149: Perimenopause, Pelvic Health & Resilience - What Every Woman Needs to Know with Dr. Heidi Gastler

The following ones, they I got a brain scan and had to be told that I had a brain tumor literally the size of a softball. You cannot in so many instances prevent the cancer from happening. You can be an on-smoker, sure. You can eat healthfully, you can do that stuff, right? Those life-self factors, but there's a lot of cancers that it doesn't matter if you're being the healthiest of healthy. And I would describe myself as like the healthiest of healthy. And the fact, though, that I went into this as a healthy, strong, physically fit individual, allowed me to fight it better. By listening to the Coherence Code podcast, you agree to not use this podcast as medical advice to treat any medical condition, either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code podcast, where we explore how the mind and body work together so you can move from stress and inner conflict to clarity, calm, and alignment. My name is Lauren Brown. I'm a doctor of traditional Chinese medicine and a clinical therapist. And through my work, I've seen that healing happens when we remove what gets in the way and allow the body and the nervous system to do what they're just trying to do to heal. Welcome to the Coherence Code podcast. Joining me today is Dr. Heidi Gasler. Now she is a pelvic floor physical therapist, a cancer survivor, and she's the voice behind, "Hey, Dr. Heidi," and the podcast, "Menopause Inscripted," which we did a swap, so I'm also on her podcast. What I appreciate most about Heidi's work is that it's deeply embodied. What I mean is that she really understands that pelvic health, hormones, and menopause aren't isolated body parts or events. There are expressions of the nervous system, lived experience, and how well we're able to stay in relationship with their bodies during change. And she brings science with her rigidity, honesty without drama, which I really like, and creates space for conversations that restore coherence rather than add that noise, that more noise that we don't want to have that causes incoherence. And so this is a grounded, real conversation about listening to the body, reducing resistance, and meeting this phase of life, "Paymentopause and Menopause" with awareness instead of fear. Heidi, welcome to the Coherence Code podcast. Thank you for having me. I'm so glad we're doing this swap today. Hey, too. And, you know, I get to interview a lot of people, and many have the professional experience. They're trained professionally and they have the knowledge. And then there's a few I have like you today that also have lived experience. So you have this history with fertility, diagnosed with premature orvarian sufficiency, cancer, medically induced menopause. You've done lots of integrative approaches for your healing. I really wanted to hear your stories. I think it's important for listeners because you've gone through it all. If you can kind of share your story before even the diagnosis and the labels, like when you were just hiding the pelvic floor PT, what was your relationship back then with your body, and how did you understand pelvic health back then just to start from there? Sure. So when I went to physiotherapies full down here in the States, we had one glass for one hour on one day on count of four PT and essentially serve to kind of just scare the daylights out of all the less thinking like this is not anything that any of us want to do. Now fast forward a number of years in my career and I kept having these patients that I would describe as the medical mystery patients where they get sent to me. And I know most of the last out shop is a physio because people were destined for a knee surgery or back surgery or hip surgery or some sort of pain people couldn't couldn't figure out. And I could tell you that nearly ever one of these people had seen maybe 10 physios before me and I saw them and went, hey listen, I'm still not the right person for you. I need you to go to pelvic floor physical therapy and because I hadn't been trained in the internal work, I was doing a lot of referring out to an internal work physiotherapist that was trained in pelvic health PT. And after a few years of this, I was like, this is really dumb. Why were we not taught this? And I need to learn how to integrate this as part of the rest of my care because the pelvic floor really is the basis of our core. And it's so integrated in with so many other aspects of our physical being. I went back and became a hermenean was trained pelvic floor physiotherapist so I can be doing this as part of my own practice. So the way I practice now and the way I think about my own body is that this is really just another muscle group inside of our body. It's just what we can't see very well. And helping people know where that is in their body, learn how to both relax it because so many of us hold so much tension there or trauma. And also how to utilize that for both general health, performance, return after pregnancy, dealing with symptoms as we're going into paramedics, menopause, as we come really integral to my practice. And I do see I would say mostly women for this. However, my male pelvic health patients almost always start an orthopedic condition that then has a pelvic health and bone to it, the only address here. So that was kind of my background. But then in my mid 30s, I started having symptoms myself that were originally diagnosed as primary and obi, I'm sorry, premature ovarian insufficiency P O I. And I was told that I was going into premature menopause at 37. The symptoms I was originally having was missed periods, really inconsistent periods, thought to problems with that. I went and saw my OB/GYN, my FSH was in the 50s. And then I was sent through traditional Chinese medicine, acupuncture, fertility clinic, and essentially self-propelled five practitioners who all agreed that this was what was going on. What we didn't know then was that I had this brain tumor that I've been growing and essentially was pan-kicking my hypothalamus. When I hear brain tumor, did they not look at your prolactin? Because sometimes those tumors push on that. Did you have high prolactin in the hindsight when they looked? I would have to go back to my lab so that there was nothing ever mentioned. But what I did ask at that time is, do you think that I have something wrong with my pituitary? Do you think that I need to do an MRI? Every person said your pituitary is fine. But it was. But my hypothalamus wasn't working so then, therefore, my nothing downstream could work as well. So a couple years later, then we get into mid-COVID times. And I started having left foot drop. And my PC brain wasn't tiny, so you see together and said, "Oh, I'm working full-time. We're essential workers down here. I'm treating patients. I'm not fitting treated. I'm powerlifting. I'm hiking on the weekends. I just have a pinch nerve in my low back." That