Erin Matlock, who struggles with ulcerative colitis, one day opened her Delzicol capsule to find her pervious medication inside.

The Bulletin, a newspaper in Central Oregon, published a piece about Matlock?s change in medication titled, ?Blocking generics.?? This piece examines the financial benefits pharmaceutical companies gain from patenting new prescriptions just before they face competition from generic manufacturers: ?With no new clinical trials, the company secured an expedited review from the FDA and got Delzicol approved six months before Asacol was due to go off-patent. ?By pulling Asacol from the market, they could get doctors to begin writing prescriptions for Delzicol and patients established on it well before a generic Asacol arrived.?

For years, Matlock took Asacol to help treat her condition.? Until it stopped being manufactured.? Her doctor told her about a new prescription from the same manufacturer called Delzicol.? Now she has the choice between taking twelve Delzicol pills (which she finds more difficult to digest) a day and spending $25 a month or taking four Apriso pills (another mesalamine-based medicine) a day while paying $125 dollars a month.

Matlock?s struggles are not uncommon.? Many patients who suffer from ulcerative colitis require medication, and even surgery, to treat their symptoms.

Although there is no known cure, correctly applied therapy has been known to markedly reduce symptoms and even lead to long-term remission.

Herman & Wallace offered their first on Bowel Pathology and Function in Stony Brook, NY last April and is in the midst of confirming dates for another course in 2014.? Keep a look out for updates!

This November, Herman & Wallace is excited to bring a new course, Manual Lymphatic Drainage for Pelvic Pain, to Houston, TX!  This course will be taught by Debora Hickman, DPT, WCS.

Pelvic Rehab Report sat down with Debbie to learn more about her upcoming course.

What can you tell us about this continuing education course that is not mentioned in the course description and objectives that are posted on-line?

This course is a must for physical therapists performing women’s health physical therapy.  I have found there is a need to reduce inflammation in pelvic pain patients either prior to beginning intravaginal treatment or following intravaginal treatment. In both cases, inflammation is prevalent.  Patients who are in an acute state of pain will be more tolerant of intravaginal treatment and those who flair up following treatment will have less discomfort and inflammation.

What inspired you to create this course?

I developed treatment protocols for a variety of diagnoses in women’s health that included MLD for patients with pelvic pain and inflammation.  A physical therapy expert on pelvic pain,who is a colleague of mine from Herman and Wallace, intimated other therapists attending her courses expressed an interest in learning techniques to treat inflammation in pelvic pain patients.  Her high regard for Herman and Wallace and the apparent need for a course motivated me to develop this program.

What resources and research were used when writing this course?

During my Klose Lymphedema Training Course, I learned the benefits of MLD included decreasing inflammation and pain.  Additionally, as I researched treatment for pelvic pain, I frequently observed that the primary treatment goals were to decrease pain and inflammation.  With my extensive knowledge of the lymphatic system combined with the current research on pelvic pain, I connected the idea that to improve the patient out come and decrease the duration of physical therapy treatment, manual lymphatic drainage needs to be apart of the treatment protocol.

Can you describe clinical/treatment approach/techniques covered in this continuing education course?

The clinical treatment approach, following a comprehensive women’s health physical therapy evaluation, includes how to decrease pain and inflammation.  You will be able to apply MLD for the pelvis and genitals to your current treatment protocol for your pelvic pain patients.  The seminar will cover emptying lymph node groups to receive additional lymph, making path ways to transport lymphatic fluid, and transporting lymph fluid from the pelvis, genitals and thighs to the terminus. When you have completed this course, you will have a general understanding of the lymphatic system, know when to use manual lymph drainage, and demonstrate how  to perform manual lymph drainage for the pelvis and genitals.

Why should a therapist take this course? How can these skill sets benefit his/her practice?

You will want to take this course to improve quality care and decrease pain and inflammation in your pelvic pain patients.  It is effective and gentle to use as a stand  alone treatment if needed due to patients in ability to tolerate more aggressive therapy.  Following this course you will be able to return to your clinic and begin   using MLD on your pelvic pain patients.

