Transcript
WEBVTT
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Hi, Tina.
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Hi, Leah.
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So today we're talking with Dr.
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Alex Hill, who on Instagram is known as OncopelvicPT, and we cover a lot, I think, in this interview.
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Yeah, who knew there was so much to talk about, about pelvic health.
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We talked about sexual health and issues around that, sexual dysfunction, urinary issues, like incontinence or retention of urine.
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We talked about kegels and I learned a few things like, I never knew there was something called a reverse kegel.
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I know, no.
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Oh.
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That's news to me.
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And there are times when you can do too many kegels.
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Didn't know that either.
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Or when kegels aren't indicated.
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Mm hmm.
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Yeah, plus a ton more.
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I mean, this is, yeah, this is a plethora of information, I think, that
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A plethora about the pelvis.
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It's a plethora of pelvic information um, that I think so many people will benefit from.
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Yeah, whether it, is cancer related or not, because she also does see people with other conditions.
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we talked a lot about.
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cancer related, cancer treatment related issues, and she also talked about pregnancy and other occasions when this comes up.
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Right.
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Yeah, so follow us wherever you're listening to us right now, and uh, let's start the show.
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I'm Dr.
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Tina Kazer, and as Leah likes to say, I'm the science y one,
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And I'm Dr.
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Leah Sherman, and I'm the Cancer Insider,
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and we're two naturopathic doctors who do integrative cancer care.
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we're not your doctors.
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We're your
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This is for education, entertainment, and informational purposes only.
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Do not apply any of this information without first speaking to your doctor.
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views and opinions expressed on this podcast by the host and the guests are solely their own.
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Welcome to the Cancer Pod.
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Okay.
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So today we have a very special guest, with us today is Dr.
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Alex Hill.
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She earned her doctor of physical therapy at the University of Florida and completed the women's health physical therapy residency at Duke Health.
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Alex is a dual board certified clinical specialist in women's health, and Oncologic Physical Therapy and a LANA, LANA, certified lymphedema therapist.
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I got that right?
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Okay.
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She is presently a physical therapist in Jacksonville, Florida, specializing in pelvic health, oncology, and lymphedema rehabilitation for all genders.
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In addition to her clinical work, Alex has multiple peer reviewed publications, is an active member and leader within the American Physical Therapy Association, has presented at national and international conferences, and is passionate about providing inclusive and empowering education on pelvic health and oncology rehab through her business, Oncopelvic PT.
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Welcome
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Thank you so much.
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I really appreciate you having me on.
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now, you're somebody that I've been wanting us to talk to for a long time.
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So I'm glad that we were able to finally connect.
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Well, I've been wanting to talk to you for a long time, so this is perfect.
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Well, great.
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Okay, let's just turn off the cameras and let's just talk.
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Um, So I, I think 1 of the things, and I was.
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kind of going over beforehand, Tina and I met and I was talking about one of the things I really love about your Instagram page is how inclusive you are.
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you cover so much in the oncology, pelvic, physical therapy realm, but you, you truly do remain inclusive.
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And I just think that is, that, that's, that's so needed.
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Yeah, thank you.
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And that's really one of the, the pillars and missions for me just with everything that I do.
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and especially, you know, I have a board certification in women's health.
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physical therapy, but it's really a misnomer because within that specialization includes men's health and oncology, which is kind of how I got into these two specialty areas.
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and when we look at the research that's available for, You know, lgbtq plus individuals for BIPOC individuals.
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These are areas that are really lacking in the research and then leading to disparities and gaps in care for our patients.
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so for me, it's just so important to, you know, just take that extra step and make sure that the content is as we can get it.
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Yeah, so maybe we should start with, what is your specialty exactly?
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So my specialty is pelvic health and oncology and lymphedema.
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So those are kind of my three specialties.
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Areas'cause within lymphedema, the majority are cancer survivors or people living within beyond cancer.
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But I do work with people who have no history of cancer and have lymphedema or lymphedema related conditions.
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So those are my primary areas within pelvic health.
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It's not just pelvic cancer related.
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I work with people just who are.
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Recently had a baby and now they're dealing with urinary leakage with prolapse where the organs are starting to descend down.
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I work with, people who are having sexual dysfunction with, people who are transgender going through gender affirming care.
