Guest Post: Sunday March 11 – Day 4 Post Op

Today was my last day of help from my Gramma. I really should have booked her train ticket with a later return date. Gramma is almost 85 years old but she kept the household running for the past 5 days. She assembled the meals I had cooked ahead of time, helped get my older son out the door to school and amused my younger daughter. She did dishes, sweeping, laundry and stocked the fridge with 2 homemade meals for the coming week.

My husband came home early from work each night to bathe, brush, read and snuggle the kids at bedtime. He also drove the kids to school in the morning, picked up groceries and cooked dinner on the weekend. Mom-friends of mine picked up the kids from school and dropped them off. If you are planning on surgery, have your support network ready!

The weather is warm and sunny today. I can’t stand being inside all day. My husband set out a lawn chair for me, but it was not comfortable. A few minutes of fresh air did lift my spirits.

I just took some Tylenol at bedtime tonight. The OxyIR really takes the edge off and relaxes me to sleep but I worry about the addictive nature of the stuff.

Guest Post: Saturday March 10 – Day 3 Post Op

I wonder what things look like under the binder and bandages? Everything is much too sore to consider a peek.

Guest Post: Friday March 9 – Day 2 Post Op

Just took some Oxy IR at bedtime. I am trying to wean off the painkillers. I spent a few hours in bed both morning and afternoon and ate meals with the family. Funny how small my appetite is when I am not exercising. Usually I snack all day long.

Guest Post: Thursday March 8 – Day 1 Post Op

I really hate sleeping on my back. It is impossible to get comfortable. The drains and the pain make any other position impossible. It is really difficult to move with no abdominal muscles from stem to stern. Trying to get in bed, adjusting pillows, getting out of bed and putting on socks are all big challenges. Pajamas with loose pants and a button top are the only somewhat comfortable option.

Guest Post: Surgery Day – Wednesday March 7

Here’s a new post from our guest blogger, Jen.

“I took the subway to the surgery facility for 9 am. It was nice to walk and clear my head. In hindsight, it would also have been nice to have someone to sit with for support.

A welcome nurse had me undress and put on a hospital gown along with a big terry robe. A surgical nurse gave me 2 Tylenol and a Celebrex and asked some questions. Dr. Brown then came in to chat and drew all over my mid-section with permanent marker. He said I was the skinniest tummy tuck he had done. Not sure I liked being an outlier. Don’t you want to be part of the average crowd when you are talking surgery? The anesthetist was the last one to chat.

Time of surgery – 10:30 am.  It was very freaky to walk in and lay down on the operating table. (My other 2 surgeries were emergency c-sections. No walking in for those). The anesthetist couldn’t find a vein. That’s what happens when I am cold and haven’t downed my usual liter of water. Her efforts made for a big bruise on my hand and blood dripping down. They started the IV. My heartbeat and breathing felt strange for a few seconds. Then on went the oxygen mask and I was out.

I awoke in a recovery room at 12:30 pm, thrashing my head back and forth and crying. Reassuringly, the surgical nurse, the recovery room nurse and Dr. Brown were all standing there watching me. I think Dr. Brown said everything went fine and then said I was making him sad so he was going to leave. The nurse placed a warm blanket over me to stop the shivering. Each leg was encased in some sort of contraption that contracted and released to lower the chance of blood clots.

At 1:30 pm the nurse gave me an oxycodone tablet. My sister arrived and came in to say hello. Dr. Brown checked back in and said my hernia had been bigger than expected, my stomach was going to be really flat and all was fine. The nurse moved me to sitting, showed me how to empty the 2 drains, mentioned that the binder was way too big for me and at 3:30 pm my sister and I departed. The nurse pushed me down in a wheelchair and my sister hailed a cab. I felt surprisingly chatty on the way home.

My dear children ran to the taxi with eager expressions on their faces as we pulled in the drive. Love ‘em.

I spent the rest of the day dozing in bed and munched on a few saltines and a banana along with more oxycodone. I’m feeling not too bad.”

Guest Post: Life After Surgery for Diastasis Recti Abdomini

One of our patients has undergone surgery to repair her diastasis recti abdominis. Keep checking in as we follow her physical and emotional journey through the recovery from surgery.

Tuesday March 6  – The Day Before Surgery

“There is no turning back now. Surgery is booked and paid for. My helpers are in place. And yet of course I am having second thoughts.