This course is a must for clinicians who wish to expand their knowledge of treating pelvic pain.  Seats are limited – register today!

The JAMA Internal Medicine recently published a study that illustrated how physicians are suggesting physical therapy and over-the-counter medicine less and less frequently. According to PT in Motion, the JAMA study illustrates that, ?[d]espite published guidelines that call for physical therapy or medications such as ibuprofen or acetaminophen for first-line management of most back pain, other treatments such as imaging, narcotics, and referrals to other physicians have increased.?

The study also concluded that ?Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy.?

This report appeared on the JAMA website yesterday.? The study, identifying ?23,918 visits for spine problems,? demonstrated that both treatment with narcotics and physician referrals have grown drastically since 1999, while ?[n]onsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9% to 24.5%?. During this time, the percent of therapist referrals has remained roughly the same.

Herman & Wallace instructor, Ginger Garner, articulated the problem clearly in her blog: ?What was startling about the study was that while narcotic prescription, referrals for diagnostic tests, and other physician referrals all increased, patient quality of care and back pain outcomes decreased.?? Sometimes PTs are better suited to treat patients than physicians.

The study concluded that, ?[b]ecause more than 10% of visits to primary care physicians relate to back and neck pain, and the treatments recommended by guidelines generally are less costly than those being used increasingly, the financial implications in the health care market are significant.?

Patients now have direct access to PT in all 50 states, but it is important to get the word out to patients and referring physicians that PT is supported as the standard of clinical care for typical low back pain management.

Yesterday, star athlete and Seahawks wide receiver, Percy Harvin, suffered a hip labrum tear.? His injury may require surgery, as one of his physicians has suggested.

The labrum is vital in such basic functions shock absorption and joint lubrication.? As described on the Mayo Clinic?s website, ?The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place.?? It?s easy to see why hip labrum tears are not uncommon among athletes.

Percy Harvin received a $67 million dollar contract when he was traded to Seattle from the Minnesota Vikings last spring.? His career has been hampered by injuries.? Frequently missing games because of migraine headaches, Harvin missed most of last season with an ankle injury.

Of course, you don?t have to be a star football player to suffer from labral tears, and acetabular labral tears are reported to be a major cause of hip dysfunction in young patients and a primary precursor to hip osteoarthritis. Herman & Wallace offers a course on Extra-Articular Pelvic and Hip Labrum Injuries.? The next course-event will be offered next year? Stay tuned for our 2014 schedule!

Inflammatory bowel disease (IBD) is an idiopathic disease estimated to affect 1.4 million people in the United States. The two main types of IBD are Chrohn's disease and ulcerative colitis (UC). Chronic inflammation occurs in all or part of the digestive tract. Symptoms related to chronic bowel inflammation include diarrhea, rectal bleeding, bowel urgency, abdominal pain, constipation and incomplete emptying of the bowels. Constitutional symptoms such as fever, weight loss, fatigue, night sweats, and changes in menstrual cycle can also be reported. To read more about the symptoms, treatment, and research updates about IBD, the Crohn's and Colitis Foundation of America (CCFA) is an excellent resource. The CCFA has a variety of events aimed towards support, education, and fundraising, and you can look for events in your part of the world by going to this page on their website.

Other resources for increasing your own knowledge and awareness and for patient education purposes are listed below.

• IBD Fact Sheet from womenshealth.gov that can be printed and shared.
• Mayo Clinic pages with information on diagnosis, treatment and management.
• Terrific collection of IBD endoscopic images from Atlanta South Gastroenterology.
• American Gastroenterological Association IBD pages.
• Patient brochures from the American Society of Colon and Rectal Surgeons
• Information for parents, kids and teens about bowel disease at kids health.org
• American Academy of Pediatrics information about bowel disorders.

