Presentation at New York Presbyterian Weill Cornell Medical Center

This past Wednesday, August 26, I had the opportunity to speak at New York Presbyterian Hospital/Weill Cornell about pediatric bowel dysfunction, the benefits of pelvic floor physical therapy, and biofeedback.  The lecture was attended by approximately fifteen physicians and clinical fellows, and they were a wonderful and captive audience.  Not only did they listen attentively and ask excellent questions, but they even managed to enjoy their breakfast despite the topic.  Mad props to the Pediatric GI department!
The first segment of the lecture was a review of pelvic floor anatomy and function, as well as normal bowel function and physiology.  I then addressed several frequently diagnosed bowel dysfunctions, including pelvic floor muscle dyssynergia, constipation, encopresis, and toilet refusal syndrome (i.e. when a child refuses to defecate in the toilet despite demonstrating the ability to use the toilet for voiding.  This is not to be confused with toilet phobia, which is when a child refuses to use the toilet for both voiding and defecating).  I also discussed how stool retention is connected to constipation and various factors that may cause stool retention.

The lecture then shifted gears and moved in the direction of how physical therapy can help children who experience bowel dysfunction.  Those in attendance learned what pelvic floor physical therapists assess in a pediatric evaluation, including lumbar and hip musculoskeletal screening, scar tissue or diastasis recti assessment, and the components of an external pelvic floor evaluation.  They also learned how the pediatric evaluation differs from the adult evaluation, most noteworthy that the pediatric evaluation is entirely external.  No internal techniques are utilized in either evaluation or treatment of the pediatric patient.  Instead, physical therapists rely on external testing, including surface electromyography (EMG) and biofeedback.  Biofeedback is used to help the child learn how to use their pelvic floor muscles properly, and it facilitates neuromuscular re-education (i.e. creating a stronger mind-body awareness for improved motor control).  Other components of treatment addressed in the presentation included appropriate hip exercises, ILU colon massage, toileting posture education, breathing exercises, and proper diet (both fiber and fluid recommendations).

This speaking engagement inspired me to further research and review my knowledge of pediatric bowel dysfunction.  I am truly grateful for the opportunity and ability to share knowledge with others, especially information about my beloved profession.  On that note, I am happy to discuss bowel, bladder, or sexual dysfunction with any individual or audience that would like to learn more.  If you are aware of a group that would benefit from a similar lecture, please inform me!  It would be my pleasure to share knowledge with you.

Book Review on Conservative Medicine

Jörg Blech, author of Inventing Disease and Pushing Pills: Pharmaceutical Companies and the Medicalisation of Normal Life
Conservative medicine is supported by Jörg Blech is his book, Inventing Disease and Pushing Pills: Pharmaceutical Companies and the Medicalisation of Normal Life (2003).  In fact, I enjoyed the book so much that I have decided to blog about it and share my favorite parts with you.  Hopefully, this will pique your interest and inspire you to read the book in its entirety.  I strongly encourage you to do so, and I look forward to hearing from you about your favorite parts.

Blech, a German science journalist and nonfiction author, studied biology and biochemistry at the University of Cologne (Germany) and the University of Sussex (UK).  Currently, he is a correspondent for Der Spiegel, a German magazine.  Blech is widely known for his critique of the pharmaceutical and medical industries.  In fact, at times, his book may even feel like an expose to the reader.  Blech addresses a variety of issues within the healthcare system, especially the invention of diseases in order for pharmaceutical companies to generate profit.  For instance, natural elements of the aging process are falsely advertised to the public as ailments which must be medically addressed.  He refers to this concept as “medicalisation”, the reframing of previously viewed healthy and normal processes as disorders that must be treated.  In fact, he cites many examples of physicians performing research on behalf of pharmaceutical companies.  These companies routinely hire physicians to perform research supporting the so-called benefits of their medication, medication which the physicians may likely prescribe to their patients.  Obviously, the physicians are aware that the companies are looking for a glowing report and for their medication to be endorsed.  It is undoubtedly extremely difficult for these researchers to remain objective.  This blatant conflict of interest calls into question the ethics, or lack thereof, inherent in such a process.

As a pelvic floor physical therapist, I found Chapter Seven, The Femininity Syndrome, to be of particular interest.  Blech describes how the natural process of menopause is now viewed by many health care providers as a pseudo-diseased phase.  The price tag imposed on insurance companies for these possibly superfluous treatments is astronomical.  In fact, in Germany alone, approximately 500 million Euros are spent on hormone replacement therapies.  According to Blech, “The medicalization of the menopause is an example par excellence of the way certain physicians’ groups and pharmaceutical firms are manipulating the evidence in medical issues.  Nowadays menopausal woman is regarded as a deficient being…Women’s health seems to have vanished, washed away by unrelenting tides of disease- as one ebbs so the next advances.  One is almost inclined to believe that to be of the female sex has become a disease in itself.”  He points out that certain tell-tale menopause symptoms, such as night sweats and hot flashes, are much more frequently reported in Western countries.  In fact, in Japan, these symptoms were only reported by approximately 15% of women older than age 50 in a study led my Margaret Lock (McGill University, Montreal).  In 1960, gynecologist Robert Wilson wrote Feminine Forever, a popular book which encouraged menopausal women to initiate hormone replacement therapy in order that “they may look forward to prolonged well-being and extended youth.” It was only revealed later on that Wilson’s writing was financially supported by the pharmaceutical company Wyeth Ayerst.

There is a time and place for medication, and obviously hormone replacement therapy is more appropriate for some women than others.  I am not shouting from the rooftops that medicine and all surgeries are bad!  I have encountered many women who have been appropriately advised to take medicine and who have benefited tremendously from their usage.  However, I do encourage you to discuss all treatment options with your physician, from conservative to more invasive.  I encourage you to be your own biggest health advocate, and to obtain as much information as possible in order to make educate health related decisions.  An excellent start is by reading Blech’s book.  He has opened the door to a fascinating and important discussion, and I encourage you to join.