Megan Pribyl, PT, CMPT is a practicing physical therapist at the Olathe Medical Center in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic rehabilitation. Megan’s longstanding passion for both nutritional sciences and manual therapy has culminated in the creation of her remote course, Nutrition Perspectives for the Pelvic Rehab Therapist, designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to continually update this course with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation.

It has been nearly 8 years since I taught my first in-person rendition of “Nutrition Perspectives for the Pelvic Rehab Therapist” in Seattle, WA through Herman & Wallace – and over a decade since I began writing the course in earnest.  Creating and teaching this course has been an honor for me and truly a full-circle opportunity to share my passion for nutrition with other clinicians.  The mission of the course is to create a ripple effect from one person to the next. But if there’s anything the last couple of years has taught me, it’s that we still have a long way to travel to reach the destination of fully integrated care centered on the whole person.  As a guide, I tap the growing body of literature on nutrition and health to help show us the way.

I recall having taught this course on 11 occasions in-person between June 2015 and October 2019 at gracious site host clinics nationwide.  I enjoyed each and every one of these experiences.  Since the 2020 pivot to remote format, I have taught Nutrition Perspectives via Zoom 18 times - after we were faced with restrictions on traveling and gathering.

Having taught Nutrition Perspectives in both formats, I’d like to share with you first why I love teaching this course, and second why I love teaching it in its remote format.  It truly is a class perfectly suited to this mode of delivery.

First, why I love teaching this course:

It is my passion to share nutrition information with peers in pelvic rehab.  Before becoming a PT, I studied nutrition as an undergrad.  After becoming a PT, and more specifically a pelvic PT, it became crystal clear that we needed to incorporate the essence of nutritional sciences into pelvic rehab– and even into general clinical practice.  Nutrition Perspectives became my answer to the burning and urgent questions I had about how we could blend the worlds of rehabilitation and nutrition.  I scoured the literature to find answers – and what I found was astonishing.  Paradigm shifting.  Compelling.

Early in my career, I would only sporadically encounter patients who would experience what I would now describe as “functional gastro-intestinal disorders with extra-intestinal manifestations”.  Fast-forwarding to today, it is rare to see a patient who does not experience any conditions such as GERD, constipation, gas/abdominal pain/bloating/discomfort, anxiety, depression, and complex or chronic pain conditions.  Because of this reality, it has become essential for healthcare providers to have a basic working knowledge of functional nutrition.  Especially providers in pelvic rehabilitation.  Having a working knowledge of these conditions and potential nutritional underpinnings can help us better understand and serve our clients.

Not only does nutrition have significant relevance to our patients – it is relevant to each of us as human beings!   But be aware – the realm of nutrition appears chock-full of confusing contradictions.  And our patients are now – more than ever – asking us for our thoughts on nutrition-related topics.  They’re listening to podcasts.  They’re reading social media posts and blogs.  They’re watching short video clips to find quick answers to complex questions.  And they want to run some of their questions by you – their trusted health professional ally.   You want to feel confident and competent in what you’re sharing.  My mission is to make evidence-informed information accessible and relevant to you, the practicing clinician so then you can, in turn, share with confidence and competence.

Now, on to why I love teaching this course remotely:

Don’t get me wrong – I love to travel.  But imagine traveling alone to new cities -not as a free-spirited adventure solo traveler – but instead as an idealistic instructor who doesn’t want to be without any supplies needed for teaching a course far from home!  This translates to a very heavy suitcase filled with visual aids and lab supplies. This humongous check-in bag contains items necessary to conduct the course descriptively – books, empty product containers, glass jars (yes, GLASS), carefully packaged kefir grains, a SCOBY, bowls, spoons, kitchen towels, and those hard-to-find food items that one can’t be certain to find in an unfamiliar city.  And a tablecloth.  Because when we’re talking about food with guests, presentation is important!

