Monthly Archives: January 2020

Five Bullet Friday: Women’s Health January 26, 2020

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NB** Sorry friends – I emailed this out on Friday but forgot to post it here… enjoy!

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Happy Friday!

Today’s Five Bullet Friday:

1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?

2. Why Can’t We Talk About Periods?

3. Patient HANDOUT: Common Food & Drink That Can Worsen Incontinence

4. Our Biological Clock Plays a Crucial Role in Healing from Surgery

5. Teens with Obesity & PCOS Have More ‘Unhealthy’ Bacteria

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

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1. Are Women Getting Incorrect Treatment When it Comes to Their Heart?
A paper published recently in Nature Medicine showed that many cardio-metabolic disorders, such as diabetes, heart disease, and stroke, are alarmingly difficulty to successfully treat in women.
Author, Professor Eva Gerdts believes health services are not considering the biological differences between men and women when treating heart disease. She explains “men and women have different biologies, and this results in different types of the same heart diseases. It is about time to recognize these differences.”
According to their study, authors of this paper found that women are more at risk of receiving the wrong treatment because health service professionals fail to spot symptoms or risk factors that are unique to women.
What were these risk factors and symptoms the authors were talking about, exactly?
Obesity was one – as women and men store fat differently and the mechanisms behind this process being different in women creates an increased risk of type 2 diabetes and heart disease. After obesity, the authors spoke of the benefits of estrogen women have in impeding metabolic syndrome, but how this changes during menopause when estrogen decreases. Researchers also talked about the different lifestyle risks women experience, all of which can be read at the reference below.
Prof. Gerdts hopes that her research will incite action among the medical community and lead to future research to discover the best way to treat heart disease in women.
 
Ref: Gerdts, E., Regitz-Zagrosek, V. Sex differences in cardiometabolic disorders. Nat Med 25, 1657–1666 (2019). https://doi.org/10.1038/s41591-019-0643-8
2. Why Can’t We Talk About Periods?
Dr. Jen Gunter, OB/GYN, Pain Medicine, and author of ‘The Vagina Bible’ recently gave a TED talk on menstruation. Dr. Gunter is doing amazing things to empower women and teach everyone about their bodies. I love to share this information with clients and patients, and highly recommend her talk!
Check it out, here!
“It shouldn’t be an act of feminism to know how your body works,” says gynecologist and author Jen Gunter. In this revelatory talk, she explains how menstrual shame silences and represses — and leads to the spread of harmful misinformation and the mismanagement of pain. Declaring the era of the menstrual taboos over, she delivers a clear, much-needed lesson on the once-mysterious mechanics of the uterus.
3. Patient HANDOUT: Common Food and Drink that Can Worsen Incontinence
This is a handout that I use A LOT in the clinic. Check out some common food and drink that could irritate the bladder and lead to worsening symptoms of incontinence, urge, and/or frequency.
Shoot me an email if you’d like a copy of this handout! cassie@tayloredtraining.ca
4. Our Biological Clock Plays a Crucial Role in Healing from Surgery
A recent study from McGill University found that timing of medication – based on our circadian clock – dictates their effectiveness when healing from a surgery.
Researchers found that taking anti-inflammatories in the morning or at noon were effective in promoting post-operative healing and recovery, but that they were much less effective if taken at night. In fact, research shows that if the anti-inflammatories were taken in the afternoon or at night, they actually severely DETER healing and bone repair following surgery.
The reason for this finding – that anti-inflammatories can both promote healing post op (if taken in the morning or noon) or hinder healing post-op (if taken in the afternoon or evening) is based on our circadian clock genes that are involved in healing.
Inflammation, following surgery, is crucial to healing since part of the process involves both destroying any bacteria that may be in the area, and signaling to attract the cells that will rebuild the tissues. But the process is not a constant.
“There are periods of inflammation that are actually very destructive, and there are periods that are constructive and important for healing,” said Faleh Tamimi. “So many pharmaceutical companies have been trying to develop drugs that will inhibit the destructive processes during inflammation but not interfere with the helpful ones.”
He adds, “The idea that I came up with in the shower one morning is that we could perhaps use the circadian variations in inflammation to our advantage. The destructive component of the circadian rhythm as it relates to bone healing occurs during the day, when cells known as osteoclasts break down bones. The constructive cells, known as osteoblasts that rebuild bones are active at night. By limiting the use of anti-inflammatories to the mornings and giving analgesics at night for the pain, I thought we might get better results in terms of bone healing than if anti-inflammatories are given throughout the day.”
For more details, see the reference below.
Side Note: as a therapist this research is fascinating to me and I believe it will have huge implications in the use of both anti-inflammatories and ice in the future in terms of optimizing the healing stages post injury!
Ref: H. Al-Waeli, B. Nicolau, L. Stone, L. Abu Nada, Q. Gao, MN. Abdallah, E. Abdulkader, M. Suzuki, A. Mansour, A. Al Subaie, F. Tamimi. Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery. Scientific Reports, 2020; 10 (1) DOI: 10.1038/s41598-019-57215-y
5. Teens with Obesity and PCOS Have More ‘Unhealthy’ Bacteria
New Research published in the Journal of Clinical Endocrinology & Metabolism suggests that the microbiome may play a role in polycystic ovary syndrome (PCOS).
PCOS affects 6-18 percent of women of reproductive age and is characterized by elevated testosterone levels in the blood that cause acne, excess hair growth and irregular periods. Teens with PCOS often also struggle with obesity and have higher risk for type 2 diabetes, infertility and depression.
Researchers discovered that “in adolescents with PCOS and obesity, the bacterial profile (microbiome) from stool has more “unhealthy” bacteria compared to teens without PCOS. The unhealthy bacteria related to higher testosterone concentrations and markers of metabolic complications.”
This information can be useful in the future as a new path to treatment – looking at the gut microbiome. Future research is still needed.
 
