The Healthy Post Natal Body Podcast

Why GPs don't understand diastasis recti

August 29, 2021 Peter Lap
The Healthy Post Natal Body Podcast
Why GPs don't understand diastasis recti
Show Notes Transcript

 I talk about GPs and why they often don't understand issues like post-natal back-pain and diastasis recti. It's not because they're stupid!

And; "In the News this Week"; A study I actually came across last week after recording the podcast so want to bring it in now. This study, published in Nature, shows that Fructose in the diet expands the surface of the gut and "nutrient absorption". I'll have a little read through it and explain why this is important. Apologies in advance for this bit, I made quite the mess of reading this thing and am not always at my most coherent :)

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Playing us out; "Can't stop/Carry on" by  Ramona Woolf

Hey, welcome to the Healthy Post Natal Body Podcast with your Post Natal expert Peter Lap. As always, that would be me. Today I'm talking about GPS. Why don't they understand diastasis recti? Why is it not their job to understand diastasis recti? But why does that mean that when you have diastasis recti, it's always a bit of a postcode lottery as to whether you get any help from your GP or any understanding from your GP. And in the news this week it's high fructose corn syrup. Oh, this is a great study I came across and you'll definitely be wanting to stick around for this one, if you drink Coca Cola and all that sort of fun stuff every day, it'll be fun, I promise. Here we go.

Hey, welcome to the Health Post Natal Body podcast with me. This is the one for the 29 August 2021. It's another beautiful day. It is again a Saturday, so it's on the 28th, as I'm recording this. I'm trying to record a bit earlier, so I have a bit more time to edit. Get it smooth. Create an excerpt, create some transcripts for all you guys and all that sort of things. So we'll start off again by the compulsory like and subscribe to the podcast. Tell your friends; There's a podcast out there that they can send questions into. They can email with any and all post-natal related questions or exercise related questions, diet related questions. Whatever you have, just fire it over. I shall answer them and I won't even sell you anything. I won't charge anything. I won't sell you anything. I'll be fine. You get some answers that you can trust. On that very, very subject as I stare out the beautiful sunny sunshine in Edinburgh. So I'll smash thought this a bit because, you know, my dogs need a walk. 

Why are GPs still terrible when it comes to diastasis recti? Why are they still ignorant on diastasis recti? Is a question I get asked a lot. Too much, really. Way, way, way too often. To be honest with you. There's a lady, Jess sent this on to me, Ten months postpartum. She goes to the doctor. She says I've got about two, two and a half fingers diastasis recti. Because you know, people still measuring fingers. Please stop doing enough right. I've said this before. I put the YouTube video up. You measure in centimeters, put your finger in the hole, and then you measure your fingers. Otherwise you can't get an accurate measurement. Anyways. Goes to the doctor. Ten months post-partum. So not the six week check up. The dreaded shitty six week check up, but the actual "it's a problem stage". Ten months postpartum, she has a two finger gap. So a three centimeter, you know 2.5-3cm gap. She goes to the GP and a GP says "yeah, I don't know. You're screwed. I don't know what to do. There's probably nothing we can do. I don't want to refer you to a physio because I don't think there's not much they can do. Maybe go do some sit-ups, literally do more sit-ups and look online, look at some YouTube stuff. Now, first of all, obviously it's grossly responsible for a GP to say "I don't know what to do" and then say "go do more situps". This GP is clearly a moron when it comes to this stuff. I'm not saying he's an idiot when it comes to all things. But when it comes to this, he clearly hasn't been paying any attention, has no idea what he's talking about. And that kind of goes from most GPS. I've trained quite a few of them as a personal trainer, and I still have one or two on the books that's regularly with me. GPs know the basic stuff, and they know more than I do about many, many things. So let me start out; I'm just an ignorant jack-ass who understands post-natal exercise better than most. I'm not going to say that, when I go to a GP, and I do go to the GP every now and again. It's been a few years, but, you know, if there's something wrong with me, I go to the GP because he might have an indication as to what it could actually be that is much more reliable than my blind guess or my Google search. Right.

