Wednesday, April 23, 2014

Anorexia: Not Just An Adult Crisis

We know we are bombarded by image obsessed media focused on the "perfect" body. For years the stereotype was that eating disorders, anorexia and bulimia were only problems faced by straight, young, white females, but gay men also have a higher prevalence of eating disorders. However, eating disorders are not just an adult crisis. Children also are at risk. Family therapy has a 50-70% success rate for children at risk for anorexia. Learn the signs and seek help. Take an online screening test  at the National Eating Disorders Association.

Friday, April 18, 2014

Guest Blog: Clitorodynia, say what? Klit-or-oh-di-knee-uhhhhh

Clitorodynia, say what? Klit-or-oh-di-knee-uhhhhh
Yes, it is a mouthful, and sounds something like a prehistoric animal.  But,  it is a very disturbing condition that many women suffer from and it is often mis-diagnosed or mis-treated. The clitoris is a powerful organ of sexual pleasure. The tip has thousands of sensory nerve endings, more than any other body part.  Women by design,  have  greater blood supply to the pelvic area. The clitoris provides the means of having multiple (or any) orgasms. Women’s sexual response has unfortuantely been defined by male standards, making our understanding of the clitoris and its function inadequate.  Too often women come to see us and say “I am really not very familiar with that area”.
Clitorodynia is a subset of pelvic pain in which pain is centered around the clitoris. It can be burning, sharp or dull pain that often limits clothing choices, time in sitting, biking and sex, of course!  The big question on our patients tongues is WHY WHY WHY???  There is often no particular injury that causes this condition.  It is likely irritation, compression or injury to the Pudendal nerve and particularly its branch called the Dorsal Nerve of the Clitoris. The dorsal nerve of the clitoris provides sensation to this structure.  When the nerve is held under tension, compression or injured directly it can be very painful.
dorsal nerve of the clitoris

This is a great illustration showing the nerves to the perineum and pelvis and you can see the Dorsal Clitoral nerve, as well as the Pudendal nerve and their path.  Nerves love movement. When you have tension in the muscles, tissues and fascia nerves are not allowed to glide and move as they are designed to and they become irritated.  As well, if you have chronic inflammation from chronic pain this affects nerves in a similar way, by irritating them with the inflammatory “soup” that becomes trapped in your tissues. Nerves also love blood flow.  Again, if you have muscle tension and tissue restrictions you do not have good blood flow.  As such, in chronic pain conditions blood flow is also poor. Activities such as biking, or professions which require long periods of sitting can reduce circulation to the perineum and aggravate the condition.  Nerves also love space. They are designed beautifully in fantastic canals of fascia and connective tissue. When these spaces are compromised, your nerves are not happy.  When you restore blood flow, movement, and give them back their space, the pain and irritation settle down.  The next question on our patients tongues is HOW do we do this?
There are many medications that your physician may prescribe to help with this pain. I am not a physician and so I will not discuss these in this blog. My experience with these drugs has been that they dull the pain to allow a patient to function at some level, but leave side effects to deal with. Medication DOES NOT address the cause of the nerve irritation, it simply treats the symptom. Other medical treatments that can be helpful are pudendal nerve injections and topical pain relievers.
Behavior Modification Therapy with a certified sex therapist can be tremendously helpful. Because the painful clitoris affects sexual function, and the brain is the primary organ for sex, a psychologist or licensed counselor who has experience with sexual disorders/pain syndromes is very important in your treatment.  When this goes on for months/years, there are often relationship issues that need to be addressed.  Stress is a significant trigger for this pain and counseling is a great way to learn better management techniques. Dealing with vulvar (that’s a fancy word for your external genital area) pain can feel embarrassing, limit your social activities and your relationships. If you have to take medications the side effects can cause problems and the stress of this builds in anyone. It is very important to manage this.
Physical Therapy (my turn!) is a great treatment for clitorodynia. Physical therapists are experts in nerve tension, compression, injury and rehabilitation for these painful structures. A pelvic physical therapist can palpate the pudendal nerve as it travels through the Pudendal canal (also called Alcock’s canal). They can palpate the muscles within the pelvic floor that house the superficial branches of this nerve to determine if they hold too much muscle tension or painful trigger points.  They can help you modify activities or exercise programs to better fit your needs an not aggravate your condition.  Plus we love to educate!  We will spend most of our time educating you regarding the anatomy and function of this area so that you can confidently return to healthy, pain free lifestyle.  At our sessions we will perform some manual therapy releasing tight muscles and tissues vaginally.  We will often use biofeedback as a tool to teach you how to relax these muscles using various techniques.  We will teach you to release these muscles vaginally through teaching a spouse or significant other, or use of  dilators or a tool called a crystal wand.  We teach deep breathing and relaxation techniques. We teach posture and body mechanics and how to modify these to reduce irritation to the involved tissues. We will also discuss sexual positions that may be more comfortable and less irritating.
The take home message is, please don’t let this very treatable condition go because it is embarrassing, or uncomfortable to discuss.  Be comfortable with your body.  I examine this area daily on many different women. The clitoris is a body part, just as equal (but definitely more sensitive) to the arm, elbow or wrist.  It was designed beautifully and serves a very important function.  There are answers, and if at first you do not find them in your first doctor you see, try and try again!  If you are reading this you are already on the right track!  Find a physical therapist who specializes in pelvic dysfunction, or a physician who specializes in pelvic pain, or a sex therapist. Each of these practitioners should have one of the other specialties that they refer to, or work alongside to help you find the right answer for you.
Sarah Dominguez, PT, MSPT, CLT

