not exercising. But at all. Yeah, or like maybe they play social soccer on the weekend. Like there's no structured physical activity. Which I mean, like what made you go? I'm gonna do exercise physiology. Yeah, I don't know.

SPEAKER_01 11:22

I mean, maybe a physiology.

SPEAKER_00 11:24

The biggest discussion that I have with them is usually it goes like this oh, you know, uni placement, trying to manage work outside of that, it's a bit busy, I just can't fit it in. And I'm like, okay, so when you sit in this chair and I sit there and I'm the client saying, I just don't have time, I can't fit it in, I've got kids, I'm a single parent, I'm working extra jobs, I'm doing this, doing that. How do you help the client navigate that? Like, what do you say to them if you yourself can't figure out how to make time for it? I'm a believer of it's not enough of a priority, there's always time. Um I have a question for you. Do you actually ask the students like that question? Like, what do you say when they say this? They just look at me blankly. You're like, oh my god, why did I get it so then I I kill the awkward silence and I'm like, okay, let's make some goals for you to participate in exercise while you're on placement here. Well, I do they do that? Do they make their goals? Before, and then I sit down and give them physical activity goals. And when I do my weekly check-ins with them, I ask them and I keep them adherent to those things. Do you know what this this is such a I just had this remember? I'm remembering back to a client who I this is obviously very different. They were they were seeing a physio for prolapse. Um, and they were very renowned physios. And she was like, I'm having troubles with my back squat, so I'm gonna go, I'm gonna go see the physio. And I was like, I can help you with that. This was someone I was friends with at the time. I hadn't, I was early in my career, but um, she's like, I went into the physio and I said, Oh, I'm I'm I'm having troubles with the back squat. And she's like, Oh, okay, yep, no problems. And then she said, honestly, at one point in time, I was like, hang on a second, I don't think she knows what I mean by back squat. Like, like she just sort of started doing a bodyweight squat in front of me. And she said, like, I had to tell her it's with a bar on your back. And she was like, Oh, a bar. Okay, like a bar. And she was like, and she's like in that moment, she realized, like, I how is this person gonna help me? I have symptoms in a back squat, but she doesn't even know what the back squat is. So, like, when I think about prolapse and back squatting, I'm like, all right, we need to look at technique, we look at movement patterns, what does progressive overload look like for this particular exercise? How do I change the variation for this to make it symptomless? Yeah, if I didn't actually know what a back squat is or how to do it, or did it regularly to understand how it feels or how to improve my own squat, how would you help? Yeah, uh I don't know. Because I think you might be doing it. Like, I don't think that that's a question. Like you should never prescribe an exercise that you've never done yourself. But I also tell students I'm like, if you've never done yoga, if you've never done Pilates, if you've never done a Zumba class, you need to go and do at least one of all of those classes. Because the weird and wonderful things that come into our room, your title is exercise physiologist. People expect that you know everything about every form of exercise. And like, if you've never done it and they're going, Oh, well, like, should I do yoga? And you don't actually understand what a yoga class entails, like, do you know the difference between a like a flow and a um a slow breathwork class?

SPEAKER_01 15:00

Like a yin yoga versus yoga versus yeah, yeah, yeah.