Now imagine navigating travel challenges with said heavy, giant suitcase; chucking it on and off a rental car bus during a cold rainstorm for example..  Imagine pushing it down a carpeted hotel hallway that is so plush, it prohibits the wheels from functioning properly.  Imagine repacking in 15 minutes what took 3 hours to initially pack in order to catch a return flight home. 

This was the reality of logistics I eagerly and enthusiastically took on to be able to teach this class.  But that giant suitcase couldn’t hold even close to everything I wanted to share, and it actually was a bit cumbersome to manage.  Maybe a lot cumbersome.  Always plastered with the bright orange “HEAVY” sticker warning – there was a limit to what I could bring along to live course events.

When we first transitioned this course to remote format, it was a quick response to begin offering CEUs when lockdown mode began.  The silver lining, we discovered, was that the remote format for this course was in fact – much better than the live event format. 

Now, all the necessary supplies are right where I need them to best instruct.  Plus, predictable kitchen and lecture spaces create a seamless experience for the participants.  Teaching from home has been life-changing as an instructor.  I can practice what I preach about nourishing the nervous system and mitigating stress with lifestyle choices.  It is nourishing to be able to sleep well at home the nights before I teach.  Adequate rest is a superpower that allows me to give my best well-rested self to the participants.

The remote format is not just nourishing to me, but also to the participants who can attend from the comfort of home or familiarity of a clinic.  Wherever you are, you can take the course.  No airports, no suitcases, nor carpeted hotel hallways.  That’s accessibility.  That’s getting this information into the hands and minds of providers in locations all around this country and beyond.  We need this accessibility if we ever hope to reach our destination of fully integrative care of the whole person – for all.

For these reasons, Nutrition Perspectives for the Pelvic Rehab Therapist will remain in this remote format – even as our lives begin to involve travel and in-person events again.  All good things.  But I do hope you enjoy taking Nutrition Perspectives as much as I enjoy teaching it.  I invite you to join me on the journey toward implementing more integrative care as standard practice.  It’s not always an easy road, nor the popular road.   And sometimes it feels as hard as dragging a giant, heavy suitcase behind you.  But it’s a path worth taking – one that will be fruitful for both you and the clients you serve.  Let’s travel it together.

Nutrition Perspectives for the Pelvic Rehab Therapist will be offered quarterly in 2023:  January 21-22, June 10-11, September 16-17, and December 2-3. 

Nutrition Perspectives for the Pelvic Rehab Therapist

Course Dates:
January 21-22, June 10-11, September 16-17, and December 2-3

Price: $525
Experience Level: Beginner
Contact Hours: 17.75

Description: Participants will be introduced to the latest research in nutrition through immersive lectures and hands-on labs.  The course will cover essential digestion concepts, nourishment strategies, and the interconnected nature of physical and emotional health across the lifespan. Further, clinicians will delve into nutritional relevancies in bowel and bladder dysfunction, pelvic health, pain, and healing.  Labs throughout include insightful demonstrations and breakout sessions. The course participant will acquire new, readily applicable tools for patient empowerment, engagement, and self-management utilizing presented principles.

As 2022 has gotten underway, it has already brought many of us to a place where we simply need to hear something lighthearted. The start of a new year also gives us a chance to examine priorities and make room for what matters most. “What matters most” can look different for each of us; for me, it’s my family – including two dogs – Stella and Sadie. Of course, the dogs fall in line behind my human nuclear and extended families, however, they are such a part of my daily life and contribute to my quality of life, it seems only natural to share this story with a wider audience -especially because this story revolves around one of my favorite topics – intentional nourishment!

Let me begin by telling you about our 5-year-old Golden Retriever named Stella. She came to us as one of only three puppies in a litter; a pleasantly plump pup, she was well developed, well-fed, and well-loved. According to everyone who has had the opportunity to meet her, she is the happiest dog they’ve ever met. When we brought her home at eight weeks, she topped the scale at 21 lbs. 