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So it's very varied amount of diagnoses that I work with which is why I say again, that kind of women's health is a little bit of a misnomer.
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And I'm in the outpatient setting.
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So, you know, in a clinic where people come to see me, weekly or, twice weekly basis.
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So you were saying that it was women's health that kind of brought you to Oncology as your specialty.
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how, how did that come about?
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Yeah, so um, it's kind of funny.
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I, I.
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I had heard about and knew a little bit about pelvic health and oncology rehab when I started PT school.
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But when I first started, I thought I wanted to get into geriatrics or neuro.
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And so in my first clinical rotation and in our clinical rotations, we work with a a physical therapist and we work with patients directly.
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And my clinical instructor was out for a couple of days.
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And so.
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I wanted to know what the pelvic health therapist did behind the doors all day.
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It was just this kind of you know, Wizard of Oz kind of thing.
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Like, what are they doing behind the doors all day?
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Like, how are they helping people?
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And so I shadowed with them and the therapist that I shadowed with did pelvic health and oncology together.
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So that was, for me, they've always been, there's always been an overlap.
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And so that includes.
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Again, not just pelvic cancers like gynecological or colorectal or prostate cancer, but also breast cancer survivors who have hormone therapy and now they're having pain with intercourse, for example.
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And so that's kind of how I got into those two areas and it was, for me, just so Exciting and incredible to be validating what people are going through, especially during their cancer journey, but also like just how much of an impact you can have on a single session with educating on, just simple things or dietary things like some of the, a lot of things that you guys talk about on this podcast and giving people those tools to be empowered, I thought was just so incredible.
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And so I knew I had to get into these areas.
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hmm.
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And that's one of the things that I love about referring patients to physical therapy in general is that they are given tools to empower themselves.
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And then part of what I think we do is remind our patients, you were given tools, you know, are you doing them because it's not, it doesn't just, and I know this from personal experience, physical therapy doesn't just work if you only do the exercises when you're in physical therapy,
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Yes.
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Works best when you're consistently doing them.
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right?
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Right.
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And I think, you know, from the patients, I know that that Tina and I have seen, it is not talked about the after effects during or after they've received radiation therapy to their pelvis or, sexual issues that come up from cancer treatments across the board, oncologists tend to dismiss, you know, dismiss it like, well, that's, collateral damage.
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You know, that's.
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know, I guess let's, should we start with sexual health?
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I guess, because that really, that we haven't covered that yet.
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We've been waiting to get experts on board.
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But yeah, I mean, sexual health is so overlooked, I think is only now kind of being talked about.
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What kinds of things do you offer your patients who are coming to you with sexual dysfunction, either from the hormonal therapies that they're taking or from things like surgery or radiation?
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Yeah, so I think, I think that's a great question.
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And there was actually a study that showed, you know, 60 percent of cancer survivors have some type of long term sexual dysfunction.
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But only 25%, so only a quarter of them are actually getting help.
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And so that's something that like I always try to tell people is like, one, you're not alone in this, like, you don't have to suffer in silence or think that this is just, you know, you have to live with this.
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But to like talk to your medical provider like you said, like it's becoming more common for medical providers on the oncology team to talk with their patients about it.
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But a lot of them either aren't comfortable, or they don't know who to refer to, or they don't know what type of treatment to recommend.
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So I think that there's a lot of gaps with people getting the help they need, which is why I love addressing this and, talking about this on my platform so much.
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So in terms of physical therapy, it's really going to depend on what, the type of treatment they had, what type of symptoms they have, and then most importantly, what are their goals?
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So if their goal is penetrative vaginal intercourse, for example, that's going to be very different from penetrative anal intercourse or non penetrative intercourse.
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There can still be ways to be intimate with your partner without having penetration.
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And I think just giving people that That knowledge that we can redefine what sex looks like for you is so important, especially if they've had a mastectomy, where now they've lost part of their body that they used to utilize with sexual activity.
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So some of the things that will do so, especially for radiation in the public area, like you mentioned, Leah that's probably 1 of the more common referrals that I get.
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So, if they have pelvic radiation, what that can do long term is basically cause a scarring and fibrosis of those tissues.
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So they can get.
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Firm, they can get hard and what that leads to, especially with Penetrative intercourse is it leads to pain.