Ref: Beza Jobira, Daniel N Frank, Laura Pyle, Lori J Silveira, Megan M Kelsey, Yesenia Garcia-Reyes, Charles E Robertson, Diana Ir, Kristen J Nadeau, Melanie Cree-Green. Obese adolescents with PCOS have altered biodiversity and relative abundance in gastrointestinal microbiota. The Journal of Clinical Endocrinology & Metabolism, 2020; DOI: 10.1210/clinem/dgz263

Five Bullet Friday: Women’s Health January 17, 2019

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Happy Friday!

Today’s Five Bullet Friday:

1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

2. NEW Guidelines for Recurrent UTIs, 2019

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

4. Weight & Major Psychiatric Disorders Genetically Linked

5. Improve Sleep by Losing Fat from Your Tongue?

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. A Clarification of Use of Mesh in Gynecological Surgeries from the President of the AAGL

President of the American Association of Gynecologic Laparoscopists (AAGL) recently commented on the announcement from the US FDA which recalled transvaginal mesh used for the treatment of pelvic organ prolapsed (POP).

Dr. Fidela Paraiso explained that there is an important distinction that many people aren’t realizing: the FDA recalled surgical mesh for some – but not all – procedures related to pelvic floor disorders, which some media sources are not disclosing that subtlety.

Dr Fidela Paraiso furthers that the mesh itself is not defective and that the recall only applies to repairing of POP. It has not, however, been recalled when the mesh is inserted through an abdominal incision for POP repair, nor mesh used in midurethral sling procedures for the treatment of stress urinary incontinence.

For more details on the difference between the use of mesh for POP repairs and for the treatment of stress urinary incontinence, please see Dr. Fidela Paraiso’s full explanation in the reference below.

Ref: Click here for Link

2. New Guidelines for Recurrent UTIs – 2019

Uncomplicated urinary tract infection is one of the most common indications for antimicrobial exposure in otherwise healthy women. We are obviously concerned with overuse of antibiotics as it has led to drug-resistant organisms in the past 20 years. Because of this, new guidelines were created and published in the Journal of Urology in 2019 to help guide treatment of recurrent UTIs.

Note: recurrent UTIs are defined as two culture-proven UTIs in a 6-month period, or three culture proven events in 1 year. The following guideline is heavily focused on treating not only symptoms, not only cultures, but rather the important combination of symptoms combined with positive cultures. This new guideline is an important step in helping physicians reduce the “collateral damage” or over-prescription of antibiotics to slow the rate of development of antimicrobial resistance.

2019_UTI_Guidelines

Ref: Anger, Jennifer & Lee, Una & Ackerman, Roger & Chou, & Chughtai, Bilal & Clemens, J. & Hickling, Duane & Kapoor, Anil & Kenton, Kimberly & Kaufman, Melissa & Rondanina, Mary & Stapleton, Ann & Stothers, Lynn & Chai, Toby. (2019). Recurrent Uncomplicated Urinary Tract Infections In Women: Aua/Cua/Sufu Guideline. Journal of Urology. 202. 10.1097/JU.0000000000000296.