SPEAKER_00 15:04

Like you kind of need to know, like, yeah, okay, if someone's doing yin yoga, I'm probably gonna be like, yeah, great, go for it. But like if they're doing a hot vinyasa flow, like have you tried that? It's so hard. That's that's what I do. That's a kind of yoga I do. I got no chill. Beginner exercise, yoga is not beginner friendly. So if you if you don't know that, yeah, you have never done it, you will be like, Yeah, do some yoga, it's easy. It's like, yeah, I remember when I thought reforma. Pilates is easy, that's a whole nother discussion. But uh me, prime example, never done reforma. And I'm like, reformers like remedial Pilates. You, I come and see you for some lessons, and I am dying. And I'm like, oh my god, I didn't realize this was so hard. I'm never putting someone on the reformer until they're ready for a reformer class. Yeah, yeah. But like, I just I cannot, I I I you should never give someone exercise or say yes to an exercise that you've never done before. Like you just can't understand it yourself. And the things that I say to students is like, how do you progress and regress the exercise? A classic one is a pal-off press. None of them have ever actually done it, so they keep just going heavier and heavier. And I'm like, now it's a weird funky chest fly. Like it's it's just a weird funky chest fly. Oh my gosh, that's hard. It's like their shoulder and chest is working so hard because it's so freaking heavy. And I'm like, okay, we that's not how we necessarily make that exercise harder. Um, but it's like you've never done it before. So like you don't know that, and it's so valuable when you're like, oh, okay, I felt this in my back, or like my knees got sore doing this. I changed this and it made it better. Like it's so much easier to work through with a card if you navigated those challenges yourself as well. Yes. Um, so I'm like, I love that you're talking about all this, but I want to know why your post was so controversial. Like I feel like everyone would have agreed. Like I commented very early. So there was like one or two people before going, Oh my god, great post, woo, LinkedIn. Um and then now I'm not sure. There's two parts. There's two parts. I'm gonna go into the first one. People, I'm gonna read what I had written. People are saying doctors can be overweight, dietitians can struggle on their nutrition, pharmacists shouldn't have to take drugs to do their job, oncologists shouldn't have to go through radiation to do their job. Like that's not even the same. No, they're missing the whole point. Like, someone wrote that. If an oncologist got cancer and then didn't want to go through radiation therapy because they didn't believe in it, that's the issue, right? But then told everyone else to do radiation. That's what the key is, right? Yes, like if I'm not doing exercise, I don't know about you, but everything I know about exercise and the benefits on preventing, managing, treating, everything. There is there is no way you could get me to not exercise in this life, knowing what I know about exercise. I know. Like it's just I'm like this, it's it's infuriating to me. But like if I knew all of that information and still chose not to exercise, because I don't know, sometimes people are like, I'm not a gym person. I don't fucking care. I want strong bones, I don't want to break my bones, it's good for my joints. Like, too bad, so sad. Okay, the fact that you dropped the F-bomb mid sentence shows me how much passion you have for this. I was like, oh my god, I'm just swearing away. I forgot what we're recording. So fine, we can swear here. We've just implemented swearing. Anyway, I should calm down. I need to I I hear you, right? Like, I feel like back in the day it was very aesthetics-driven exercise, right? Like, oh, I want to be muscly, I want to be thinner. I was always a fat kid. So um now I'm literally like on the assault bike doing intervals at sprint, full sprint, because I'm like, my cells are gonna love this. Like, this is doing such great work for my cells. And like, all I can think about is like, didn't do my resistance training this week because I was away, didn't have my gym membership, whatever. Uh, maybe I just did walking instead or went for an attempted run. And I'm like, oh my god, my bone health. Like, I'm literally like, oh, I need to load my bones. Like, I never would have thought about that before. I learned all of this stuff, and now I'm like, I'm gonna be my own, the reason why I'm frail. Championing for my own house. An example I always give to people, or an analogy I always give is like if you're actually building your house, you don't choose the shittest, cheapest builder, or think, oh, I'll do it myself. You want that house to be beautiful.

SPEAKER_01 20:00

Yeah, true.