 So let's not start with the GPS are all useless because they're not. But when it comes to diastasis recti, they are because it's a specific condition and one that comes up a lot admittedly and one they should be familiar with, I think. But I find that most GPS, when it comes to the anatomy of, especially muscular anatomy, they've kind of forgotten all that stuff. Whenever they show up at mine for personal training, something like that, they're kind of like "Yeah, I kind of know what you're talking about, but I'm not sure exactly where all the muscles are", That sort of thing. And that's kind of what I do. I do muscle, right. And physios will really nerd out about muscles. Gps don't, that is not their thing. Nine out of ten times. You know, if you go to a GP surgery their waiting room is full of old people. They're not going to come in with diastasis recti. They come in with the sniffles or something else, and they need to be referred out to other people if they're really sick.  It's just not what GPS do. Now, don't get me wrong, I think they should know what it is. Because it affects almost everybody who's post-partum, and that is still, you know, in Edinburg alone, I know there are 5000 babies being born every year. So say, you know, you throw in 500 twins, and I don't think anywhere near that. But that's still 4700 women that go to X amount of GPS in Edinburgh. I don't know how many GPS there are in Edinburgh, but you know, everybody, every GP will probably see ten women here post-partum, for a post-partum check-up? I can't be that far out, right? So every GP in Edinburgh sees about 10. Let's just say that I'm probably low. And say that we carry that forward onto every other GP in the world as well, because Edinburgh, as you all know, is the world because that's where I live. But it's the so if you see ten people with the same condition every year, you kind of should know what that condition is and how it can be resolved. And you should kind of know, that, especially if it's condition like diastasis recti. When people come in, come to you ten months post-partum and they say, "I think I have diastasis recti" and too many people...Too many GPS close up. As soon as you say "I think I have.., "I have diagnosed something XYZ myself" a lot of GPs go, "Oh Jesus, this woman has found something" that is just the mindset I come across with. A lot of GPS, selfdiagnosis admittedly is a pain in the ass for those guys because it works against them. But you know, in some cases, Google is a good thing. So you come in and you say after diastasis recti ten months post-partum, a GP should go, I will refer you out. End of. What the GP should never do is say, "I don't think they can fix this" because. Dude, you have no idea what the hell you're talking about. "I think you should do more sit-ups" because... Dude, you don't even understand the basics of exercise if you think that sit ups are still an exercise people do. I'm guessing that this GP is like 70 years old or something like that. You know, one of those guys that should have retired 20 years ago. I mean, no decent exercise professional still does sit ups with his clients. End of! Not a single fecking one! Right now. Cue emails from personal trainers that say "I run a boot camp and I still do situps with people". Yeah, like I said, not a decent personal trainer. If you're boot camps, you're not a decent personal trainer. You're a group exercise instructor. Well, there you go. Pissed everybody off. That's a slow email week this week. So a GP should always refer out to a physio. If your GP doesn't and says, I don't think blah blah blah insists you're well within your rights to say to your GP, I need a physio referral. To be fair, I wouldn't take an NHS physio referral. I would pay £40 £50 myself for a private consultation with with a women's health specialist. You could even go see a PT. If there's a good post-natal personal trainer in the area. The first session is usually free anyway, so you can check out. They will let you know, but you know, they're what they will do is sell you a PT pack afterwards and it is a little bit of a thing that there's a bit shitty. You know, you show up and you have no interest in signing up for PT. You are wasting the PT's time a little bit. And by a little bit I mean massively. Because they could be making money in that time, at least the physio gets paid. But if you were to ask most post-natal PTs in your area if they could check you out and you'd be willing to pay them a one off fee for that, they'd be more than happy to do that. I'm sure actually they'd be delighted to just give you a quick 15-20 minutes check over. I did one for a couple of ladies in the Edinburgh area and by Edinburgh area, I mean the Lothian region. It was just measuring diastasis recti, testing muscle functionality. It wasn't even that expensive, to be honest. Or at least I didn;'t charge that much. Because there isn't always...If there isn't a women's health physio. So a physio specializing in postpartum issues or women's health. Then I would maybe consider going to a post-natal PT and say "Listen, I need one session. I need you to check out whether I have the stuff and then give me the first four to eight week program of what I should do about it". Because most PTs that you'll come across will be absolutely delighted to write out something for you. To be honest, as I bump into my cupboard, they'd be delighted to do a little check up. We've all got hours to fill. And if someone says listen, can you just do something straightforward as a measure gap, check muscle functionality, all that sort of stuff and then give me a little program. Yeah, they'll be delighted to, I have no doubt at all. All decent Pts will be more than happy to help you out there. 