These conditions are different from Irritable Bowel Syndrome primarily due to the inflammation that occurs. While the etiology of IBD is still unclear, what is known is that the body's immune system response is abnormal. The condition is more common in patients who are caucasian, and there is also a familial link. Structural abnormalities including inflammation, lesions, ulcers or tearing are common. While Crohn's can affect any part of the gastrointestinal tract, ulcerative colitis affects the lining of the colon. If a patient of any age presents with symptoms of bowel dysfunction, a worsening of or lack of improvement of bowel complaints, he or she should be referred to an appropriate medical provider to rule out inflammatory conditions of the bowel. In children, IBD can affect growth and development, so the sooner the condition is managed, the better for overall health. The presentation of IBD can be cyclical, with flare-ups that occur, and while pelvic rehabilitation providers are a valuable part of the team treating the symptoms and functional bowel dysfunction related to IBD, we also must be astute in recognizing when a patient requires the evaluation of a medical provider.

Herman & Wallace is excited to announce that Institute founder and instructor Hollis Herman, PT, DPT MS, OCS, WCS, BCB-PMD will be going to Chile this September to teach a comprehensive educational seminar on pelvic floor dysfunction!

This four-day seminar will cover everything from basic terminology to advanced treatment. Much of the seminar will focus on topics taught in our popular Pelvic Floor Series as well as our Pregnancy and Postpartum Courses.

For Holly, this is her second time visiting Chile to speak this year. In April, she presented on women?s health topics to students at Universidad del Desarrollo in Santiago.

Holly is a physical therapists with more than 35 years of experience.? She owns her own practice, Healthy Women Healthy Men, in Cambridge, MA.? On top of that, Holly is an internationally renowned lecturer and speaker on physical therapy for women and men, co-author of ?How to Raise Children without Breaking Your Back,? as well as a contributor to numerous chapters and peer-reviewed articles on sexual medicine, geriatric foot care, pelvic pain, urinary and fecal continence and pregnancy and postpartum evaluation and treatment.

The September trip will be the first of two journeys to Chile to teach pelvic rehabilitation. Holly will return to Chile in 2014 to present a follow-up course to the same group.

This October, Herman & Wallace is excited to bring a new course, Rehabilitation for Breast Cancer Patients, to White Plains, NY!  This course will be taught by Susannah Haarmann, PT, CLT, WCS and Christine Cabelka, MPT, CLT, WCS.

Pelvic Rehab Report sat down with Susannah and Christine to ask them a bit about the course.

What can you tell us about this continuing education course that is not mentioned in the course description and objectives that are posted on-line?

Susannah: I would say that even though this course is entitled, “Rehabilitation for the Breast Cancer Patient,” much of the knowledge and skills learned in this course will transfer to other oncology populations. For example, we address fatigue, neuropathy, cardiomyopathy and osteoporosis, which are side effects many oncology patients report. I believe the demand for rehabilitation oncology programs will rise in the future. Clinicians attending this course have so much to bring to the table in terms of their current knowledge and skill-sets. It is my hope that blending the information and treatment approaches in this course with other specialty knowledge will bring about great inspiration and a whole host of creative treatment ideas!

Christine: We’re so excited to be teaching this course.  We’re hoping to take the participants on the journey that the patients go through.  Throughout the course the participant will be provided with multiple examples of what they may see in the clinic so they can begin building that image of a patient in their heads.  They’ll be provided with the insight and reflection from real patients regarding their journey through breast cancer diagnosis, treatment, and recovery.

What inspired you to create this course?

C: Working with cancer patients inspired me to co-create this course.  Seeing the lack of comfort from my colleagues working with the cancer population I wanted to create something that would provide any practitioner the knowledge and confidence to work with cancer patients, even if they don’t have training in lymphedema management.  Not all patients will have access to therapists with advanced training in the oncology population, so being able to provide a high-quality course designed to train more practitioners will hopefully provide patients with better access to care.

S: When breast cancer patients and health care practitioners become aware of the potential of oncologic rehabilitation and the positive impact we can make, the current lack of services in this area is often seen as a travesty. Skilled rehabilitation providers are rare, and in-depth education addressing medical intervention and lab-based treatment approaches is difficult to find.  As a result, many preventable side effects are not being addressed, referrals are not being made, and many patients are missing out on receiving these beneficial services.