Do I really need to do it?  I’ve put up with it for 4 years. Why not the rest of my life? Is it fair to my kids? The surgeon says 6 weeks until resuming all normal activities. The surgery is expensive. OHIP does not cover it. We are hoping my husband’s insurance will cover part or all of the surgery but there is no guarantee. The surgery is reconstructive, (hernia repair, placation of the fascia, neoumbilicoplasty), but it is being performed by a plastic surgeon and is better know as a tummy tuck.

There is such a stigma around plastic surgeons and tummy tucks. I felt so weird researching the whole thing. I am a slim, athletic almost 40 year old mother of two. I was an Ironman prior to having children. I run or cycle or do something active every single day. Why the heck am I looking into plastic surgery?

I really need it. It has been almost 4 years since the birth of my second child. The diastasis recti is not closing despite my best efforts with exercise and physiotherapy guidance from Julia. My core strength is lacking. My lower back hurts when I swim. There is mild incontinence. I am tired of having a first trimester belly and a belly button that protrudes further than my breasts.”

When the Shoe is on the Other Foot…

Those of you that see me in real life are fully aware of my dental woes. It’s a humbling experience to be in such a vulnerable situation. I have had a myriad of MSK issues; fracture, sprains, strains, disc bulges, pelvic organ prolapse, incontinence and even a diastasis. When these arise, it’s upsetting or just plain maddening, that I can’t play or run for a few weeks, but it’s not the same feeling when you’re out of your comfort zone.

The thought of having a root canal done was upsetting enough. I was angry, feeling like my dentist had failed me, after all I had been complaining about this tooth for 3 years (yes years). She would reassure me, do some desensitizing and send me on my way. Nothing beyond conservative treatment was considered until I went in with real pain. I couldn’t chew on that side, so out came the filling and the revelation that there was indeed something worse. So begrudgingly off I went to the endodontist for a root canal. Nervous, but relieved that finally this tooth would be dealt with and I could move on. After all it’s not life threatening, it’s just a root canal. So after about an hour of drilling, he gives me the bad news: he can’t save the tooth. It’s too far gone. Cue the waterworks. I can’t describe the emotions I went through, from disbelief and denial to anger and resentment. Not toward him, he is great and I highly recommend him, but toward my dentist of 5 years. I am angry that she didn’t listen to me and that she brushed it aside. Could this have been prevented? Maybe. But maybe is good enough for me. I am typically pro-active. As a physio I know how much easier it is to resolve something in the acute or early stages and the importance of early intervention. The good news is that this will make me more aware of how my patients feel when I give them the news of their diagnosis. I am also feeling very vulnerable. I didn’t study teeth. I don’t treat teeth. I treat TMJ, but that’s a joint like any other, it just happens to be in the mouth. Dr. Moncarz was very sympathetic to my tears. He reassured me, same as I do to my patients when I tell them they have a disc bulge or pelvic organ prolapse. I felt better, after all it’s not life threatening, and in fact, a disc bulge is probably worse. I guess at the end of the day, what we don’t know, or don’t understand is scary. Whether or not it should be. As far as my anger, it will subside. I don’t think I can trust my former dentist again. My endodontist has referred me to a new dentist. I’ll let you know how that goes.

Bottom line: Physios, please remember the emotional impact that your diagnosis can have on your patient. Patients, ask your therapist, dentist, doctor questions, we are here to guide you through. We’ve seen it a million times. It’s not scary to us.

2011: A Year in Review

As the end of the year approaches, and with a new year on the horizon, I look back on 2011 fondly as a year of inspiration and change.

The first major change was leaving my former clinic, CBI Spine and Sport Physiotherapy after 11 years. I had the privilege of being mentored for 6 of those years by Anita Lorelli Reg PT, a phenomenal clinician with her diploma in MDT from the McKenzie Institute.  Although my leaving was met with fear and anger, it was the best decision for me and my family. I have followed my heart and my dreams and opened an idealistic clinic where our goal is to teach you how to get well and stay well. I have surrounded myself with skilful therapists and am looking ahead to the great things that are yet to come.

A game changer was completing my course in pelvic floor physiotherapy. Being able to assess the pelvic floor muscles internally by placing my fingers on the individual muscles and palpating their strength and function has made a huge difference in the effectiveness of my treatments for diastasis recti abdominis (DRA) and incontinence. It also gave me the opportunity to assess for a pelvic organ prolapse and make much better treatment programs for all women.

Another big change was to my DRA program. I had the opportunity to learn from two inspiring physiotherapists that are on the forefront of rehabilitation – Julie Wiebe and Diane Lee.  Julie has taken the research on how the core muscles work together and made it clinical. She put that piece of the puzzle in place for me. She changed how I teach recruitment of the core muscles to my patients. In adapting it to my DRA patients, my good friend Kim Vopni of pelvic floor wellness coined the term “the core breath”.