went on for a few months, but then I had this incident where I really knew something was not right. And it's an incredibly boring story, so I won't go into it. But it essentially led me to calling my primary and saying, "Hey, listen, I think you need to scan my brain. There's something wrong. I don't know if I just had a stroke. I had TIA. I'm not sure what happened, but something is not right." So abundance of caution, can we do an MRI? Did you have intuitively something? There's that sense of something's not right. So what were some of your experiences, or was it just annoying? Or like, I know you had the foot drop, drop-seating, anything else? So what I've had migraines consistently since I was a teenager. And they were very kind of consistent with my hormonal cycles. I hadn't changed over the years, but since I was 17 and I was in 40, I had never once had a migraine that had resolved without an intervention. So the foot drop came on, simultaneously with the migraine aura. And five minutes later, footchop went away. Migraine aura went away with zero intervention. And that was the thing that was like, "There's something wrong, because this has never once happened to me. And is there something with my brain and my foot that are happening together?" And I started thinking like, "Maybe I'm having like little mini-shokes or something." I'm stressed and working out at time. Like, maybe there's something. And intuitively, I knew something wasn't right. So that was a Sunday. The following Wednesday, I got a brain scan and had it be quality told that I had a brain tumor, literally the size of a softball. And that had shifted my midline to the side in my brain, hypothelmusles, I basically pancate. And I had emergency brain surgery three weeks to the day later. One of the most interesting things for me was that I had the surgery, the pressure was removed, and my cycle completely normalized. So the P.O.I, premature menopause, everything just completely righted itself. Right. So that was a symptom of a structural issue in your brain. And that was why I was asking, you know, you talked about the hypothalamus, the pituitary binoff. Sometimes when they're, I'm sharing this with the audience, when people are missing their cycle of all the common and cheapest ways to evaluate, one of them is they're looking at the pituitary hormone prolactin, because their tumor can push on the pituitary when we get hyperlactin, which causes is a delay or no more ovulation. And if they have that, and stress can do that by the way, but a tumor can do that. And that's how we rule out something like that. To, you know, we always look at, do no harm. So when somebody's having a regular cycles, we rule things out, like make sure it's not the very bad stuff. And unfortunately you had the very bad thing, a tumor in your brain. - Yeah, and that just was never possible. So, and I don't harbor bad feelings about this time in my life because I really feel like, obviously, like I'm doing very well. So I feel like things maybe happen kind of at the right timing. And I think back then I'm going, okay, well, if we taught it then, you know, what I still got into the right surgeon and the right care team to take care of this. So I try not to harbor like a lot of bad feelings about it, but you know, you have to wonder, but there's more frustration about like, why didn't anyone just look? Especially when I asked, is there something wrong with my pituitary? And was told no. - Maybe they did look at your blood and your pituitary is normal, which is why they said probably not, right? Like you said, you don't harbor it because back crates resistance and doesn't serve you the blame game. So you have the surgery and that premature or very insufficiency diagnosis and all the weird stuff happening for your cycle change. So now you're back to ovulating again. You're no longer told you're menopausal. - You know, and at this point of that, my regularly like 27 days cycle on the nose every month. Things are fine. And so you recover from that surgery and I get 15 months of things are great. And I know more symptoms, nothing could trigger anything, but I'm just having brain scans every three months. And 15 months later, we saw that it was coming back and metastasizing and quite rapidly within like December to February. I had three separate tumors growing all at a fast rate. And at this point, I was up stage. You know, you're no longer stage two, you're now stage three. And so I had another brain surgery. And at this point, we knew that they were gonna want to do chemo and radiation. And I was told by my oncologist, which thankfully she was thinking this way too, as soon as you start this chemo, all bets are up. You're probably gonna go into chemically induced menopause. And there's this time and now or never. If you think you might wanna have kids, then this is the time. So, part of the interesting thing was that the one I was doing, and I skipped over this is that when I was doing that fertility set before surgery of one, the IVF drugs weren't working. It's due to every three months. I was doing acupuncture. I was doing all the things, but really my body wasn't responding. And like you've got that, it couldn't respond. You know, it couldn't respond to the medications. It couldn't respond to the other therapies because it didn't have an organ to go to. So after the pressure was off, my body responded to the meds. And I thought that was a really interesting thing. So I was like, oh, this is such a different experience in time one. So I got a couple of cycles in. And at that point, you know, the acupuncture was helping, you know, the drugs for working. I had a couple of successful cycles. And very literally the minute I started high dose chemo, the cycles stopped. I mean, that was it. There's nothing more. And that was the beginning of like a chemically induced menopause. And my particular experience with going into a menopausal transition was so abrupt that my symptoms were incredibly severe. So we kind of got from, you know, that October when that started to the following August. And we are left to put my, put me on HRT. And so my neuro oncologist was working hand in hand with my OBGYN to then start me on HRT so we can see. Was it my brain that was creating these symptoms? Was it hormones or was it my brain without the hormones? And I think that the third pain was really the big deal because as we know the brain has so many hormonal receptors. And I just had nothing left in its hang. So my experience with going on HRT was incredibly positive. And you know, in that time before, I mean, I've been trying to do every lifestyle factor I could to kind of try to combat this. And I still do do all of that. But adding in that hormonal replacement therapy for me was basically felt like it saved my life. So that brings us to now. - So you went through everything. So you've had IVF, so egg retrievals. You did lots of integration. You got your, you know, your train