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I P** When I Sneeze! Advice from a Pelvic Floor Specialist

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Reema Thakkar, PT, DPT and Family

Long before I ever heard the term “pelvic floor” my new mum friends and I would speak in hushed tones (if at all) about 

“accidents” while sneezing or coughing or laughing and issues around post-baby sex. Even now these items can be delicate and embarrassing to discuss,

even with healthcare professionals. I met Reema Thakkar, PT, DPT Professor at Touro College of Health Sciences and One Wellness & Rehabilitation, specializing in wellness for new moms at an event here at the studio for expectant mums hosted by Modi Toys

I was struck by her honesty and humor around this very tricky subject. Her comfort around discussing care during and post-pregnancy was refreshing. I asked her to share some insights for our blog and newsletter. 

Hi Reema- Thanks so much for taking the time to speak with me! As a mom of a two-year-old and a little one due any day now in addition to your certification and experience, you are an amazing resource for mums and mums to be! 

I have loads of questions! Let’s start with all those initials after your name- what does a PT, DPT mean for women seeking help with pelvic floor issues? How did you get onto this specialty?

Hello! PT, DPT is just a bunch of fancy letters saying I did my Doctorate in Physical Therapy and am licensed to practice in New York State and the State of New Jersey. So, I’m a Doctor of Physical Therapy pursuing her WCS (Women’s Health Certified Specialist) qualifications, just to add some letters.

I got into this particular field working with female gymnasts, actually. I had little to no intention of exploring women’s health and was mainly specializing in sports orthopedics post-graduation. It was there that I realized that there was a hole (literally) in our treatment plans as we ignored the anchor of the female body (and male for that reason – because everyone has a pelvis!!) when trying to rehabilitate them. It was here that my curiosity and practice niche stemmed.

When should a woman see someone like you- are there things that you can help with to mitigate pelvic floor issues before the baby arrives?

I usually recommend that women seek out pelvic rehabilitation treatment around their second trimester if they have no previous history of any dysfunction. Of course I always make sure their OBGYN or Midwifery team is on board. This way we can assess the integrity of the pelvic floor during the partum phase, help with any of the discomfort that pregnancy brings and of course guide them to prepare for the labor experience itself.

What are some issues that crop up before giving birth that can be alleviated by seeing a pelvic floor therapist? 

Many women have pelvic complaints even before they decide to get pregnant. This can be in the form of pain with intercourse, discomfort during menstrual cycles, urinary incontinence or leaking. It’s not just pregnancy that brings these on but pregnancy can often exacerbate the pain, which is why we end up seeing more patients this way.

Pelvic Floor Physical Therapists are able to help manage and mitigate this dysfunction but also, our main goal is to help you figure out how to do this at home. Very often I see patients once or twice prior to sending them on their way with the tools needed for successful rehabilitation.

Very often friends will ask- is this or that “normal” after giving birth- my question is- being uncomfortable after having a child is understandable to a point- whether a vaginal birth or a C-section

but what issues occur after birth that would indicate seeing a pelvic floor specialist?

This is a tough question for me because I TRULY believe that we need better post-partum care for mothers. In France and Canada, a 6-week pelvic floor evaluation by a PT is standard practice. Nothing has to “happen” to send you there because the biggest thing HAPPENED ALREADY!!! …..and this goes for C-section deliveries as well. The pelvic floor still carried that uterus for a long time and had relaxin (the protein that allows all of your pelvic ligaments to stretch and get ready for childbirth) run rampant through the body – so it still can use some help.

However since I know it’s unrealistic that everyone will come, I often say that you shouldn’t have any leakage, pain or irritation in the vagina or along the C-section scar by 8 weeks post-delivery. I can even stretch it to 12 weeks if we want to be more conservative. However, that should paint a picture for a lot of the moms out there because I often see people who are carrying 8 month olds and still peeing their pants when they laugh. Not normal or needed – at any age!!

Sex after baby may be one of the most sensitive subjects in this area. Tell me how a pelvic floor specialist can help get intimate relations back on track.

Allowing your pelvic floor muscles and the tissues to heal post-partum is needed and normal but oftem depending on tearing during labor or any sort of stitching that ensued, women stop enjoying sex. In addition, dryness can cause this. This can lead to a lack of sexual appetite overall as well. We can always discuss this in the clinic and then do a thorough assessment to see what the hindrance is. Is it dryness? In which case we can recommend creams and lubrications; or is it tightness from post-operative stitches and healing?. Either way a plan of action can be put in place to combat this ASAP.

Outside of having a child- are there other reasons why a woman would have pelvic floor issues? What situations would warrant seeing you?

So as I’ve mentioned above, any incontinence, pain during menstrual cycles or general pain in the pelvic region, difficulty with bowel movements, painful intercourse are all things that we can address together. As with any musculoskeletal injury, there are varying degrees of help that conventional rehabilitation can do but I have seen pelvic rehab work wonders on all of the above, often coupled with other treatments as needed.

Should readers wish to reach out to you for information how should they reach out?

Since we do not see patients in a single brick and mortar location, the best way to contact me for information or help setting an appointment in your area would be to use the Instagram handle @pelvicdpt and sending me a direct message. At that point, I can always link you to our online portal as well.