But we have to remember what the GP is actually for GP. A GP is not really there to understand, post-natal back pain and diastasis recti. They should recognize it for what it is. So don't get me wrong, as soon as you come in and say "I have diastasis recti" then the GP should go. "I know I need to refer you out". But it's not their job to understand it. That is not. These guys see a ridiculous amount of aches and pains and niggle and sniffles and viruses and bacterial infections and all that sort of stuff to come their way. Their job is not to  heal that sort of thing. Their job is to just go "Listen, I recognize this for what it is and I can send you on to this Department". And like I said before, I mean, they recognize a hell of a lot more shit than I do. That's why they went to medical school. These guys are qualified, they're just not familiar with. That is kind of the difference. In the case of diastasis recti. Like I said before, it is frustrating. And I know Wendy from MuTu has been trying to get the NHS on board. And I've been trying in Scotland to get GPS and the NHS in Scotland on board with some sort of diastasis recti stuff and increase awareness, increase solutions. And affordable solutions in my case as well. Just let people know that; it is a common condition and this is what you need to do to fix it. Or at least to help fix it and maybe even give GPs and GP surgeries some information on it. But I have made no, zero progress with regards to that in official NHS structure. Obviously currently with COVID and all that sort of stuff they've all got other things to do, right? I completely get it.

 I just wish I could print 50000 leaflets and just distribute them around Dr Surgeries and just go; "This is what diastasis recti is. Get your three months free plans. You don't have to pay anything". But it's damn impossible to get that. I even sent an email out to the people that do that. In Scotland you get a baby box in the same way you're doing in some Scandinavian countries. I think it contains lots of useful things, apparently for new moms. So as soon as you poop out of a baby, the Scottish government sends you out a baby box. I wanted to get leaflets in there. Just informational leaflets, non sales. Just; "This is what you have. This is what you probably likely have. This what you can do about it. You know, this is how you find out what you have". That that sort of thing. But I've had no joy whatsoever with got it. Because fundamentally, all these things turn out to be a commercial thing, a commercial problem. It costs money. And currently in Scotland, the NHS is spending it's money in different areas. Like I said, I did offer to pay for it. Or to do it at my own, at HPNB's expense, but there were no takers on that one. Right? So that's why your GP doesn't understand. It will always be a postcode lottery. This will never improve. I've tried improving it. It will never happen because even if they talk GPS about diastasis recti and taught them well, they only see ten cases a year. Like I said, I think if you see something ten times a year it should probably register with you. But then again, I don't know, ten minute appointments, four appointments an hour. So 32 a day, 150 people a week. GPs write into me. How many how many people do you get? Do you see a week? 150?. So that's 600-700 people a month, a year 7-8000 people? I can't be that far off. That must be about right. If you think it's more, if you think it's less, if you know what the answer is. Actually, I might ask one of my GP clients about that next couple of weeks,7000-8000 people are here. That's a lot. And ten people have the same thing. And you know, that's why they don't know. They see a tremendous amount of people that have that have various different issues, and they can spot all, if not most of them. So let's give them some credit. If you put 7000 sick people in front of me I spot three things. You know, I'm sure that most of the stuff that they see will be completely normal and standard and boring and all that sort of stuff, but there must be interesting stuff in there as well. If you're a GP want to come on to the podcast email You can berate me for being an ignoramous that only focuses on one small part and knows nothing about the rest.