is a pelvic floor therapist, but you did acupuncture, some bodywork, sure some supplements, and even HRT, hormone replacement therapy. And now that you're still on the HRT now. - Yes. - And how did this shift now, how you practice? And how did it shift you? And where I'm going as so many people when there's life changing events like you have had, I call them wake up calls, like something happens. And it just shifts, you know, you take a new trajectory in your life, a new path because it's such a wake up call. And I never call them gifts. You know, some people say it's a gift even after, because I say, well, I like gifts, and I wouldn't ask for that. I call them opportunities. That's my, I'm pretty, I like to be, if I can, impeccable with language here on this part, they're opportunities. It happens to you. It is what is. I'm knowing you and doing some preparation before our interview, you're doing well because of it, I would say. And I'd like to hear, or have you share kind of how this was a wake up call, and has it changed you from Heidi before that diagnosis to Heidi now? How are you living, how you practice? - Absolutely. I feel like it was important to kind of backtrack a little bit and go into this and tell you that I have been doing a lot of self work and a lot of work on my mental health since I was in my 20s. So that was already a really big part of my life. And so I feel as though I came into this very mentally well and with a lot of tools for stress management and for just deliberate coping. And I have been an endurance athlete for a long time. And I have talked to a number of other friends of mine who have shared experiences being endurance athletes. And I've then also gone through different cancers and treatments like myself. And we've all agreed on the same thing that through that endurance activity and the stuff that we did before this and hopefully continue to still do, we essentially have learned how to be really comfortable of being uncomfortable. - Oh, that's key. You gotta say that again. - Yeah, I feel like we all agree that we've become really comfortable with being uncomfortable. To put it in a different phrase, one guy told me, we really know how to suffer better than other people. - Because endurance athletics, I mean, there's a certain amount of acceptance you have to have that this is gonna be type three fun. - You called it acceptance, I gotta unpack this 'cause we're gonna talk about this later in your episode with me. But in that notice, accept choose again, in my process, accept. So I'm gonna say, that's the key, being comfortable in your uncomfortableness. So you have to lean into this comfort. So Buddhism has a beautiful expression for this Heidi is pain is inevitable, suffering is optional. - I like that. - So endurance athletes, it's painful. You're experiencing the discomfort, but you're not fighting with it. Oh, why? Shouldn't be this way, I don't want to be this way. That creates the suffering when you're not accepting what is. So when I do my conscious work, the question I have is, are you willing to be uncomfortable? But now you have some agency. Like when you are doing endurance training or racing, you are choosing it. It hasn't forced upon you, right? It's still uncomfortable, but you've chosen it. So I call that letting go or acceptance, meaning, it's not that you're at peace in that unhappy situation or in this case, you're uncomfortable and you're accepting the discomfort. Therefore, that Buddhist expression, pain is inevitable, suffering is optional. It's uncomfortable, but you're not amplifying it by thinking, I don't want this, I shouldn't have this. - Or that, like, why is this happening to me or feeling like some sort of victim party, exactly? And reality when it comes to like a cancer treatment type of a thing is that I've been chosen to not deradiation in chemo. Like, I have that agency, but I was also informed by people who are way smarter than me about cancer, that for my condition, this is the recommended protocol that we have at this time. And obviously, medicine is always evolving and changing. So if I have to go through this again, the protocol might be different. I could better, might be worse, but I can kind of accept, do I want to fight this? And in that, there's going to be discomfort. Where do I want to let go and go? I'm done and I'm nowhere near that, you know, and I'm so fortunate that I have practitioners who really encouraged me to continue to live my life. And I always feel very fortunate that my doctors wanted me to do everything I could remain strong, encouraged me to continue to do my athletics and do my recreational pursuits. They encouraged me to work if I could versus kind of giving me to like, well, you're gonna be like carpet slippers in a bathroom here pretty soon. Could I have heard that too, where everyone's like expecting me to get sick? You know, and in some ways, I almost think like, I'm like a social perspective. If I had looked sick at some point or acted sick, maybe in a way socially, people would have been more comfortable with like my condition. But in no point did I kind of accept that like, stopping my life or being sick was what I wanted to do. And so I was kind of using that as a, this is how I want to approach this. And I want to approach it from like a perspective of I went into this healthy. I did everything I could to be healthy. I know how to be uncomfortable as an athlete. And I can accept that as comfort and I can continue to move forward. And I don't have to just wallow, you know, in this discomfort. I think there was one week during the entire thing that I missed work. And it was simply because I was so fatigued at that point that I like, there's no way I could work. But every other day I came in, I treated my patients, I did my athletics, I went for mental health hikes and did like, you know, forest time on the weekends. My dog, I can't stress this enough, having a dog. And no matter how crappy I felt on any given day, telling myself, I'm having a bad day, but I'm in make sure my dog has a really good day. He and I are gonna go for our walks and we're gonna get him outside and play. And I can focus on giving someone else a good day. Even you're just your dog, but like, I mean, he's my baby, right? And doing that and spending time and energy focusing on that versus focusing on me feeling crappy. I mean, it's just an absolute mental game changer. - You remind me of a book I read by, I was called Two Zays with Mori. I'm trying to think of the author now, but it's a famous book, Two Zays with Mori. I've read it a long time ago. - But he asked, 'cause I think he has Lugerix's ZZLS, the guy he's interviewing. And he says, I don't understand how you do this. You seem to have better attitude and life and spirit than most people and you're gonna die the most horrible way. And he says, oh, I feel sorry for myself, but I only give myself one hour a day. So I have my pity power for one hour. - Mm-hmm. - That's, 