More recently, Diane Lee invited me to take her course on restoring form and function of the abdominal wall after pregnancy. It really underscored the complexity of the compensations that occur with a diastasis and the need for women to be assessed by a physiotherapist prior to beginning an exercise program, particularly post partum. Optimising proper core strategies is essential in resolving a DRA, and resuming a meaningful task.

The year ahead looks just as exciting, building on where we are with more courses, new research  and products. Join me for what is sure to be another exciting year.  Stay tuned!

What about you? What did 2011 bring?

Is it Worth it?

I treat a lot of women with diastasis recti (DRA) one of the most common questions I get asked is:  I want to have another baby is it worth all this effort if it’s just going to separate again? Well, the simple answer is YES!!!

Here’s why:

All the work you do now to close the separation, prior to getting pregnant will pay off now, during the pregnancy, during the delivery and after when you need strength to look after your new bundle of joy, and want your tummy flat again.

 Now

DRA is the separation of the rectus abdominis muscle. It happens during pregnancy or repetitive strain on the abs (like doing crunches). DRA causes muscle weakness and imbalance throughout the core. A weakened core puts you at risk for injuries to your back, neck and pelvic floor (incontinence, and prolapse among others). Doing appropriate DRA exercises will help restore the proper neuromuscular patterning of the core. When your muscles work properly, everything falls into place (including that flat tummy)

During pregnancy

Yes, with every pregnancy you increase your risk of developing a DRA. However, doing appropriate exercises during your pregnancy will help keep you strong, especially if you have a toddler or two at home to keep up with. It will also help decrease the severity of the separation. Strong muscles will also help maintain your posture as the baby grows. Proper posture is critical for preventing injuries to your back and neck. It will also encourage proper patterning of your pelvic floor helping to avoid incontinence. There is also strong evidence that appropriate exercises during pregnancy has health benefits for your baby.

During delivery

Having control of your pelvic floor muscles (PFM) and your transversis abdominis will be beneficial during the pushing stage, easing delivery and recovery and decreasing complications. Learning how to contract and more importantly relax the pelvic floor muscles is critical. If you are able to relax the PFM the baby can descend more easily through the birthing canal.

After

Muscles have memory. The more frequently an exercise was done before, the easier it is to pattern after. It’s like riding a bike. An exercised muscle also has more blood flow to it so it repairs faster (think elite athlete vs couch potato). It’s much easier to start an exercise you’ve done before than to learn one on little sleep. The core breath can be done immediately after delivery and used as a foundation for the rest of the core program. Basically, learning the exercises prior to delivery will increase their efficacy after delivery.

Now if you didn’t start before, don’t worry, it’s never too late. I have had women in their twenties, thirties, forties, fifties, and yes even in their sixties feel better and close their separation. Stay tuned for a later blog post that will talk about the proper exercises we should all be doing!

So, are you convinced? Is it worth it?

Physio After Pregnancy. When to Start?

New moms ask me this all the time, so I thought it would make a great blog post!

Q: How quickly after giving birth can I begin post-natal diastasis physio?

A:The sooner you begin the better.

My preference is to start during the pregnancy, as soon as the diastasis is noticed, presumed or diagnosed. This way we can start patterning your muscles to work together, in synergy. When you are more aware of how your core abdominals work it patterns your neurological system and that’s really half the battle. It also helps bring more blood flow to these muscles, and that translates to quicker healing times. Also if I get to see you before the baby does, I can show you exactly what you need to do immediately post delivery, I’m talking minutes, ok let’s be more realistic, hours, after delivery.

If you have already delivered your baby I can see you now. In my program, the first step is education. The beginning exercises to close the diastasis deal with the synergy between the diaphragm, pelvic floor, transverses abdominis and multifidis. They are 100% safe post natally as there is no resistance involved, just posture, breathing and patterning. We then build this into your everyday patterns of movement (ADLs). Once you are cleared by your midwife or physician, we start to add resistance and peak engagement exercises.

Splinting is often recommended, depending on the size of your diastasis and integrity of the connective tissue (that linea alba between the two recti). Most of the healing happens in your first 6 weeks, so doing the right thing from the start is the most effective way to resolve a DRA.

It is truly never too late to start either. It’s just more work the later you start, and the results can take longer to achieve.

Do you have a DRA? If so, when did you get diagnosed? Have you started treatment?