SPEAKER_00 20:01

But you want like you've got a budget, I understand that. But like you want something that's reputable that's gonna put the walls up and the roof is gonna stay over your head and not collapse, right? Your body is your house for the rest of your life. The best thing that you can do for it is to exercise. So load your bones with mechanical strain, exercise your heart and lungs with aerobic activity. Like there is so much more than just that. But like yeah, I feel like those people that are saying the doctors can be overweight, and like pharmacists shouldn't have to take drugs to be good at their job that it misses the whole point of exercise. Yep. Yeah, I hear you. I can't believe that. The part two of the controversial post just keeps getting better and better. There were then people saying we are confusing personal participation with professional competence. If exercising becomes a requirement for professional credibility, what does that mean for people with disabilities, injuries, or physical limitations? Expertise should be judged by knowledge, experience, and the ability to help others, not by personal participation. I yeah, well, I didn't go and stalk any of these people because I'm like, I do not need you in my circle of people. Like I don't really need you in my network. I mean, like it's it's not like like you said, it's not like they um like I'm just thinking of where that comes from. That mindset is like you don't need to be doing the thing that you do for a job. I kind of understand how that would land in someone's brain. But it's like you can't not tell you can't tell someone to do something that you also don't do yourself or believe in. That's it's still the same problem. The comment that I actually wrote back, I'm gonna read it. Out because I feel like I feel like they kind of missed the whole point of the post anyway. But I wrote people with limitations, disabilities, or injuries need to exercise too. That's literally our whole job. Empowering people to move regardless of their limitations. Adapting exercise to the individual is exactly what we do. So a disability or an injury isn't an exemption from participation. It's the very thing our profession exists to work around. We spend our careers championing exercises, prevention, and treatment for nearly every chronic disease. If we don't apply that to ourselves, it's worth asking whether we truly back our own evidence. I cannot imagine going to an EP that doesn't exercise and being like, oh, I'm gonna listen to them.

SPEAKER_01 22:52

Yeah.