'cause again, we're not talking about spiritual bypass or denying here. He accepted it. So there's to me, I tell you, I see an AC everywhere, I notice it. He said, yeah. - He was able to accept, he was able to lean into, well, I don't like this, I hate this, that it, like, go through it. And then he chooses again. Now I'm gonna, like you, I'm gonna be with my dog. I'm gonna give my dog a great day. And so, 'cause you're not saying, if you're fatigued, you need to push through it. You're not saying that, right? - No. - But you were trained as an endurance athlete. So you've been trained to push yourself when you don't want to do something. And so you have that training physically and mentally, which a lot of people, unfortunately, who get cancer are an endurance athlete. So they need the extra support because they don't have the background. Like you said, in your 20s, you're already working this way mentally. And because of who you were, you had trained for cancer treatment. - Yeah. And that's the best thing I can tell, like a lot of people going into it, that it's like, you cannot in so many instances prevent the cancer from happening. Like you can be an on-smoker, sure. Those life self-actors, but there's a lot of cancers. It doesn't matter, you know, like if you're doing, you know, if you're being the healthiest of healthy. You know, and I think that that's something that we need to think about as we're aging too, is we're creating this resilience one more younger so that we can tackle things older, whether it be cancer or be a pro-sister, or what have you, you know, they're all chronic diseases. And so if we are stronger going into it and we're healthy both physically and mentally, you can then have the resilience then to get through it. - And this brings me to your menopause journey and your professional, like how you support women. And so, because you said there were resilience and I often think of you need to have that resilience capacity internally to go through menopause and menopause smoothly, right? - Yes. - And so then we'll talk about that possibly later, definitely on your episode with me. I really can talk about that. I want to hear your side of it. So you're a pelvic floor therapist and we often, in my clinic, we refer out to people like you for our endometriosis and pelvic pain patients. And then a lot of parent menopause, the women are having issues with urination, frequency, urgency. So what is your approach? And I'm actually gonna ask you some more questions around this. So I'm gonna wanna know about your approach, the urinal genital, like where you as a physio. Like, because some people with menopause go physiotherapists, like what, so I wanna bring that awareness to them. In my practice, I don't know if it's like your practice, but women that I'm seeing often have been dismissed on forcing the medical system by female and male physicians, by the way, it's not. And they come in because they just don't, they don't have hot flashes, night sweats, but they have other things. Brain fog, start to get skin rashes, vaginal itching, urination issues, painful sex. - In a sex. - In a sex, right? And they come in like with a medication for the pain, they come in with a medication for their depression, medication for their sleep. So there are a lot of different medications. I will usually assess them and say, oh, you're impairment a pause or it's menopausal related. So there's other ways we can address this. So I'm curious now, your way, like when somebody comes in with these cascades of symptoms, what is your approach? How do you assess them? You talk to people, you have tools for stress management, maybe you'll share some of those, but as a physiotherapist, who are you integrating with? What tools are you using to make sure these women feel heard and seeing and not just feel seen heard, but get assessed properly and get the medallys and treatments so they can stop suffering unnecessarily. - Sure. So during the first assessment, when I'm first meeting somebody, we probably talk like for 45 minutes out of an hour session. This is usually pretty unexpected for people, but I want to hear their story. I want to hear about their lifestyle. I want to hear about their complaints. I want to hear about their relationships. And oftentimes I start people with incredibly simple tools. Like what, when I say simple, I mean, not easy to do, but like the baseline foundational pieces. If women are coming in and they're telling me that they do nothing for stress management, I talk about with them about what are they, because you'll be willing to do that you like. Because the tools I use might not be the tools that you use, but I'll use myself as an example. Well, hey, this is what I do. What do you like to do? And I want to get them kind of thinking about like water things I could be doing to help to reduce my stress. The second thing I'd ask them about is diet, exercise and hydration, because I would say that the majority of my patients, especially when we're talking about like the paramedical and menopausal females, and then also like my postpartum mothers, which the postpartum moms are another big group that I see in the pelvic health space. They're eating terribly. They're not drinking enough water. So they're not feeling basic nutrition, they're not getting basic hydration, and they're getting a little to no movement. A lot of times they're very sedentary and they're high stress, whether that's because they've got a family, they're taking care of, and maybe they've got a newborn and two other kids at home. Maybe they got the newborn two other kids and they're trying to return to work. Maybe they don't feel like they're supported by their partner at home. And I want to hear those things because those help to clue me in as to what we have going on psychosocially that we need to address in order to make them whole and treat them as a whole person. And that might be professionals that are not me. Oftentimes I'm referring out to diatetics and nutritionists and I've been registered on nutritionists that I love to work with that I refer to often, especially for my older women, because this nutritionist is a 72 year old triathlete. And she walks the walk, but is the correct age. So instead of sending my patient in her their 70s and their 80s to a 20 year old, they feel much more connected to somebody who's more age appropriate. So I really like to send someone, and I try to match patients to other providers and I think are a great personality match as well as a match of what they need to learn professionally. The other things that I do during the first visit is I really wanna hear about what they've already tried, what's worked and what hasn't. So not trying to beat a dead horse. If you have already tried all of these things, I try to come in and think, what haven't we tried? If I'm the first stop, like first stop, then the other thing is that we're doing an initial assessment is looking at