My initial inspiration for creating this course came while working as a resident at Duke University and Medical Center. As a therapist at an educational institution, we received referrals from states away. Many times our patients were commuting hours to consult our rehab services or living locally on a short-term basis for treatment. Our team would make every attempt to find therapists in the patient’s area who were skilled in oncologic care and lymphedema treatment, but often times our searches were futile. In addition to being a rare commodity, often times I found confusion among therapists regarding medical interventions or standardized treatment approaches. I was inspired to create the course in order to ‘connect-the-dots’ for rehab professionals passionate about oncology care.

However, I feel my greatest inspiration for creating this course will come while teaching it; I can make a splash by treating one patient at a time, but educating practitioners who can then go out into the world and treat, we can really make waves!

What resources and research were used when writing this course?

S: Oh my goodness, the time performing literature reviews and collaborating with expert health care practitioners in the area of breast oncology was immense! With that said, I still feel like we only scratched the surface and I am very dedicated to the evolution of this course as new findings and materials are born! Specifically, the American Cancer Society’s journal ‘Cancer’ published a special issue entitled, “A Prospective Surveillance Model for Rehabilitation for Women with Breast Cancer;” the article reviews and expert opinions in these synopses were a great starting point. As a certified lymphedema therapist through the Norton School of Lymphedema, I definitely found myself delving into former course materials. Some of the best leads and most rewarding learning opportunities, however, came from collaborating with other practitioners within the field, such as nurse practitioners in plastic surgery, breast cancer nurse navigators, nutritionists, Pilate’s instructors, etc.   Rehabilitation for the breast cancer patient truly is an integrative approach and we have a lot to learn from each other!

C: Numerous research articles were reviewed and cited.  Issues and supplements of the Cancer journal are presented.  We also were able to gain permission to use material from public cancer sources such as the American Cancer Society, National Institute of Health, National Lymphedema Network, and Chemocare.com.

Can you describe clinical/treatment approach/techniques covered in this continuing education course?

C: We’ll be covering a mix of everything from evaluation to treatment techniques.  Based on the side effect of treatment being discussed we’ll be providing and/or reviewing techniques for evaluation of sensation, balance, and screening for lymphedema.  We’ll also be providing instruction on manual techniques for treatment of axillary webbing.  Specific intervention ideas for each treatment side effect will be covered.

S: Treatment techniques for this course run the gamut from exercise prescription for core strengthening status post breast cancer reconstruction to hands-on manual therapy for lymphatic cording. Although treatment approaches are impairment-based, this course supports the Prospective Surveillance Model which aims at preventative styles of treatment as well.

Why should a therapist take this course? How can these skill sets benefit his/her practice?

S: I have many answers to this question, but I will choose my top 3:

1. YOUR SERVICES ARE NEEDED!

A therapist should take this course because breast cancer is the most commonly diagnosed cancer among women, rehabilitation for the oncology patient is underutilized, and I guarantee there are cancer patients in your area that would greatly benefit from your services.

2. CHANGE LIVES!

I think that many therapists shy away from working with the oncology population because it may be considered depressing. However, the work can be incredibly rewarding and that is why this is one of my favorite populations! It is so evident to me on a daily basis how much my abilities as a therapist impact my breast cancer patients’ lives and often in a very short period of time. Frequently my oncology patients say therapy is their favorite form of treatment and that makes me smile!

3. GENERATE REFERRAL SOURCES!!!

A therapist who successfully completes this course, and makes a good relationship with an oncologist in their area, may create the potential for a greater number of referral sources to their clinic, thereby adding value and demand to their practice.

C: Therapists should take this course to build on their existing skills and give themselves the confidence to work with this patient population.  We’re hoping to provide the tools needed for a therapist to recognize the need for early lymphedema intervention.  Also to provide the skills to be able to work with breast cancer patients at any stage, from early on in the diagnosis, to 5 years into their survivorship.