3. Heavy Menstrual Bleeding Common in Teens and Requires Multidisciplinary Care

The reported prevalence of heavy menstrual bleeding in adolescents ranges from 34% to 37%, authors Dr. Borzutzky and Dr. Jaffray note in their recent paper.

This can lead to anemia, fatigue, and hemodynamic instability which may result in ED visits, hospital stays, the need for transfusion and oral or intravenous therapies to stop blood loss.

Authors say it is important to distinguish the etiology of this in adolescent girls to guide treatment, which can include hemostatic medications, hormonal agents, or a combination of both. They also note that historically the evaluation of heavy menstrual bleeding has been predominately the role of a primary care clinician or gynecologist, but given that a high prevalence of female individuals (specifically adolescents) with heavy menstrual bleeding have underlying bleeding disorders, hematologists should also have a prominent role.

Ref: Borzutzky C, Jaffray J. Diagnosis and Management of Heavy Menstrual Bleeding and Bleeding Disorders in Adolescents. JAMA Pediatr. Published online December 30, 2019. doi:10.1001/jamapediatrics.2019.5040

4. Weight & Major Psychiatric Disorders Genetically Linked

New research shows that there appears to be a robust genetic link between body weight and major psychiatric disorders, an international research team has concluded.

Using data from more than a 500,000 individuals with major depression, bipolar disorder, and schizophrenia, the investigators showed extensive genetic overlap between body mass index (BMI) and psychiatric disorders. Interesting, they found that although the genetic risk variants for major depression and bipolar disorder were primary associated with increased weight, the majority of genetic variants for schizophrenia were related to reduced weight.

Authors found this quite interesting, because essentially this meant that if people had a susceptibility for increased BMI they were also likely to suffer from depression or bipolar disorder, but for schizophrenia it was the opposite: if they were at risk of schizophrenia, they were less likely to be obese. They conclude that increased body weight in schizophrenia seems to be directed mainly by diet, lifestyle, and side effects of mediation, but that it is a completely different picture with bipolar disorder and depression.

Authors further conclude that, “aligned with epidemiological findings, [their] results underscore the importance of considering both metabolic and psychiatric factors when trying to understand and treat mental illness effectively.” They are hopeful that this could lead to more prediction tools and better treatment choices for individuals with severe mental disorders.

Ref: Bahrami S, Steen NE, Shadrin A, et al. Shared Genetic Loci Between Body Mass Index and Major Psychiatric Disorders: A Genome-wide Association Study. JAMA Psychiatry. Published online January 08, 2020. doi:10.1001/jamapsychiatry.2019.4188

5. Improve Sleep by Losing Fat from Your Tongue?

A new study published in the American Journal of Respiratory and Critical Care Medicine just this month discovered that reducing the amount of fat in your tongue improves sleep apnea.

Previous research has shown that obesity is a key risk factor for sleep apnea, and that those who are obese who suffer from the condition tend to have considerably larger tongues with a higher percentage of tongue fat than obese people who do not suffer from sleep apnea.

So, how do you trim down your tongue fat? It comes down to overall body fat loss, the study found. “This study shows reducing excess fat in general can reduce tongue size. [And] the more tongue fat you lost, the more your apnea improved”.

This leads authors to believe that tongue fat is a potential new therapeutic target for improving sleep apnea, and they suggest future studies explore whether certain diets are better than others in reducing tongue fat, and whether cold therapies might be applied to reducing tongue fat.

Ref: Stephen H. Wang, Brendan T Keenan, Andrew Wiemken, Yinyin Zang, Bethany Staley, David B. Sarwer, Drew A. Torigian, Noel Williams, Allan I Pack, Richard J Schwab. Effect of Weight Loss on Upper Airway Anatomy and the Apnea Hypopnea Index: The Importance of Tongue Fat. American Journal of Respiratory and Critical Care Medicine, 2020; DOI: 10.1164/rccm.201903-0692OC

Five Bullet Friday: Women’s Health January 10, 2019

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Happy Friday!