what, where do you have pain, like doing like a pelvic mat, with palpation if someone's comfortable and if they're not, we just wait until they are because I tell people, "I'm not here to add trauma for you." So if you're not comfortable doing a vaginal exam today, we just wait until you feel ready for that. You know, I'm a stranger to you. You might have walked to my door and five minutes later, I'm doing a vaginal exam and I understand that that can cause people a lot of stress tension trauma. And if I'm a perceived threat, we're not going to develop a good professional relationship. So if that's the case, we might be using external biofeedback to look, can they contract their pelvic floor at will, can they relax it? Can they coordinate their breath work with it? And can they do it that laying down, sitting and standing? And so we're starting usually with a lot of talking and just basics of where we are. And then that helps to guide me in terms of other professionals I might need to refer out to being a therapist. Sometimes that's a sex therapist. Sometimes that is somebody who does somatic therapy or cognitive behavioral therapy. You know, sometimes that is in orthopedic surgeon because I need to get them involved. Maybe that's a Euro-Gynecologist or some sort of other like a TYN who can help me do more internal testing that I don't have the ability for. Sometimes that's neurology because I suspect it might be some sort of neuropathic component. For someone maybe like myself who maybe had chemotherapy or something and there it be some sort of neuropathic pain. But then initial assessment kind of helps me to guide like what folks in the wheel I need to pull from to create a care team around that individual patient because I recognize that I can't do it all. But also it's a lot having to do with that first visit about making sure they feel seen and heard, making sure that they feel safe in my office. And I really try to have this be a warm safe space. And this is like a podcast background. So you can't really see my office. But every patient who comes in here, they're the only patient that I see for an hour. And the spaces there is once they come in. So once they come in, the spaces there is I want people to like just take a load off, be able to like have this be their space for that hour and really feel as though they have my one and one personal attention for that whole time. And I think that that's part of what makes me really different is that there isn't somebody on another partition of another wall, they can hear them. So they can really let it all go, whatever that is. And that allows me then to kind of start the process. And I think that my own personal experience bringing this in has really been, I started this practice because I wanted to treat patients the way I wanted to be treated as a patient. And that was before I ever turned into the patient per se, if I'm this avenue. But then that is only, my personal experience is only really increased my empathy and understanding for the difficulty of the exam, the difficulty of being patient in realizing that this isn't going to be something that just fixes self overnight, really understanding like the impacts on personal life. And I'll say this with like no, you know, hesitation that huge part of my conditions have become things I have to do with menopausal and like vaginally related issues that that has been a big part of my post chemo journey and recognizing how much that impacts my personal life and my relationship at home. And recognizing how these patients are going to be exact same thing and how alone I have felt multiple times because my peers and my best friends aren't going through this yet. So if I've had a patient coming to see me for something like that going, OK, this is how I felt in really trying to make sure that person does not feel the same way. And that has really led me into these other aspects my career, creating these online educational platforms and groups of trying to help women find community and helping them also to bring their partners and if their partners are willing to, so that their partners start to learn so that they can become better partners for their female counterpart so that the woman doesn't feel alone and crazy at home either. I think that's so important. I have so many men I see and a lot of my male patients who are not palved with four patients, they come in and they're telling me, oh my God, this is what's happening at home. And I'm like, let me tell you about something called perimenopausal. And almost universally, every single one of them is like, tell me more. I want to learn more. I want to learn how to be a better partner. In recognizing that we as women don't know enough, we as providers are learning because we had this kind of 20 year gap in knowledge that we weren't educated in school. So everyone's trying to play catch up. So if the doctors are trying to play catch up, the women are trying to learn, I want Earth, are there male partners who are trying to be more prone to this? Can a male partner, or if it's a female partner who isn't in the same life stage, how are they going to know? And helping to provide this educational resource to expand general knowledge base and be another voice of service here. And hoping that then this has the struggle down to the next generation that maybe they have more knowledge coming into this and can handle it better than we have. And certainly how my, you know, my elders are not. You know, the people are, your patients are so fortunate to have you because of your experience so you can have that empathy. And from the guys perspective, I have a large group of guys ago, who is regularly and all of our wives, either parent menopausal and menopausal. And there once was a discussion of all the wives, some of them have changed. And it wasn't a beat on your wife dinner. Few of them were genuinely scared of their wives, like what has happened? The rage. And after we chatted, people were experiencing-- one of the guys was so grateful we shared. Because he thought it was just isolated to his relationship. And he wasn't sure whether he should stay in the relationship or whether she wanted to-- like he just couldn't understand it. And then when he started to learn about what's this period of menopause, because a few of us are health professionals, he said, I can stay in it now. Like this doesn't last forever, but like no. And then how do you support her? And how do you not support her? Right? It became-- it was a really interesting conversation. He literally said, this is going to help, because he thought it was unfixable. And some, like basically an alien had taken over his wife and stopped the same person he was married to. He was like, I don't know what happened. But when he understood there was a shift happening, and more than what's happening, he stopped taking it personally. And now he could have empathy and compassion and patience and understanding. So this goes