This course is a must for clinicians who are eager to learn more about breast cancer rehab.  Seats are limited – register today!

Although pelvic organ prolapse (POP) affects ?50% of women [who] have had children? (according to a Yale School of Medicine Presentation, ?Female Urinary Disorders and Pelvic Organ Prolapse? few realize that childbirth could lead to POP.

Maternal Goddess, an educational support community for soon-to-be and new moms, posted a blog, ?Down and Out ? identifying pelvic organ prolapse.?? This blog examines the importance of early detection and prevention for POP. ?Often, POP can occur without showing any usual symptoms.? However, because there are often so few symptoms, POP is often missed.

POP stems from weakened pelvic floor muscles.? Risk factors include stress on the pelvic floor from childbirth, aging, injury, or heavy lifting.? Pelvic floor exercises and internal treatment can often relieve symptoms; however, in some cases, surgery may be required.

This is the best time for treatment to begin.? When symptoms do show up, POP is usually at a stage at which it can dramatically affect the wellness of the patient and can require more advanced treatment: ?Early stage prolapse is often reversible and very manageable, however once the prolapse progresses to a stage 3 or 4 it becomes life altering, and may require surgery ? surgery that can in turn cause other challenges.?

Herman & Wallace?s course Pelvic Floor Level 2B offers and in-depth look into evaluating and treating POP.? Coming next to St. Louis this December, this course is ideal for therapists interested in learning about POP as well as other urogynecological conditions.? Seats are limited ? register today!

Last Friday, The Atlanticpublished a blog titled ?How Long Can You Wait to Have a Baby??, written by Jean Twenge.? Twenge, herself a woman who entered motherhood in her mid-30s, talks about the panic brought on by a number of articles citing studies which implored women not to wait ?too long?.

Twenge?s article focuses on an article from TIME Magazine, titled ?Making Time for Babies,? written in 2002 that expressed the dangers of waiting too long to have children.? ?Within corporate America, 42 percent of the professional women interviewed?had no children at age 40, and most said they deeply regretted it.?

Twenge speaks from personal experience about the ticking clock-driven sense of urgency and her own feelings of panic over ?time running out?. She then examines ways in which the data from the 2002 study was flawed, and how decline in fertility for women in their late twenties has been exaggerated based on that data.

While much of her article boils down to an expos? on how statistics can be contextualized to spread misinformation, more striking in her piece is the way Twenge?s voice captures the deeply personal and emotional way women view fertility, motherhood, and the ?biological clock?.

Herman & Wallace is currently vetting a product concept called Pregnancy After 30.? This product explains the lifestyle changes that occur in women over thirty as well as plans for diet and exercise and educational tools that can help fulfill the special needs of women who conceive in their thirties and forties.? The product can be purchased at a discounted rate before August 16^th!

Amy Stein, MPT, BCB-PMD is a long-time friend of Herman & Wallace.? As the founder of Beyond Basics Physical Therapy, in NY, has been working in pelvic rehabilitation for more than ten years.? Amy Stein?s work outside of the clinic has made her a pioneer in the field.? She co-founded Alliance for Pelvic Pain, an educational retreat for patients, as well as penned several books on pelvic pain and dysfunction.? Her most recent book, Heal Pelvic Pain, is a significant resource for patients and practitioners suffering from or interested in pelvic pain and dysfunction.

Heal Pelvic Pain

By: Amy Stein

Heal Pelvic Pain describes the many types of pelvic pain and pelvic floor dysfunction (PFD). ?It also encourages an array of treatments that blend exercise, massage, nutrition, and other self-care practices in lieu of surgery.? There is a need for a broader discussion of pelvic pain, its prevalence, and alternative treatment options.? Heal Pelvic Pain does just that.

For patients and practitioners, Stein?s book clearly articulates many different types of PFD as well as encourages natural healing.? Furthermore, its accessibility allows anyone to understand the consequences of untreated pain or dysfunction.