SPEAKER_00 22:53

Like if someone presents as like no knowledge on movement, doesn't like when I say, Oh, so tell me, like, when do you go to the gym? Like, I would I would probably ask that. Like, oh, what do you do for exercise? Like, give me some ideas if I'm struggling with exercise. Like, oh, I don't, I don't do it. I'm like, I would literally just be like, I'm sorry. Like, should I just stop? Do you believe in this or not? Yeah, like I don't know. It's just wild. Anyway, if you want to read all the comments, it has gone off and it still is. I'm getting notifications here there and everywhere. People are reposting it with their opinions. And uh anyway, give me a follow on LinkedIn if you uh what's more controversial. Oh my gosh, I just looked at it. We're crazy. I just I I I'm gonna go through these now. Yeah, it's currently on 39 comments, and uh yeah, it's a little bit wild. Like I'm just baffled by this conversation, also how it got there, but that's the nature of uh writing messages online and people being keyboard warriors behind things. I'm not saying that someone with a disability shouldn't be an exercise physiologist or someone should be a certain weight or look a certain way. But I'm saying if you actually believe in the whole concept of exercise as medicine, exercise as preventative health, then you should be doing it. Oh my god, I'm actually sorry, I'm just scrolling through reacting to this live. I'm just like, I'm just surprised that people aren't really understanding. It's so good to see it's it's literally one or the other. Like it's not like oh yeah, contrary. It's like, yes, amen, sister. Say it louder for the people in the back. Yeah. Or it's like how's this one? I don't even know who this person like this, as Aragosarchi once said, I never realized that in order to become a jockey, you first have to be a horse. Yes. I'm sorry, why are they so not the same? Yeah, it's um I just I have no more words. Anyway, I think you should exercise. And we all have trouble, we all have struggles, we all have ups and downs, we're all motive not motivated at times, and blah blah blah. But like how do we inspire people to like if I can sit in the room with my client and be like, I've been through that too. How much does that connect you with that client? Oh, I was literally just thinking of a session I had yesterday that was someone saying, like, they found it super hard to get motivated and like I have to do this, like I'm sick of having to do this. And I said, you know what? This week I went to the gym and did strength training. And I've previously not been able to do the strength training from an injury, and I was literally doing basic activation exercises and retraining, and I was like, I wish I could just go strength training. And I said, I used to feel like I wish I could be here doing strength training, like I get to do this now, not in I have to do this now. And the mindset shift in you could just see in her face that she was like, Oh, actually, yes, I I I feel you, like that that has just changed. You had felt what she felt in that moment, is just like so powerful to connect with people. And like, sure, there's days when I miss the gym or weeks where my exercise doesn't look perfect, and like all that stuff, and that's okay, like we're allowed to do that, but we do need to take our own medicine and practice as we preach. Also, we're not saying, okay, let's just reframe this. We're not saying every person who prescribes exercise has to meet the recommended guidelines every single week, otherwise, you're a failure as an EP. It's like, no, we should just be living our lives like this, the same as our clients, knowing that sometimes you don't meet them and other times you do. And the goal is to actually try and do this and work out your barriers and like what you prioritize and like it's intensity-driven, and there's a purpose behind it. And what like it's not about oh, you don't exercise enough. Sorry, you can't work. And like the original post was exercise consistently. That's the point. I'm the one who wrote the guidelines. That's so crazy. I'm I'm so shocked that you got such like I'm like, I want to sit down and have a conversation with these people, be like, what do you do? Like, tell me about your work. I just actually first when I replied to it, and then the rest of them, I was like, I I'm not replying to this. Like, I'm not I'm not here for a LinkedIn war. You should be you can have your opinion. I think you're an idiot. I will keep my opinion over you. I'm and I know that my muscles and bones and joints and the rest of my cardiovascular health are gonna thank me for what I do. And when you need some help, give me a call. You'll be calling me when you can't. Oh man, wow, okay, so uh that's so funny. But I think you can probably um probably guess what our take control of the week is gonna be. Uh post on LinkedIn. On the post. Come and join the LinkedIn wall. No, have a look at your own physical activity and what you're doing, and I don't want to say you sort your shit out, but like figure out how you can be consistent. Find a friend, find a buddy, reach out to another EP if you need help, reach out to one of us. Like, yeah, if I can empower someone to exercise more consistently, happy to help. Also, sometimes you might just want someone else to write you a program, right? Like sometimes I'm like, I'm just bored of my own exercises. I need something else. Like, someone write me something. And it's like one of the best things I did as an early career professional was to get a coach, someone else to prescribe for me, someone else to write things that I wouldn't have picked, expose me to different exercises, make me do the things I don't want to do and that I avoid. Yeah, reach out. Like if you need help, just because you're an exercise physiologist doesn't mean you need to be afraid to ask for help. We all need accountability. Like realistically, those people that come in for weekly sessions, a lot of them could probably do things on their own. It's like they just want the accountability, they want to turn up. So you're allowed to want accountability as well. Yeah, like I feel like that's something every single person struggles with accountability with exercise at some point. Yeah. Or if you've got the problem, like I have I actually have so many um EPs come through the virtual clinic for endocare and they're in chronic pain, they've got endo, they don't know how to, they've not really dived into how to actually support them. And they're like, hey, I need some help. I'm an EP, but like I'm happy to like jump on. Obviously, they believe in EP because they're coming to see one. But if you actually need some support with a condition that you've got and maybe you don't know what you're doing with it, or you want someone to have an outside look at it, because doing your own rehab is like the hardest thing in the world. Yeah, like reach out to someone, like give us a buzz. Yeah, drop into our LinkedIn or Instagram and we're like in our possession. Yeah, always happy to help. And yeah, that's that's how take control of the week. Have a look at your own exercise and be consistent, right? Figure out a plan. And uh that's a wrap on the episode this week. Thanks for being here. Thanks for listening to us. We we really appreciate it. Um, I hope you enjoy these conversations. But don't forget, like, subscribe, share it with your EP networks. Feel free to share this on your LinkedIn profile if you want to spread the word or your Instagram, whatever that might be. But um, the conversations around what the industry is doing, what's going on in their realistic, real problems are is only going to get bigger if we can grow the audience and have everyone connect and um be together. So please, if you can appreciate the share. Anyway, thanks for being here, and I guess we'll see you in the next one. Bye.