back to you being one of those people that people can go to. You understand you have a community. We'll put some of that information in the show notes so people can find you as well. There's two. I'm curious then, could you mention a bunch of different medalities? Have you or do you? Because you're physiotherapists. Do you ever do the acupuncture or dry kneeling for pelvic health? And low-level laser therapy, because I think of the pelvic one that's put out by fringe. Is that something that gets used in your practice? Because we offer that to patients. We don't use it in our practice. We offer it that they can buy and take home to use the pelvic one low-level laser therapy. And I'm curious about acupuncture and dry kneeling for pelvic health. So, dry kneeling and acupuncture is interesting. So California is one of the few states that does not allow physios to dry kneel legally. I did dry kneeling in Minnesota before I moved to California. And I moved out here in 2010 and has not changed in terms of legalities much to my dismembering. So I generally refer out to acupuncture for pelvic health because we simply can't do it. I'd love to. But we just simply legally can't do it. And with that being said, I refer out to acupuncturists often, whether it's your pelvic pain, your rapidly orthopedic pain, fertility, you name it. And I have several acupuncturists that I really like locally that I kind of have part of that scope of my network that I will add to the patient's care team. The low level laser therapy, the fringe wand. - Oh, let me follow. - I have my hair. And I refer to this very, very often. And I also, they're showing telephoto. - You both have a fringe wand, everybody. - Let me see, hold on, let me get my natch. It's like a lightsaber. - You know what I am? First started, I'm carrying the pelvic wand here. So I'm holding the pelvic wand. My side charged, but Tracy, a midwife, colleague, I made a post about the pelvic wand for my women patients, et cetera. There she goes, how do you hold it up? And it does blue, red and infrared. And I thought-- - Yes, it was like the high power. And then that's medium power. - That's red, yeah. And then you'd have-- - The blue, which is kind of hard to see on your up note to actually turn off, I'll say it. There you go. There's the blue, it's the sound of frame. - Yeah. - So I'm wanna curious, you're experienced with this and with patients, 'cause the people at fringe and Tracy were really excited about it. And we could talk a little bit about the mechanism of it. But I was sharing that Tracy, I was talking about, you know, blah, blah, blah, the women, the women, the women, and she posted, there's a place in Mankasik, there's two A, they do have a prostate and they do have issues with that. So I was like, fair enough. - Fair enough. And it is not very big. And like I'll tell you, like I was on the team helping with a physical divine of this. You helped design this. I did. And so I-- Great. Yeah. I was not on the side. It does like the science behind the lights and stuff. That was all them. But I have so many light therapy ones in my office right now. It looks slightly ridiculous because I was trying all the different-- the ones that were on the market. Because the whole idea here was how to make a better product, right? And we purposely made it. So there's a graduated end. So it's a narrower before it gets wider. Because so many of the other ones were so wide, if you've got somebody who's coming in with pelvic pain, that looks incredibly intimidating, or is just not doable. And so I will use this with patients often. Like in now, I'm clinical, I'll have them get them for at home. But sometimes, I tell people start with a light therapy panel that they're shining externally in between their legs for the red light therapy. Because they might need more superficial care. And they might need more superficial inflammation reduction before they can do something internally. But as we know, proximity matters. And so it's awfully hard to get light therapy at a low level into the vaginal tissues from the outside. So sometimes we need to do more of the labia. We need to do more of the vulva and that like vaginal introidus. So we'll do light from the outside. And I may instruct somebody that you're going to do light from the outside and use a much smaller dilator kit to get started, especially when we're dealing with the vaginal pain issue, if I'm wanting to add light therapy in. And then from there, once they graduate to a dilator kit size, if that they can use light therapy internationally, I think it's a fabulous treatment, both for vaginal dryness, vaginal inflammation, pain of sex, lubrication, because dryness becomes such a problem with paramanopausal menopausal and postpartum. And we don't want to forget about that. The reduction in estrogen postpartum can really create that vaginal dryness and discomfort as well. As well, someone has a vaginal birth, the healing internally that might need to be happening. And I love the fact that you can let this one sit in the internal canal. You can just let it sit there. Or you can also use that end. We made it a kind of a gentle palpating end. So people can actually use that for trigger point release and therapy and vaginal stretching internally of those internal muscles that are very difficult to stretch and can open up externally. And it's easier to access through the vaginal canal. And I actually just recommended this for the blue light therapy specifically to a patient yesterday who's been dealing with chronic recurrent bacterial vaginosis. And the blue light, because of the antimicrobial effects, is fabulous for things like chronic yeast. Or if you've got something that has to do with a BV and just helping to normalize and regulate that vaginal pH, which again can get off because of hormonal shifts and changes. - Yeah, when we brought this in, we were excited about it because A, for our paramanopausal menopausal women, as you're sharing blood flow lubrication, but my endometriosis pelvic pain patients. And then theoretically fertility, 'cause with light, as there's distance, it loses its power, its edge, right? And there's an inverse relationship and with distance to the target tissue. So right now currently light therapy for fertility is over the lower abdomen in the sacrum. But there's a lot of distance to get to. And if you have a probe, you push into the abdomen, try and get close to the ovaries. But it was an REI many years ago when I gave a presentation on light therapy for fertility, he said, well, why don't you just put a laser diode on the end of the camera that we do for an egg retrieval, but rather than an edel, it's a diode and just pointed out the ovaries. - And it doesn't exist. - That would be great. And when this was, when I saw this, I was like, here's an opportunity to put light into the pelvic bowl through the vaginal wall, 'cause it's thinner. This, I mean, nobody studied it. So I don't know the