Today’s Five Bullet Friday:

1. Fragmented Sleep May Trigger Migraine 2 Days Later

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

5. Women’s Health RESEARCH Opportunities Local and Online

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

  1. Fragmented Sleep May Trigger Migraine 2 Days Later

A fascinating new study published in Neurology found that people whose sleep is fragmented during the night are at a higher risk of experiencing a migraine episode not the next day, but the day after that.

Authors Dr. Bertishch knew that sleep and migraines have been linked for a long time, both anecdotally and by scientific research, and wanted to look a bit deeper in to their relationship.

What they found that was sleeping for 6.5 hours or under each night, as well as having poor quality sleep, did not correlate with migraine episodes the next day or day following. However, having a fragmented sleep was linked with a 39% higher risk of migraine on the day after the fragmented sleep.

Further research is needed at this time to better understand this low sleep efficiency and migraine correlation going forward.

Ref: Suzanne M. Bertisch, Wenyuan Li, Catherine Buettner, Elizabeth Mostofsky, Michael Rueschman, Emily R. Kaplan, Jacqueline Fung, Shaelah Huntington, Tess Murphy, Courtney Stead, Rami Burstein, Susan Redline, Murray A. Mittleman. Neurology Dec 2019, 10.1212/WNL.0000000000008740; DOI: 10.1212/WNL.0000000000008740

2. Patient RESOURCE: Back to Basics: 10 Facts Every Person Should Know About Back Pain

Low back pain is the leading cause of disability worldwide, and is often associated with costly, ineffective and sometimes harmful care, yet unhelpful patient beliefs about low back pain remain pervasive. This great, free to- the -public resource printed in the British Journal of Sports Medicine outlines 10 facts about our back and back health that everyone should know, especially those who are struggling with back pain.

Find this helpful info graphic along with the rest of the article at the reference below, or see attached to this email.

bjsports-2019-101611-F1.large

Ref: O’Sullivan PB, Caneiro J, O’Sullivan K, et al Back to basics: 10 facts every person should know about back pain British Journal of Sports Medicine Published Online First: 31 December 2019. doi: 10.1136/bjsports-2019-101611

3. Pelvic Pain-Focused Interventions Worthwhile after Vaginal Mesh or Mesh Sling Removal:

Transvaginal synthetic mesh and mesh sling placement for the treatment of stress urinary incontinence and pelvic organ prolapse can yielded adverse outcomes, including pelvic pain and dyspareunia. Pelvic floor physical therapy (and medications and injections as necessary) in compliant patients experience significant improvement of their symptoms, and pelvic pain-focused interventions are a worthwhile recommendation in women with refractory pelvic pain after vaginal mesh or mesh sling removal.

Ref: Abraham, Annie & Scott, Kelly & Christie, Alana & Morita-Nagai, Patricia & Chhabra, Avneesh & Zimmern, Philippe. (2019). Outcomes Following Multidisciplinary Management of Women With Residual Pelvic Pain and Dyspareunia Following Synthetic Vaginal Mesh and/or Mesh Sling Removal. Journal of Womenʼs Health Physical Therapy. 1. 10.1097/JWH.0000000000000140.

4. The Fuzz Speech: Explaining Fascia and the Importance of Movement

This is an older video, but one that I love to share because it is so well done. The Fuzz Speech, but Dr. Gil Hedley, is a fantastic explanation of our fascia, how important movement is, and what can happen to our bodies if we are consistently sedentary. Most patients very much love this video and learn a lot from it. I do say most, however, as Gil does show a cadaver at some point.. so your more squeamish patients may not enjoy the recommendation!

Check out this 5 minute video, here.

5. Women’s Health RESEARCH Opportunities – Local in Kingston, ON and Online

Some amazing and important research is happening right now at Queen’s University in Kingston, Ontario looking at a number of topics including:

  • Psychoscial and Treatment Factors Associated with Persistent Genital Arousal Disorder
  • Biopsychosocial Investigation of Persistent Genital Arousal Disorders in Women
  • Sexual Wellbeing of Women Using SSRIs
  • Sexual Wellbeing of Women Experiencing Depression Symptoms
  • Sexuality and Breast Cancer
  • Sexuality and Menopause

Some studies are available to online participants, while others are in lab. For more details for you or your patients, visit here.

 

Five Bullet Friday: Women’s Health – January 3, 2020

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Happy Friday!