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It leads to difficulty with penetration, bleeding, discomfort, dryness, and so we can instruct people on how to use dilators or trainers.
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So these are devices that are either like hard plastic or silicone dilators to help retrain the muscles and to help with decreasing that sensitivity, improving the mobility, especially if there is fibrosis.
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So that's probably the most common thing that I'll get referrals for.
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Um, But also on the flip side, so if somebody has a penis and they are having erectile dysfunction, there are also things that we can help people with with that if they've had radiation or hormone therapy or prostate cancer surgery, something like that.
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So we can instruct on.
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pelvic floor exercises or kegels, which they're commonly called to see if we can help improve blood flow, help improve the erectile tissue teach them different strategies or devices that they can use for that as well.
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And then we were talking about breast cancer survivors or really anybody who has a vagina and is on hormone therapy or they're, they've gone through menopause.
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Those tissues get so dry.
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They get really fragile.
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They don't get as flexible.
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And so we can recommend things like vaginal moisturizers something that's still a topic, but there's more research coming out about it is actually the use of vaginal estrogen for breast cancer survivors and to address pain with intercourse or even recurrent UTIs, which can happen after menopause as well.
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So a lot, I think I've gotten completely off course with what your question was, but really um, pelvic floor exercises, different strategies, tools, devices um, and the dilator training are probably the The primary things that we'll do as well as different exercises like stretches, mobility, especially for the hip muscles, if they have had radiation, the hips are really tight, that can be helpful too.
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Yeah, for anyone who is a medical provider out there who's listening to this and you're seeing patients who have had cancer or treatment for cancer asking is important.
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You know, asking about their sexual health, asking about their pelvic health, and in a review of systems kind of way.
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Because I think that it's hard for patients to overcome this, the cultural or social hurdles of bringing it up themselves.
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But if, asked, they probably will be honest.
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So I think I just want to urge everyone to like put that on their to do list because we are taught to ask about certain things in every appointment.
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Maybe this should be on the list.
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Yes.
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Open the door to talk about sex and that
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Mm hmm.
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Mm hmm.
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Mm hmm.
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as, as a cancer survivor myself, when I would follow up at the cancer center, I was given like a, an iPad with you know, Do you have these?
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You know, symptoms going on and there was always a question about sexual health and I would answer it and It wasn't usually addressed even though there was Whatever it was that I wrote, you know there there is this kind of uncomfortable thing or if it was discussed it was kind of in a use it or you or lose it kind of way and You know, and so I am glad that there are more people like yourself who are talking about it.
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there are doctors who are talking about you know, urologists are talking about the use of, hormone therapies.
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You're super open about talking about dilators and I know your Amazon store, you have this whole Collection of, you know, of options for people, all of them, you know?
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And so um, yeah, we definitely need more people like you out there.
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Um, Because you, yeah, there, there's no, you know, you're, you're talking about these things that are so in some mindset, you know, taboo, to discuss and you're talking about it the way that it should be talked about, you know?
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You know, like you're, you're, you're, you're talking to your, you're, you're talking to your bestie and you're just, I don't know.
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I, I love your posts.
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That's I always tend to fan fan girl, but it's, it's true.
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I learned so
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But this is, but this is what we should be doing.
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exactly.
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And I and I feel like your posts have made me more comfortable bringing things up with patients as well.
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Cause I know that I'm also, you know.
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Depending on, where my patients are from or what their backgrounds are, you know, it is kind of awkward to kind of bring these things up, but once you get people talking, they start talking.
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Yep, if they're being referred to me for something that's not sexual health related, One, again, like, you said, Tina, like, it's in my systems review of sexual health.
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But I always also ask them, is it okay that we talk about your sexual health?
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This can be a common concern among people who have gone through, you know, XYZ treatment.
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do you want to talk about it?
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So I, I ask them, I open that door, but I also give them permission to be asking about it.
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Because if they're coming to see me for, you know, You know, shoulder pain or neck pain from their head and neck cancer.
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I'm like, Hey, but also how's your sex life?
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Like, they're going to be like, what the hell?
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Like, where is this coming from?
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You know, but if we approach it in a way and asking patients, is it okay that we talk about it?
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It's so much less like in your face.
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Let's talk about sex.
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Right?
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So I think that's really important as providers for anybody that's listening is like how you bring it up is going to be really important, but I think we can also say that for the patient.