benefits, but theoretically, this looks great. I did take their device and we have a light reader for photons. - F-ish. - 'Cause a lot of them that I, people bring to me to assess my patients, I can't get a reading off of them, meaning they're not sufficient in power given off photons, 'cause the photons have to reach the target tissue to have benefit. The fringe wand does. So I can, we had a read. - That's awesome. - Now I'm seeing this as an opportunity for pelvic health, pelvic pain, and then menopausal women and potential infertility. So it's a really interesting device. And like you said, it's got blue, red, and red combined with infrared. So three options to use it. - And I, I'll tell you two, 'cause I have no TMI, with my own personal pelvic health stuff, I use the wand of myself. Because of having all of these chemo-related vaginitis, you know, vaginitis and vaginitis types of things, I think this has really made a big difference for me. And I have no problem saying that, because I have tried probably every device on the market at this point. And this one has not only helped more with the pain, but also the inflammation I've been having, and some of the modulation of the neuropathic pain. And right now I'm not trying to retrieve more agnorm I'm trying to get pregnant, but like, those things have been such a gift. And so I've, you know, give, I've, we've fur these to patients often, because I think that it really is a fantastic device. And opportunities for us to get into those deeper tissues, and you mentioned Endo, and I hadn't mentioned that before, but that part of it. And I also think even some things like potentially like, like, interstitial cystitis or things where you could like, have bladder, stuff where like having, you know, overactive bladder, just because you can get it closer from a different angle, and getting it kind of towards that bladder neck could also be helpful. - So the light therapy for IC, so interstitial cystitis, as you mentioned, just externally, where we give the array and they place it on the lower abdomen over the pubic bone in the sacrum, we've been able to get great resolution for that for patients. And I haven't had patients try this yet, but yes, theoretically, it even be better if you got it closer, so, intravaginally would be really beneficial. For our Canadians, we buy, 'cause of the tariffs we had now having got them, by the end of the day and the exchange rate, we often buy some bulk orders, so we can keep them cheaper than if you go directly to the, to their site. So checking with us, we go in and out of supplies for people that are getting kind of that, just to let you know especially in the Vancouver area. And for the acupuncture, I do wanna share, it's unfortunate that you can't practice that in California, but I will share on the site that I run the platform, Healthy Seminars, we have an acupuncturist in California named Denise Weezner, trained as an acupuncturist, and trained in dry meddling, and her whole thing is on pelvic health, pelvic floor health. And so she has a course in Healthy Seminars for physios and acupuncturists that wanna learn to treat pelvic, pelvic pain, and she teaches a combined dry meddling approach and traditional acupuncture using distal points as well, just to shadow for those that are interested in acupuncture. And if you're looking for some of your colleagues to get trained, that's available on Healthy Through Denise Weezner. - I appreciate that, and trust me the minutes that we're allowed to do it here, I'm gonna be taking a pelvic pain force, because I get in least two emails a day, I will come join the seminar for dry meddling, for pelvic pain, I would love to. I believe you can't do it here. I'm like, in a minute I can, or if I move state, I will absolutely do it. - So what do you think from the nervous, 'cause you talked about tools for stress, and I often see, and I'll share with you my observation for women in paramedics and menopause, I often share that it's not just the hormones, like the underlying causes not so much the hormones, and I say this way, is that if it was the hormones shift as the issue, then every woman would have symptoms, and pretty much the same symptoms. But we know some women, the usually expression, sail through paramedic, menopause, menopause, and some people don't. And what I share, and I bring this in from my clinical diagnosis background, and it's a clinical, a therapist in conscious work, and Chinese medicine, is this idea of resilience, you brought up this word resilience here as well. When there's, and this is on a cellular level, so it's not like, you know, it's the biology part here. If there's resilience in the body, then it has the capacity to deal with change. We're all familiar with external change, change in work, change in city, relationship change. That's obvious. But there's internal changes happening all the time, that we don't even know because the autonomic nervous system is dealing with everything. And what I see with paramedic, menopause, which is why I like to address the resilience part, is all of a sudden you're having fluctuating estrogens in paramedic, with a decline in progesterone. And then in menopause, like in your case, medically induced, you actually have a drop now in estrogen progesterone. That's a change. And if your body does not have the internal resilience, and I don't know why, there's not a judgment here. It's just that the body's giving you messages, then you don't have the capacity to deal with the change, and now you suffer. So first of all, I don't know if that aligns with you, or it resonates with you. And if it doesn't, let's discuss what is part of your approach, because we talk a lot, and people are pretty getting familiar with the physical approaches. Oh, I can do dry needle, we can do PT, we can take HRT. There's all these things that can help a lot. And it may not be actually addressing the underlying underlying cause, but you got relief. So I'm all for that. The reason I say the underlying cause is, if we just treat and the symptoms go away by giving you hormones and your hormones are balanced. This is great. You sleep well at night, you got your mental capacity, everything feels good, but at that internal resilience is low. Then at 70 or 75, now new diseases are going to show up because that underlying resilience was never addressed. And as we age, we're going to have a less resilience capacity and then there's more breakdown. If we address the resilience in our 40s and 50s and learn to maintain that, then we live well longer. And so, how do you look at the mental, spiritual, or the autonomic nervous system approach, if at all? And my idea of resilience and capacity to adapt to the internal hormonal shifts, is that something that you've seen or is there agreement or disagreement on that? I absolutely agree. And I can tell you, like, it's probably the same things for myself that I also impart about my patients. And again, I like to use