Chocolate Dipped Strawberries

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This is an easy low sugar solution- use non dairy chocolate for vegans and this is perfect for your gluten-free folks!

INGREDIENTS

24 whole strawberries rinsed and dried thoroughly

10 ounces good quality dark or milk chocolate If using bar chocolate, finely chop before melting

5 ounces good quality white chocolate if desired

INSTRUCTIONS

Rinse berries in cool water and dry thoroughly with a paper towel. Arrange in a single layer on a towel and allow to air dry for 10-15 minutes (or until completely dry.)

Place the chocolate in a microwave safe bowl and heat at high power for 30 seconds. Stir and heat in 30 second increments until melted and smooth.

Dip the strawberries, one at a time, in the chocolate turning to coat. Allow the excess to drip off the strawberry and place on the baking sheet lined with parchment. Push the strawberry forward 1/2 inch to help avoid the chocolate puddle from forming at the tip of the berry. Repeat with the remaining berries until all are coated.

Transfer the baking sheet to a cool, dry place to allow the chocolate to set.

If desired, melt white chocolate in 30-second increments then transfer the melted chocolate to a zip top bag. Snip off a corner and drizzle over the strawberry.

Allow the chocolate to set.
Serve the strawberries immediately or transfer to an airtight container lined with a paper towel (to absorb moisture) and refrigerate for up to 2 days.

Parenting Your Anxious Teen

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Choosing a college and the battle to complete essays and applications. Empowering advice from Parenting Coach Maria Sanders, LSW

Early days as a mum were about feeding, sleeping, or not- teen years had their own struggles and now- every friend I encounter has experienced the battle of senior-itis and college applications. I heard about Maria’s

workshop on children and anxiety and reached out to her for a chat.

Maria thanks for speaking with me- I wish I’d met you sooner! Please tell me a little bit about your practice and how you work with parents.

Thanks Jennifer! I am a Licensed Social Worker and PCI Certified Parent Coach®. I work with parents struggling with any parenting challenge, from getting a child to sleep to communicating with a taciturn teen. A lot of my work is supported by Conscious Parenting and Collaborative Problem Solving. I work one on one with parents virtually or in my Montclair office. I also offer programs at public schools, independent schools, preschools, pediatrician offices, professional organizations, and corporate settings.

Currently, the struggle among many of my friends is parenting teenagers about to head off to high school or college. Everything from choosing a school, to narrowing choices, to finishing essays seems to be an epic and

on-going battle.

We all want our children to own and manage their own process but leaving them to their own devices leads to late or unsubmitted essays and missed deadlines. There are times when kids seem to need hand-holding and

support and other times when they totally shut parents out of the process- refusing to allow a look at completed essays or applications or sharing thoughts on where they stand on key decisions – like where they will apply! How do you know when to back off and when to offer support?

That’s a great question I think it’s really important to recognize this importance for balance between backing off and offering support. The best way to approach this is early on before it’s even an issue. Planning

ahead and being proactive will be your best friend.

Together with your child, come up with a plan on how you will handle these key decisions. Maybe there’s a third-party/ another trusted adult who can also help, someone that the teen feels comfortable with if for

some reason they don’t want you to see the completed essays or applications.  

Instead of telling your teen all the things they need to do ask them questions about how they will handle time management and organization.  Together you will come up with a calendar and a to-do list that works for the both of you.

Managing our own anxiety first.

Many times when parents feel like they’re losing control they hold on tighter by taking over all the tasks that their child should be doing themselves. It’s important for us as parents to be aware of our fears,

worries and concerns related to our kids getting into college and their next steps. If we allow our fears, worries, and concerns to take over- that’s when tension and friction occurs. So, with some work, we need to move from a place of fear to a place of confidence and trust that we have parented our child well and supported them.  

Coaching is a partnership with the goal of moving forward.

How do I introduce a child who is already challenging authority and suggestions to the idea of this type of coaching?

Coaching is a partnership with the goal of moving forward.  As your coach, I don’t dictate and tell you all the things you need to do what I do is listen to what your goals are and help you get there. That means the goals of both the child and the parent. Coaching is non-judgemental. My role is to make sure that through collaborative problem-solving both the parent and child concerns are heard and understood.  And through this process, we will come up with an action plan that puts both concerns on the table and find a mutually satisfactory solution.

Recognizing your own triggers and fears.

A lot of my work is supported by conscious parenting and collaborative problem-solving. For the parent, it’s important for us to recognize our triggers, our fears, our worries, our concerns and all those things that are getting in the way of us being able to connect and support our child. More than ever at this time our teens want to be seen and heard and respected as an adult. Through this work I can help parents build a helping

relationship, foster communication and avoid many of the challenging behaviors that occur.  And finally by working with a coach ahead of time, we can proactively address many of the challenging issues before they

spiral into bigger concerns.

This is all extremely valuable. If a parent wanted to reach out to explore the possibility of working with you- what is the best way to do that?

I offer a 20-minute complimentary phone consultation. This is a good way for parents to tell me a bit about themselves and their family and ask me questions about my practice to see if this would be a good fit. You can

check out my website and you can follow me on Instagram and Facebook. www.mariasandersparentcoach.com Or you can call me directly at 201-500-7397