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I feel like the amount of advocacy that people need to do on their behalf in their health care.
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And I heard that sigh, Tina, right?
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and especially like.
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during their cancer journey, it shouldn't be a battle to feel heard in health care so I give people tips on, okay, how to, how should you bring this up?
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So, like, if you fill out that distress thermometer, that iPad questionnaire, take a picture with your phone, so that you have it in front of you with your doctor, your medical provider, so you can say, Hey, you know, we didn't talk about this.
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I actually marked this.
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Can we talk about it?
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Or come to your appointments.
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With that list of questions or concerns, especially if it's something you're not comfortable talking.
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about, like sex, or maybe you're having leakage and you're peeing your pants, right.
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It could be anything.
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But if you come to the appointment with that list in hand, that helps to kind of prompt you and give you a little bit more of a template than, 15 minutes.
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All right.
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No evidence of disease.
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You're good.
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Move on.
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I'll see you in six months kind of thing.
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if you come with that, that can be so helpful to start that conversation?
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Specializing, just quickly, it just reminded me of a question.
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I know you're doctorate in physical therapy.
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Is there a certain initials behind the designation that people should look for, for oncology specialized or pelvic floor specialty or what would guide people to someone like you?
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The good thing is there are more of us that are treating both pelvic health and oncology.
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Um, It's still hard to find somebody.
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For the board certification, that would be a W.
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C.
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S.
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So women's health clinical specialist.
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However, our professional organization I think maybe four or five years ago actually did away technically with our designations.
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To make it not as confusing for people to understand what are all the alphabet letters soup after our name.
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So that can make it a little bit tricky.
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But WCS is going to be kind of the top line like board certification.
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PRPC is another certification that, Is showing a very advanced proficiency in pelvic health for oncology, because this is a newer specialty and specialization.
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We did not get any letters because this was started after they did away with the designations.
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Okay.
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so again, that's a little bit, it's a little bit tricky.
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I would say more pelvic health therapists crossover into oncology.
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Then oncology therapists crossover into pelvic health just because of pelvic health.
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We see again like prostate cancer.
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We see the colorectal, right?
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So there's a little bit more overlap.
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So B.
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More likely to have success finding finding a pelvic health therapist that does oncology.
00:18:35.997 --> 00:18:38.681
There are a couple of websites, that I can give out.
00:18:38.681 --> 00:18:45.361
And if you want to put them in the show notes, but there's a couple of different places that, I always go to, to try to find somebody and you can actually look by zip code.
00:18:45.361 --> 00:18:49.060
You can look by specialty specialization, like, that kind of thing.
00:18:49.278 --> 00:18:50.567
so that can be really helpful too.
00:18:50.955 --> 00:18:51.286
Okay.
00:18:51.306 --> 00:18:59.644
We'll put that in our show notes for sure so that the listeners can, find, when, when we introduce ideas or solutions to a problem, I like to, you know, give them the last bit of
00:18:59.884 --> 00:19:00.345
How to do it.
00:19:01.555 --> 00:19:02.085
Yeah.
00:19:03.051 --> 00:19:05.276
Yeah, especially because not every cancer center is like that.
00:19:05.606 --> 00:19:09.586
Or, you know, community hospital may not have these resources.
00:19:09.616 --> 00:19:19.750
And so being able to give patients a way to find someone themselves so they can get their doctor to make a referral if that's needed wherever, you know, they're living, that'd be great.
00:19:21.257 --> 00:19:22.287
Let's take a quick break.
00:19:22.656 --> 00:19:26.037
And when we come back, we will continue our conversation with Dr.
00:19:26.037 --> 00:19:26.707
Alex Hill.
00:19:28.083 --> 00:19:28.573
All right.
00:19:28.673 --> 00:19:30.843
I have one question.
00:19:30.873 --> 00:19:34.923
You had a post that had to do with four reasons you're not emptying your bladder.
00:19:35.242 --> 00:19:36.573
Can you go over that for us?
00:19:36.919 --> 00:19:37.999
Yes, absolutely.
00:19:38.298 --> 00:19:44.429
So first I want to preface this with it is totally normal to not completely empty your bladder.
00:19:45.138 --> 00:19:46.259
So I'm gonna start with that.