Thursday, April 17, 2014

MO Medicaid advocacy visit

Lisa Meyers, LCSW/LSCSW, and Joy Durham, social work intern, went to Jefferson City on April 16, 2014 to engage in social justice advocacy.
They met with Representative Judy Morgan and Senator Jason Holsman to discuss mental health services for people with developmental and intellectual disabilities. Currently MO Medicaid limits licensed clinical social workers in providing counseling to Medicaid recipients upon their 21st birthday. Kansas Medicaid has no such age limit for LCSWs providing the same service. Lisa and Joy explained to the legislators that there would be no impact on the state budget by removing the age limitation in Missouri. This is because there would not be a change to the reimbursement schedule or a change in the scope of work for clinical social workers. It would merely allow LCSWs to provide counseling to children AND adults.
This change would positively impact Missourians in TPG’s geographic area because Lisa is an LCSW with two areas of specialization: developmental/intellectual disabilities and human sexuality. There are a number of adults with disabilities here locally, who have Medicaid, who would be able to do counseling with Lisa if the age restriction was lifted. Currently, these Missourians either get shuffled through the community mental health centers before being prematurely discharged (because mainstream therapists are either uncomfortable or untrained to work effectively with them doing talk therapy) or they go without counseling that could have a positive effect on their overall quality of life.
If you believe strongly, like Lisa does, that all people, regardless of their resources, deserve access to the highest quality services, then please reach out to your own legislators and share this message with them: Please remove the age restriction on LCSWs providing counseling through MO Medicaid.

Monday, April 14, 2014

Learn To Be Confident

Is Confidence in your DNA, or can you learn to be more of a warrior and less of a worrier. A story reported by ABC's World News seems to indicate that you can train yourself, essentially re-wiring your brain for confidence.

Smart Fighting Tips

Arguing on a full stomach seems to be the Smart Fighting Tips suggestion in a recent ABC World News story.