myself as a personal example and then just say, listen, this is what I do. And these are my tools, but like, what do you like to do? Because I'm not going to push me onto them. But the things that I like to do is I have the first thing I'd say is exercise. The second thing I say is time outdoors. The third thing I say is friendships and relationships. Exercise, I power lift. And that's like, I like to lift heavy. It helps me present and focused. And for me, it's like a movement, a meditation through movement. You know, some people like to do yoga. I don't like just like yoga at all. But when I'm lifting heavy and I have to be very focused in presence, I'm doing this thing right here right now. It helps me to kind of ground, recenter, be super focused and then get all the happy hormones afterwards. So having a consistent lifting practice has been very helpful for me because again, for me, it's meditation through movement. And it's just being very focused and present in the moment. The second main thing that I do for exercise, which also coincides with my time outdoors, currently is hiking. And my best friend here in California, she and I hike almost every single Sunday, anywhere from five miles to 20 miles, just depending on how we're feeling, weather, etc. And we call it our like cortisol reduction walks. You know, we're not going for time. We're not sprinting. We like look at flowers and we're looking at the rocks. We're solving the world's problems like through like talking for five hours. I dog those with us, you know, until we're just outside enjoying nature for a day. And that reset on Sundays before starting my week is just invaluable. In the weeks, we miss it for whatever reason. I feel at the entire week. And then that kind of also goes into friendship time and having very solid friends and an economic emotional support group. And I am very fortunate in the fact that I have very good, very long term friends, especially for me, having my solid female friendships and having had that like support through these, you know, through these difficult times and just on a daily daily basis and having time speaking with friends, talking with friends, talking through, you know, what's going on our lives. And having that support, I think is really the big, I want my big three. And of course, there's other things, you know, but those are kind of my big three. It's like exercise time outside friendship connection. Yeah, I'll summarize that because it lines with kind of the Chinese medicine ideas well and we'll be doing our practice. So movement, and you talk to a different type of movement, community, and then getting outdoors, you know, being in nature, getting your morning sunlight and just fresh air. So yeah, and those are the simple things in Chinese medicine. Lifestyles, one of the pillars of Chinese medicine, right? Diet, lifestyle, movement, rest, sleep, and then stress management, like community, connectivity with other people. So you're doing it. And that third one, well, I guess any of these three pillars are things I see break down with patients that are struggling with their own resilience. But of those three, the thing that I see the most clinically is people not having that connectivity and having that that support and people feeling isolated, especially with my older folks who feel like they're kind of increasingly isolated on my younger folks that they just get really like isolated for whatever reason. That is the one thing that I try so hard and there's nothing I can really do about it, but I can encourage people to find ways and help to find them, get them to find tools to find groups to connect with and get out of their own heads and have that connectivity because when that fails and when that's lacking in my patients' lives, they really feel it and I really see it in clinic. You know, you have an abundance of clinical experience and knowledge. As we wrap up, what would you like to share from the host of menopause and scripted? What would you like to share with this population of just any closing remarks or suggestions advice and also where they can find you? Yes. So you can find me at www.heydoctorjustdrhey.com or menopause unscripted. Either those places were on all social. If you want to come and watch the podcast, there's a video podcast on YouTube. It's on every other channel you can imagine. And the conversations in both of these spaces really have to do with midlife women's health. But don't be thrown out of the fact that I say women because again, it's very inclusive. If you are a gentleman or if you're with a female partner who's going through this and you aren't, you can certainly learn a lot to how to be a better supportive partner. So that's what you can find me. But you're welcome to come in if you've happened to be in a Los Angeles area. I do also do virtuals for people as well. They recognize that a lot of people may live in an area where finding a pelvic floor physical therapist is challenging. I'm happy to help you that way as well. And in terms of last closing notes, I just really encourage people to learn more about what they're going through and become more educated as a consumer so that you can be a better advocate for yourself with your healthcare providers. Learn some questions and go into your doctor's visits with a list of questions. So you get the questions you have answered and you go out leaving feeling as though you've been seen and heard because a lot of times, if you don't know the questions to ask, then you don't get the information you're actually seeking. And so I think going in and having some preparation for that visit is really helpful because we all do need to be our best, you know, own best self advocates. Yeah, it'd be an advocate. And I like when patients come organized with the list and then they wrap it up fire. It's like great. Yeah. It's nice to be organized. I appreciate it. Dr. Heidi, I want to say thank you very much. A for sharing your personal story and then bringing it to your community. So they get to benefit and heal and thrive. So thank you very much. Everybody, we will put all those links. Social media or websites are going to be in the show notes. So do check that out as well. I'll ask my team to put information about that pelvic wand as well if you're interested. No more about that. And we've we're doing Dennis swap. So I'm also on Heidi's podcast. So that men in positive scripted you can see what we talk about over there on hers as well. Heidi, thank you very much for today. Thank you so much for having me. I look forward to seeing you in like one minute. Thank you for spending this time with us on the coherence code podcast. I'm Dr. Lauren Brown and I will see you next week for another conversation on coherence and healing. If this conversation resonated with you, please like, subscribe or follow the show and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect and stay connected. Welcome to the coherence code podcast.