Stella's fur was shiny, her disposition sunny; she emanated maturity and wisdom. She slept through the night with such efficiency, we hardly remember having to let her out at night as a puppy. She was content; the perfect combination of calm and energetic. She was a breeze to housetrain, has an impeccable record of only two accidents in the house, and nary an indoor fecal incontinence episode. Stella brought us so much joy that we decided on a whim to add a second puppy to the milieu.

The second puppy is our ~16-week-old Golden Retriever puppy named Sadie. This past October – by coincidence – my family learned about some surprise Goldens needing homes – 17 to be exact – and we wondered if we might be interested in one. Two weeks later, sweet Sadie came home with us. 

Weighing in at only 13 lbs 6 oz at eight weeks, she was miniature compared to Stella at the same age. It didn’t take us long to figure out that not only was she smaller, but her digestive tract and elimination systems were not like Stella’s either. Sadie pooped often - what seemed like every hour – including sometimes in the house. Her bottom was sore and irritated, and she seemed frustrated and uncomfortable. My husband and I looked at each other more than once thinking the same thought: WHAT did we get ourselves into?!?

Sadie tested negative for parasites, and the vet said she was just working on adjusting to her new home and to give it time. He also suggested we might be feeding her too much. So, we fed her less - but that didn’t help. We tried adding pumpkin, that didn’t help either. Then we upped her food amount again, tried timing her foods differently, tried feeding her more often, then less often. None of these approaches helped. The messes continued. 

We began to feel exasperated. I was reluctant to try adding new foods for fear of upsetting her GI tract further. 

This puppy was pooping nonstop – much of it type 6 & 7 applying the Bristol Scale to dogs (1). She barely came in at 16 lbs. week 10 and alarmingly, she still weighed 16 lbs. at week 12. The vet confirmed our concerns – she was too thin and needed to put on weight.  

Now I started to worry. With all the bowel troubles she had, how could she thrive? We weren’t getting any continuous hours of sleep at night which meant she wasn’t either. It was an exhausting few weeks. 

Given what we had tried – with no success – we had no choice but to begin what we called “Operation Nourishment” for this little puppy. We put worries aside about adding new foods and applied what we understand about functional nutrition to help our sweet Sadie.

“Operation Nourishment” consisted of following several basic digestive principles:

1. Make her food more digestible
2. Feed her nutrient-dense options (dog appropriate, of course)
3. Practice puppy-version mindfulness at mealtime
4. Help support her puppy microbiome

#1: Make her food more digestible: Without changing the kibble she was eating, we soaked it with a bit of water before ingestion to soften it. This helped make her food easier to break down in her digestive tract and also helped S L O W D O W N her tendency to inhale food. Prior, she was definitely not chewing her food thoroughly which can result in undigested food reaching the colon and causing irritation. The softened food facilitated just the slightest bit of chewing and tripled the time it took her to finish a meal, giving her GI tract less of a shock.

#2: Feed her nutrient-dense options: We began adding an organic egg (3,4) softly cooked in a tiny bit of coconut oil (2) to her breakfast. The egg adds a whole food-based protein-containing cholesterol, vitamins, and minerals -all important for building her gut lining and nervous system. Coming from such a large litter in a somewhat stressful/chaotic environment, her gut and nervous system may not have been at their healthiest and needed extra support (4).

#3: Practice mindfulness at mealtime: The egg at breakfast has quickly become the highlight of her day.

The anticipation while watching us cook it calms her. She intently follows as the pan comes out of the cupboard and onto the stove. She watches more intently as we slowly cook the egg. Then she must wait even longer while it sits in her bowl to cool up on the countertop. 

I presume this has taught her mindfulness and presence before eating – essential for thorough digestion!

#4: Help support her puppy microbiome: We gradually began to add a dollop of kefir (5) to her breakfast and dinner – knowing that even dogs have a microbiome and that cultured foods can help normalize gut flora which can help normalize stool consistency. A healthy gut helps us extract nutrients from the food we eat. It can also, fascinatingly, modulate our stress responses.

“Operation Nourishment” began to take effect almost immediately. She jumped from 16 to 24 lbs. in 3 weeks! We were so proud! She finally began to have a soft, healthy belly - and the vet was thrilled, “whatever you’re doing, keep it up!”. She began to sleep through the night – and WE were thrilled. She also began to sprout her golden retriever fur patterns and take on more shine. Brilliantly, her stools became formed – a perfect 4 on the Bristol Stool Scale (1) and had significantly less urgency which led to the elimination of accidents. We were shocked at how quickly her body adapted to a diet higher in nutrient density and digestibility– one that was safe and appropriate for puppies.

Upping her nutrient density and digestibility helped unlock her potential so she could become the best sweet version of herself. Once more deeply nourished, she happily settled into her calm, gentle nature. She and Stella have become quite the pair. And we – her humans - are finally, gratefully sleeping again (most nights), which makes us adore her even more.

How might A Tale of Two Goldens provide us with insight relevant to pelvic rehabilitation?

We acknowledge that no two people come into this world in exactly the same circumstance and that we each arrive with a certain level of built-in resiliency. Some of us come into this world with our tails wagging, ready to greet everything that comes our way. Many of us and those we serve– let’s face it –are figuratively more like Sadie. We have the potential waiting inside of us to become the best version of ourselves.  

Sometimes reaching that potential takes just a little tweaking, a little coaxing, a little know-how. Maybe that tweaking, coaxing, and know-how could include principles of “Operation Nourishment” for ourselves and those we serve in the form of nourishment-focused guidance. With a little patience, time, and intentional action, we may be surprised to see how a few small changes have an enormous impact on what matters most to each of us and those we serve. 

Nourishment knowledge – now more than ever – is vital. 

Join us in 2022 for Nutrition Perspectives for the Pelvic Rehab Therapist to learn more about these principles and beyond. Upcoming 2022 remote offerings include Feb 26-27, April 29-30, July 23-24, August 27-28, Sept 23-24, Oct 22-23, and Nov 11-12. We welcome you to join us.

References:

1. https://www.bladderandbowel.org/wp-content/uploads/2017/05/BBC002_Bristol-Stool-Chart-Jan-2016.pdf  Accessed January 11, 2022.

2. Alves DVS, Sousa MSB, Tavares MGB, Batista-de-Oliveira Hornsby M, Amancio-Dos-Santos A . Coconut oil supplementation during development reduces brain excitability in adult rats nourished and overnourished in lactation. Food Funct. 2021 Apr 7;12(7):3096-3103. doi: 10.1039/d1fo00086a. Epub 2021 Mar 15. PMID: 33720258.

3. Avirineni BS, Singh A, Zapata RC, Phillips CD, Chelikani PK. Dietary whey and egg proteins interact with inulin fiber to modulate energy balance and gut microbiota in obese rats. J Nutr Biochem. 2022 Jan;99:108860. doi: 10.1016/j.jnutbio.2021.108860. Epub 2021 Sep 11. PMID: 34520853.

4. Choi, M., Lee, J. H., Lee, Y. J., Paik, H. D., & Park, E. (2022). Egg Yolk Protein Water Extracts Modulate the Immune Response in BALB/c Mice with Immune Dysfunction Caused by Forced Swimming. Foods, 11(1). doi:10.3390/foods11010121

5. Vieira CP, Rosario AILS, Lelis CA, Rekowsky BSS, Carvalho APA, Rosário DKA, Elias TA, Costa MP, Foguel D, Conte-Junior CA. Bioactive Compounds from Kefir and Their Potential Benefits on Health: A Systematic Review and Meta-Analysis. Oxid Med Cell Longev. 2021 Oct 27;2021:9081738. doi: 10.1155/2021/9081738. PMID: 34745425; PMCID: PMC8566050.