Wednesday, April 9, 2014

Kansas & Missouri: Receive an "F" for Sex Ed

Why are we so afraid to provide our youth with basic sex education? I know... I KNOW, its "embarrassing", "taboo", "icky", "scary". Ive heard it all before, but there are some really great resources out there for parents. And our youth deserve better than the mediorce sexuality education provided in Missouri and Kansas. Check out where we rank across the map in "terrifying sex education".
Check out these great resources:
4. Its Perfectly Normal  & Its not the Stork by Robie Harris
There are many aspects to a quality sexuality education and our sexual health expert help parents customize a plan that works for them. Things to consider are age-appropriate, medically accurate, comprehensive talking points. For example, many youth are far more tech savvy than adults and should have lessons on smart use of the Internet. It might be difficult for parents to consider, but teaching youth to be sexually literate includes conversations about sexting and porn. Consider the following from Marty Klein, sex therapist:
  • What is porn literacy? How do I help my kids develop it?
  • Why not just tell kids to stay away from porn?
  • Realistically, what should parents be concerned about? What do we not need to be worried about?
  • What about sexting?
  • What do you mean, “sex is more than an activity—it’s an idea”?
    Today’s teens live in a world that we never had to navigate. Dr. Klein will share reassuring information and valuable tools to help parents help young people deal with the challenges—and the feelings—they will inevitably face. He’ll share evidence that today’s youth are actually safer than we may imagine. He’ll even talk about how healthy parenting on this subject can lead to family growth.
    Marty Klein's website
    Marty Klein has two down loadable DVDs. One is Talking With Our Kids About Sex

    Tuesday, April 8, 2014

    Stress May Affect Fertility

    Although the results from her recent study are far from definitive, Courtney Lynch, director of reproductive epidemiology at Ohio State University is quoting as saying, "if a woman [is] having difficulty getting pregnant, it would be harmless, and might be helpful, to consider stress-reduction techniques.  Yoga, meditation, and mindfulness have been successful in other health outcomes, and might be helpful for fertility as well."

    Check out the full article here: New York Times - Stress May Affect Fertility

    Curious to know more about mindfulness and meditation and how they can help you?  Check back soon for a blog entry all about mindfulness and its benefits to your mental, physical, and spiritual health!

    Monday, April 7, 2014

    Massage: More Than a Luxury - Part II

     Last week we sat down with massage expert, Sarah Chapman, one of the professionals at Turner Professional Group. From the medical benefits of massage to reducing stress, a professional massage is often prescibed to increase the quality of life of patients. Sarah has graciously agreed to offer our clients suggestions on how to maximize their rejuvination and renewal through massage.

    TPG: Do you specialize in a certain type of massage?

    SC:      Yes, I specialize in Aromatherapy & Acupressure massage. I find these help my clients to release physical and emotional tensions more easily while maintaining the benefits of their massage for a longer time period. I also work primarily with Swedish massage, which is more relaxing, and Deep Tissue massage, which is more therapeutic.

    TPG: Some people are more modest or dislike the idea of disrobing completely. Do clients have to take all their clothes off?
    SC:      Not at all. I am so glad you asked this question as many people do not realize a massage is meant to be tailored to what is the most comfortable for them! I always ask clients to undress to their comfort level and having a massage or acupressure while fully clothed is an option too. When getting a massage, it’s always good to express your expectations and give feedback if you are too hot or cold, if the pressure is too light or deep, or anything else that may make it a better experience for you.

     TPG:  Are there any considerations before receiving a massage?
    SC:      Yes, it’s important to remember to stay hydrated. A massage will flush toxins out of the system so drink extra water and think about skipping the extra glass of wine at dinner that night. If you feel sore after a massage take an epsom salt bath and remember, your therapist is always a phone call away if you have questions. I am also a big fan of “homework” as I believe massage is not just the hour on the table, and is more about your overall health goals. This is my favorite 5-minute fix routine to do at home:

    TPG:  What are the biggest barriers you see that keep people from getting massage?

    SC:      We all think our budgets are our biggest constraint, and while that is definitely important I find time is the biggest barrier to getting a massage. We all lead busy lives and can forget that we need to put our wellbeing first in order to be our best selves. Once people make it a priority to care for themselves, it’s easier to make it a routine on the schedule. As far as budget is concerned, there are always options. Ask your therapist if they have specials or package discounts and think outside the hour massage. You may find a 30min. massage on your trouble spots is what you need, or a 90min. massage every two months might be best for you. Don’t let time or money stand in your way, chat with your therapist to find a solution that works for you both.