Today’s Five Bullet Friday:

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article in NEJM

2. Explaining Pain to Your Patients – A Physio’s Favourite Resource

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

5. PATIENT HANDOUT: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Five Bullet Friday: Women’s Health is meant to be a quick, easy to skim resource for you and other health and medical professionals to keep you up to date with all things related to women’s health. My goal for these emails will be to bring to you pertinent and helpful resources for patients (such as short videos or handouts), new research and guidelines, clinical pearls, or anything else interesting related to women’s health! If you’d like to be added to my email list to receive my Five Bullet Friday: Women’s Health, or if you would like suggest particular topics you are eager to hear about, please send an email to cassie@tayloredtraining.ca.

Thank-you, and happy reading!

 

1. The Effects of Intermittent Fasting on Health, Aging and Disease – NEW Article NEJM

In this excellent review article in the New England Journal of Medicine, authors Cabo and Mattson discuss intermittent fasting and its many benefits for humans. They discuss previous nutrition animal studies that assumed that benefits came from calorie restriction, at the time not recognizing that the animals typically consumed their entire daily food allotment within a few hours after its provision, thus meaning they had a daily fasting period of up to 20 hours, during which ketogenesis occurs.

For humans, preclinical studies and clinical trials have shown that intermittent fasting has broad-spectrum benefits for many health conditions, such as obesity, diabetes mellitus, cardiovascular disease, cancers, and neurologic disorders. Positive outcomes from intermittent fasting extend past those of simply restricting calories and the beneficial effects involve metabolic switching and cellular stress resistance.

In this review article, it is recommended that physicians can advise patients to gradually reduce the time window during which they consume food each day with the goal of fasting for 16 to 18 hours a day. They can alternatively recommend another intermittent fasting protocol as outlined in the review.

Reference: De Cabo, R. & Mattson, M. New Engl J Med. 2019; 381: 2541-51. DOI: 10.1056/NEJMra1905136

 

2. Explaining Pain to Your Patients: a Physio’s Favourite Resource

One of my favourite resources to share with patients regarding why they experience pain and what to do about it comes from pain specialists in Australia. Check out the following video “Understanding Pain and What to Do About it in Less Than Five Minutes”

Check out this great resource, here!

 

3. Urinary and Gynaecological Dysfunctions Common with EDS and Associated Hypermobility Disorders

Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a group of connective tissue disorders associated with significant morbidity. A recent review suggests that in this population a higher index of suspicion for urorgenital problems is warranted in this population, with urinary, gynaecological and obstetrical complications reported as common.

This information is helpful to encourage early referrals to appropriate disciplines in this population, including pelvic health physiotherapists.

Reference: Gilliam, E, Hoffman, JD, Yeh, G. Urogenital and pelvic complications in the Ehlers‐Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet. 2019; 1– 11. https://doi.org/10.1111/cge.13624

 

4. Global Consensus Guidelines on Use of Testosterone in Women (2019)

A Task Force of representatives of leading societies, whose international memberships include clinicians assessing and managing sex steroid therapy for women, was established in order to create a global consensus position statement on the use of testosterone in women. This Guideline was published in December 2019, it addresses available evidence and states:

  • No cut-off blood level can be used for any measured circulating androgen to differentials women with and without sexual dysfunction
  • There are insufficient data to make any recommendations regarding the use of testosterone in premenopausal women for treatment of sexual function or any other outcome
  • The only evidence-based indication for testosterone therapy for women is the treatment of HSDD, with available data supporting a moderate therapeutic effect, in postmenopausal women
  • There are insufficient data to support the use of testosterone for the treatment of any other symptom or clinical condition, or for disease prevention
Reference: Davis, Susan & Baber, Rodney & Panay, Nicholas & Bitzer, Johannes & Perez, Sonia & Islam, Rakibul & Kaunitz, Andrew & Kingsberg, Sheryl & Lambrinoudaki, Irene & Liu, James & Parish, Sharon & Pinkerton, Joann & Rymer, Janice & Simon, James & Vignozzi, Linda & Wierman, Margaret. (2019). Global Consensus Position Statement on the Use of Testosterone Therapy for Women. The Journal of Clinical Endocrinology & Metabolism. 104. 10.1210/jc.2019-01603.

 

5. Patient Handout: 5 Toileting Mistakes that Could Contribute to Pelvic Floor Dysfunction

Toileting habits are something we don’t often talk about but that can absolutely encourage or exacerbate pelvic floor dysfunctions. See attached to this email a great resource for patient’s talking about common toileting mistakes and what they can do to correct them!