    TPG: Can you suggest any resources?
    SC:      There are a lot of great scientific studies that prove the benefits of massage. Dr. Brent Bauer of the Mayo Clinic speaks on the many benefitsof massage therapy. I think one of the best pieces of advice is get to know a massage expert by interviewing them for your wellness team. Ask questions to determine if its a good fit. Id be happy to visit with potential patients, but I think the best way to get to know me is to schedule an initial massage. Let me show you how I can benefit your life!

    Friday, April 4, 2014

    Feels Sooooo Good: A Massage Is More Than a Luxury!

    Along with a diverse team of mental health clinicians, Turner Professional Group has several massage therapists to provide clients relief and rejuvenation. One of the many benefits of a multi-disciplinary practice is being able to offer patients who are struggling with stress a proven method of relaxation, such as massage. Massage Benefits Are More Than Skin Deep according to the NY Times. As holistic practitioners, this is a great alternative to the over-reliance on medications.

    Some of the ways we utilize massage for our clients, include patients who are experiencing anxiety or stress. An example of this might be women who are seeking our help with painful intercourse. There can be great deal of emotional frustration with the process and massage can be a welcomed and soothing tool in their healing.

    In addition, massage is a good tool to help clients become more mindful and present in the moment. For those folks who have a tough time slowing down or taking time for themselves, this can be a useful but sometimes challenging homework assignment. So suggesting a massage appointment can be a fun way to train patients in the skill of ‘self-care’.

    To get a better understanding of massage, we sat down with one of the skilled massage professionals at Turner Professional Group,  Sarah Chapman.
    TPG:    How long have you been practicing massage?
    SC:       I began practicing after graduating from massage school and becoming nationally certified in August 2011. I have also been practicing Jin Shin Jyutsu acupressure since 2004 and Raindrop essential oil sessions & Emotional Release with essential oils since 2008.

    TPG:    People think of massage when they have a kinked up back, but what are some other reasons a person might want to integrate massage therapy into their routine?
    SC:      People who receive massage and bodywork on a regular schedule see improvement in their muscle tone, circulation, and overall body function. Their bodies are better equipped to cope instead of holding on to those knots and kinks, so they are able to perform at an optimal level and feel their best. A small portion of my regular clients also report that routine massage helps them lose weight and maintain their weight goals.
    TPG:    Many people think of massage as a vacation-type luxury. Is there any benefit to routine massage?
    SC:      Yes! Besides the physical benefits, there is a huge emotional and mental wellness component to massage. My clients share that they often feel more calm, balanced, and are better able to respond to stressful situations in their lives. It will also boost the immune system, keep brain function sharp, and lead to more restful sleep.
    TPG:    How often should someone schedule a session?
    SC:      This really varies for each individual. Some of my clients come weekly, others come every 6-8 weeks, but overall most people do really well with a monthly massage. For the majority of people, getting a monthly massage is the perfect schedule to keep the body and mind at optimal wellness. Another great benefit of routine massage is that the effects are cumulative. One massage does wonders, and the effects of receiving massage on a regular basis adds up!
    TPG:  Sarah, this has been very useful. Thank you. Would you mind taking some questions from folks who are following us?
    SC:     Thats a great idea! Ill post answers to more questions next week and Ill add some resources for folks. Hope everyone joins us here again soon. Thanks, again and happy relaxing to everyone!
    TPG:   You can post your questions in the comments sections and Sarah will give you some useful tips.

    Thursday, April 3, 2014

    The Bodysex Effect

    "My research will assess women’s perceptions of the effects of the Bodysex workshops, including feelings of sisterhood, decrease of shame, and increased sexual agency and ownership of one’s own body and sexuality. Gathering the narrative experiences of female participants in Bodysex workshops may yield answers to why such an experience is an effective method of sexual healing and whether it needs to be more broadly incorporated into other educational and therapeutic activities directed at personal growth and problem solving." ~Lisa Meyers

    I am thrilled that Betty and Carlin are as excited as I am about my dissertation research! Check out their podcast here: