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Better pelvic healthcare starts now. If you’ve been one of the many women (or men) who struggle with pelvic health conditions, you’ve likely been cast aside or medically gaslit. These events are all too common in our medical system today, and leave you with continued pain or dysfunction and without answers or tools to make a difference to your symptoms.
If this has happened to you, or a loved one, we are sorry. Truly, deeply, sorry that you had to suffer longer than necessary. But today, we offer some hope. Better pelvic healthcare isn’t something we have to wait decades for…it’s available right now!
There are so many amazing, knowledgeable and compassionate people in healthcare that can provide you with real solutions to your very real problems. In this interview with Dr. Holly Tanner, we help you learn the right questions to ask and the right people to look for so that you can get the better pelvic healthcare that you deserve.
Listen or watch the full episode today!
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Holly Tanner is a licensed physical therapist and massage therapist with specialty practice in the field of pelvic health. From the College of St. Scholastica (CSS) in Duluth, Minnesota she earned her undergraduate degree in Health Sciences, Master of Arts in Physical Therapy, and a Doctor of Physical Therapy. She has served as adjunct faculty at St. Scholastica as well as at the University of Puget Sound in Tacoma, Washington.
As the Director of Education for the Herman & Wallace Pelvic Rehab Institute, Holly has managed and developed curriculum and faculty training and was the coordinator for the Pelvic Rehabilitation Practitioner Certification writing. She has authored many courses including in the peripartum series and the Men’s Pelvic Health course. She has presented at several state chapters and for the APTA combined sections meeting as well as the first Pelvicon conference.
Holly has taught in several countries including Nepal, Israel, and Ireland.
She owns a clinical practice in Seattle, Washington as well as a consulting company, Tanner Therapies. She has been teaching in the field of pelvic health for nearly 25 years and has mentored dozens of clinicians and students. Holly has held ABPTS board certifications in Orthopedics and Women’s Health, as well as certification as an APTA Clinical Instructor.
0:00 Dr. Ginger Garner: Hi, everyone, and welcome. I am thrilled to have an amazing colleague here with me today, Dr. Holly Tanner. Holly, welcome.
0:13 Dr. Holly Tanner: Thank you. Happy to be here.
0:14 Dr. Ginger Garner: I’m so glad that you’re here. I want to give you guys a little bit of background on her first. We are going to be talking about, gosh, all things pelvic health. So, you know, strap on and get ready to listen. Holly has all kinds of accolades and has earned all kinds of degrees, specializations, etc. We’re gonna we’re going to get through part of the list here.
But she is a physical therapist and a massage therapist in the area of pelvic health. She has her undergrad degree from College of St. Scholastica in Minnesota in Health Sciences, a Master of Arts in Physical Therapy and a Doctor of Physical Therapy, and she serves as adjunct faculty in a couple of different places.
She’s also Director of Education for Herman Wallace Pelvic Rehab Institute. She has been managing, developing curriculum and faculty training for a long time. She’s authored many courses. She teaches many courses in the peripartum series and men’s pelvic health. She has presented at state conferences as well as the first Pelvicon conference, and she has taught internationally in places like Nepal, Israel, and Ireland. Holly owns her own practice in Seattle and a consulting company, Tanner Therapies, and she’s been teaching for a quarter of a century, nearly so, and has mentored so many clinicians and students.
And she has many specialty certifications, one of those being in women’s health. But I want to get down to the nitty gritty of her brilliance. And so I’ll let you guys read the rest of that online if you go to HermanWallace.com. So HermanWallace.com. and look her up, but also flowrehab.com. Is that correct?
2:12 Dr. Holly Tanner: Yeah. Correct.
2:14 Dr. Ginger Garner: So don’t miss out on checking out those links. Before we hit record, Holly, we were talking about some very interesting topics. It’s things that have hit us personally and are meaningful to us professionally, but you are sharing a story that I would love to go back and revisit and have you share with everyone. And it was born out of this phrase, of healthcare looking at us as our problem instead of us as a person. And I think that many of us probably have personal experience with that, but would you share that story?
03:09 Dr. Holly Tanner: You bet. And thank you, Ginger. I think that you and I often see eye to eye and aren’t afraid to confront situations of unfairness and let our good feminist vibes come forward from time to time, which I think is really good for our profession.
So recently I worked with a patient who, um, has a very, very well regarded job. And anyone would look at this person and think, oh, this is a high achieving human who has experienced a lot of success. And again, our society would judge this person very favorably. And they unfortunately had been dealing with a very serious medical disease that sidelined their work, their often very vigorous physical activities and goals. And they presented with just a lot of almost fragility, if you will, you know, in terms of things could flare them easily. And they were very concerned about what we did at what intensity.
And so on the second visit, I said, you know, since you haven’t been able to be as physically active as you’re used to being, how are you keeping your brain engaged? And he said, you are the first person to ask me that. And he started saying, so I’ve been learning, I’ve been studying languages, I’ve been doing this, I try to do that. So it really struck me that here’s a person and this is a medical provider we’re talking about.
And here’s a person who is seeing colleagues and being among a lot of folks and never got the opportunity to have someone look at him and say, Huh. Your sense of self may have shifted. Your perception of how society views your value and your contributions might have changed. How have you managed that? How have you dealt with that? How have you continued to keep your very active intellect stimulated? And that was just another one of those moments of recognition that we have such power. We hold such power and it often comes through that recognition of other people as humans who are having this very human experience that could be entirely different from what it looks like on the outside. And it’s through our language and through our communication that we just hold this immense power.
And we can create these connections with people that go so far beyond the clinical skills or acumen that we hold, right? It’s that I see you. I honor you, I value you. And because I think we hold that power and these are skills we can all learn, especially if we’re willing to dig into our own stuff and quote unquote, do the work and find out when ego is driving our bus and all those kinds of things, be willing to confront our own fears and challenges and grow from that.
You know, this is a person who then I also looked at and I said, I noticed you doing this. I’d like you to challenge yourself a little bit and try overcoming the natural fear that might have come from some of these pain experiences. I’d encourage you to try a little bit more of this. Does that sound safe to you? And they looked at me and said, I can do that. And I think it’s because we had built that trust that this person was able to say, well, I don’t feel judged that you’re saying I’m doing this avoided behavior and also I feel a bit encouraged and hopeful and brave to try this thing that I might not otherwise have wanted to try.
That is the kind of thing that we tend to see, is the medical system checking off their boxes, oh, you don’t have a tumor, you don’t have an infection, or we’ve given you the medication and a prognosis. What else is there?
Well, there’s that huge helping of humanity. And again, recognizing that people may be struggling just with that sense of self and who they are. And I think you would agree with me a lot. And I’ll let you take the lead here on where you want to go next. But so many times when we’re working with people, it is truly about, again, holding witness, holding space for what they’re dealing with, so far beyond the fact that they might even not heal in our presence. They might not make any progress.
But if we take that opportunity to say, again, I see you, I hear you, I am not necessarily sure what your next step looks like. But I am interested in being available to you if there’s something I can do to be helpful.
08:02 Dr. Ginger Garner: You know, yeah. One thing you just mentioned really hit home with me because I know that anyone in the healthcare system long enough, not as a provider, but as a consumer, as a patient, as a person in the healthcare system, will have felt that some provider or practitioner they were seeing was not present and maybe the ego was driving the bus, as you mentioned.
And that tends to happen so much, and we’ll talk about different populations and people, but let’s start off with the most classic definition of that. If you look in the research and look at statistics, you don’t have to look very deep to see that medical gaslighting is rather rampant among women. Women of color, people of color, transgender people, and the LGBTQIA community. But at the top of that list, it starts with gender.
And so if we start there, what for everyone listening, you know, what does it look like when someone when a provider’s ego is driving the bus? I think that’s probably worth talking about. Because if I wasn’t in healthcare, it based on what I’ve experienced alone, it would be terrifying to go in and think that I’m going to get the best care that I need if I didn’t know what care I should need before I walk in the door.
09:38 Dr. Holly Tanner: That’s a really great question because I think we can start to help people fast track a little bit. And there are times that a person presenting as a patient needs that particular provider. Maybe the person they’re working with is the only endocrinologist in town and there really isn’t an option to go anywhere else. They may need to maintain that relationship with that person out of their own survival and needs.
But let’s say you’re talking about a gynecologist, and the gynecologist says, you have this condition, we need to rule out these, you know, these things that might need further medical intervention. Oh, hey, we did these tests that came back negative. And the person says, and I still don’t feel well.
That’s the crucial point where I feel like, you know, the patient might not know what it is they need. They might not know, do they need a different test? Do they need some supplementation? Do they need, you know, whatever that might be. Is that provider then going to help dig in?
And this is where I feel that the patient might be able to try and figure out, can this person help me? And if not, rather than digging in and saying, but I’m asking for this, you’re supposed to give me this, you’re supposed to care about me. Instead of that, we instantly look at that person and say, thank you for what you’ve done for me.
And move to the next person and say, this is what I’m hoping to feel like. You know, do you have some tools to help me with that? And I don’t think enough medical providers are comfortable looking at someone saying, you do need, you deserve more support. I don’t think I have the tools to help you. I’ve written down a couple names of people that my patients have really liked working with. Does it interest you to chat with them?
Right, so I think finding out which providers are passionate about certain topics. And this, I feel like I’ve known this for, you know, almost 30 years. If you want to talk to a provider about hormones, you find the provider who likes talking about hormones, right? Because otherwise they’re just going to like, your numbers are in the normal range. And we know that that kind of data doesn’t tell the whole story.
You know, this is a little bit of a segue, but I just started reading a marvelous book about the thyroid and it’s like rethinking thyroid health. And this physician who was on the side of being a medical gaslighter is coming forth and saying, I apologize, I was wrong. Because the abbreviated story is that some people’s bodies are good at converting T4 to T3. Some people’s bodies are not as good and they benefit from having a little bit of T3 supplementation, right?
And I know over the years, uh, having, I had a thyroid surgery in 2004 for cancer. And I remember hearing some inklings of this over the years. And I would go to an endocrinologist and I’d say, is there anything to this, you know, T3 supplementation? Oh, you don’t need that: convert T4 to T3, that’s all you need is your synthetic hormones.
And now this provider is saying, you know what? I finally listened to some of my colleagues and looked at the abundant research to learn that some people’s bodies function so much better if they can have a little bit of both. And it’s that kind of story that I hope keeps repeating itself. Not, hey, you know, we unfortunately disregarded a lot of people’s lack of wellness and didn’t listen to them. Even when they said they felt better in a little T3.
And so what happens is these people who aren’t getting their needs met, they’re going and talking to functional medicine practitioners, the naturopaths, these other folks who are going to look at them and say, hmm, let’s dig in. Let’s be curious. Let’s try a couple of things. Are you willing to try a couple of things? What’s your gut feel? You know, really leaning into what does the patient want? What’s their nudge about what has worked and what are they curious about trying? And is that safe? Right?
And so to me, that’s such a great example of all these people over decades. And you know what it comes down to? An amazing study that had financial implications from the drug companies that suppressed research that was done in a university contractually, so you can’t release the results of this work.
And now that folks have gone back, they’ve changed how drug companies can create those kinds of contracts, because in fact, it showed that some people did have better effects from having some T3 supplementation. So that’s, to me, that’s just like one amazing story of someone coming full circle and saying, oof, I was a part of that committee that actually created these guidelines. And I would tell patients the same things that now I know are not helpful.
And again, I’m saying women, because it was a lot of these women in the study that were studies that were reported on, but, but anyone who isn’t feeling their best self deserves to have the opportunity to work with providers who are passionate and are curious. And as soon as someone, you know, shuts a patient down, I feel like it’s an opportunity. If you have the privilege and the luxury of being able to burn that bridge, to say, I don’t feel like my needs are getting met. I’m not angry about it. I’m so curious, though, if there’s some other things that you think we could try together. I’d like to know if you have some ideas.
If we can come at it from that lack of frustration, which is very difficult to do, but just to say, This isn’t working for me. Have you heard about some other things? Because I think you would acknowledge this is 100% true. So many times these patients, whether it’s after a knee surgery or a prolapse surgery or anything else, they’ll say, what do you think about sending me to physical therapy? And the medical provider will go, Oh, sure, would you like to do that? And the patient’s sitting there thinking like, yeah, why wasn’t this recommended three years ago, three months ago? Why didn’t you bring it up?
So the providers sometimes are willing. It just didn’t occur to them. It isn’t just a natural part of their practice pattern for whatever reason. So I think having these conversations hopefully don’t have to feel that confrontational. But again, as you mentioned, you know, there’s a lot of bias in healthcare. And certainly, you know, the color of a person’s skin is going to absolutely 100% affect whether or not they feel safe in challenging a medical provider or in burning a bridge for someone who, again, might be giving them life saving medications or procedures.
16:32 Dr. Ginger Garner: Yeah. And there are so many conditions and maybe we should just, um, rattle off a few of those conditions since you and I work in, in this particular, you know, industry where gaslighting is happening pretty often in pelvic health, because we have a lack of standards of care for post-op abdominal surgeries like hysterectomy or myomectomy or, C-section, and certainly just postpartum in general.
So, I’ll start with a few and then you can throw out some more, I’m sure. One of the most common things that I see, and I had someone in last week who said, well, I’m of a certain age. I am postmenopausal. And I asked my OBGYN about hormone replacement. And, she said, well, we don’t do that unless you have, um, hot flashes or night sweats. That’s it. And that was the end of the conversation.
And so as the person, as the patient sitting there in the patient hot seat, you may feel inclined to just say, oh, OK, well, they must be right. But instead, we have to question that and know that’s also not good science for them to answer in that way and say we only prescribe hormones for A or B, which is not really relevant when you’re talking about the importance of and safety of hormone replacement. Looking at the current literature and what it says now, which does not support that statement.
And then I’ve also heard a statement many times over of, we don’t even test hormones because it doesn’t matter. When we know that it does and blood serum measure in that capacity. So if you’re looking at a blood test to measure hormones, doesn’t matter as much, whereas urine testing, you get a 24 hour portrait, And then you can look at how well your hormones are being metabolized. So if you’re listening and you’ve gotten that answer. It is a bad answer because testing hormones is valid. Hormone replacement is prescribed for many different reasons. And it is never just because you’re having some transient hot flashes.
So that’s the first thing you could question. You could definitely take the approach of, you know, controlling frustration saying, Well, I have heard of this. And are you willing to consider this? Or have you heard of this test before? Or you can also, you know, push back or just simply not return to that provider. I mean, I think I’ve called that quiet quitting your health care provider before, instead of it being confrontational, because you usually will feel pretty soon into the conversation, whether or not you’re being dismissed or invalidated or, you know, otherwise.
So I just wanted to bring up the hormone conversation first, because science has vastly shifted since the first flawed study was done that said, all HRT is bad, which isn’t true.
19:46 Dr. Holly Tanner: Absolutely. And that’s also one of the frustrating things about the medical sciences is that we can be victims of just not knowing enough yet to have had the opportunity to be on HRT for bone health or those kinds of things, because we just, you know, we’re coming into those healthcare questions at certain time points.
20:12 Dr. Ginger Garner: Yeah. So we are at this time in 2023 have patients and people that come to us and they’re a victim of that gap where bad science would say never replace and it increases your risk of breast cancer, which we know is not true. And it was based on synthetics. It was based on estradiol only. It was based on things that are now debunked.
But now you have a generation of women coming in who missed that window for care. And so other things are happening too. We don’t even have to, you know, bio identical or hormone replacement is one one issue, but then you also have women with prolapse and tissue issues, continence issues that are also a product of that generation that missed getting pelvic care in the way that it’s available now.
So what are some of the things that you hear? Some of the stories that you hear that we could share with the listener that would help direct them to know, when do I need to get care? When is this prolapse thing a problem? Like, when should I push back? What question should I ask to make sure that…And I’ll give you an example. This is a good feeder. I had someone coming last coming last week. And She had booked an appointment after talking to me on the phone first, because I do free consults, and she said, my OB-GYN did an exam. He said it was a rectocele, and not to worry about it, and we’ll just watch it and see what happens. She was like, I didn’t think that that was a good answer. So that’s why I called you.
And she came in last week and we’re moving along with all of that. But a person could get that answer. Oh, you have a prolapse? Yeah, we’ll just watch it. That kind of thing. So what would you say to that person? What questions should they ask? What should they do at that point?
22:15 Dr. Holly Tanner: Well, if you’re in a state with self-referral, go directly to rehab, you know. And that is one of the lovely things that has happened for our profession, of course, is that patients can come directly to us. And obviously we want to know that they have seen a medical provider to screen for things that need screening. But beyond that point, if they don’t need to have a physician referral, that’s always fortunate.
You know, you’d asked about what other conditions or scenarios are a lot of women experiencing gaslighting during, and as you mentioned, it isn’t just women. I mean, I can think of, you know, these men who have post vasectomy pain syndrome, and they’ll go back into their surgeon and the surgeon says, well, there’s no infection, so this couldn’t be causing your pain.
And I had the opportunity to work with Dr. John Fair, urologist, and he had the most honest and frank approach with patients, almost comic, probably further, if you’re on the receiving end, it might’ve been a little bit too frank. But he would say things to patients like, “hey, during the vasectomy, I was digging around for your, you know, for your vas deferens on the left side and turns out congenitally, you don’t have one, but I was digging around. So that’s probably why you have this pain. So therefore, go see rehab.” Or he’d say, “Hey, during your prostatectomy, I nicked this nerve and that’s why you’ve got this weakness. So I want you to go to rehab.”
I mean, it was so helpful. to have that type of honesty and just direct acknowledgement of what was going on. And I can think of so many patients who I think of a woman who would come in and she had so much pain and all this pelvic dysfunction, and she would lie on the table and she would literally just sort of, oh, she would moan and, oh, and be weepy and just so, uh, you know, having so much emotion tied to the pain and her husband would kind of stand off to the side and look at me almost apologetically like, oh, sorry, you know, this is just this overreaction, you know, dealing with this all the time. And I said to them, you know, we always have to leave space for there being something really serious going on here.
And so I don’t know if it was, it was many years ago, but I don’t know if it was an MRI or getting her to, I think it was just a different referral. I said, why don’t you follow up with this particular person? They’re, they’re really good at sleuthing out the tough stuff. And it turns out she had a space-occupying lesion in her spinal cord. And yeah, that was causing all of her pain. And it’s that type of situation and scenario that patients can be stuck in. And it isn’t someone just being overreactive, not being able to manage their pain, et cetera.
Another patient recently, a young woman, I think occult hernias is another one of those conditions where people are just having these really deep, especially women will have these really deep hernias that are causing a lot of their symptoms, neuralgias and other pains. And the medical community looks at them and says, there’s nothing wrong with you. You know, just learn to live with it. Right. And there was a young woman who had gone to, I had sent her to a doctor to be evaluated for possible hydro dissection. Cause she definitely had some nerve irritation in her lower abdomen and, and vulvar her area.
And the physician was very brilliant while she was doing the ultrasound to consider the hydro dissection said, “Oh, look at this hernia.” So the doctor sent this patient to a colleague for a hernia consult patient walked in and the doctor said, you don’t have a hernia. And it was just so baffling. And yet this young woman is very bright, was very aware of medical gaslighting. And here’s this provider who had received a referral, including video evidence of this person having a hernia. I mean, even I could see it, having not been trained on looking for these, once it was pointed out to me, of course.
And so that type of experience. And then, when this person mentioned, oh, do you know Dr. Tofi down in California, who’s this brilliant surgeon who does these corrections, that same physician said, oh yeah, oh, she’s amazing. That’s great. So this disconnect between the fact that these hernias can be difficult to find, they can be repaired, having been referred, anyway, that’s again, another example of why was she told she didn’t have a hernia when a colleague, a brilliant colleague had observed and documented it and then create that referral. What’s the value? Do you think that patient would have felt safe having that doctor do their surgical repair? If they don’t even believe you have something.
27:13 Dr. Ginger Garner: I had, I actually had, it brings up a personal story for me because I often see, and I’ve caught anemia several times in patients coming in because the entire iron panel wasn’t done, only hemoglobin was checked. And it was born out of it happening to me where a brilliant colleague discovered the anemia issue, he did the entire iron panel, then referred me to the appropriate provider for that so that I could probably get an infusion because it was so low. He wanted to retest. He wouldn’t do the entire panel.
Actually, my iron was so low, I couldn’t even, I could barely walk. I could not drive. I was not able to work. It was that low. But the practitioner did not do the entire panel. Would not do the infusion, I had driven two and a half hours one way to have this appointment, because I really needed that to happen. Because my colleague who’s brilliant in functional medicine had already said this is too low, you have to go and get this done. But you’re going to have to go back into the regular system again, and go through the hoops.
That practitioner actually called me back several months later, and apologized for missing it. Now that hardly ever happens, I know, but I wanted to like plug a good story that we knew the issue is the same thing as your patient. It had been clearly identified. The labs were there. It was inarguable. He said, I would have done an infusion that day. I had no idea. I didn’t know you were driving two and a half hours one way. I didn’t do the full panel. It was totally on me. I apologize. And he said, oh, by the way, I’m also retiring.
So, you know, he apologized and we had a conversation after that he said, you know, when I was coming up through school we learned to identify anemia by looking at a patient by looking at them talking to them, he said. And I know what he was hinting at, which is absolutely true. Now you don’t have time to look at the patient. You don’t have time to talk to the patient. They are so strapped for time in this system that he didn’t have time to talk to me or get to know me. I could barely hold my head up.
But according to the one, one dimensional panel that he did, which is not, you know, the three dimensional view that you needed. it was not an issue. So if you don’t feel right, trust your gut. Because even though practitioners specialize in this area, they can still make oversight and mistakes too. It’s not always right. It’s not always that it’s outright gaslighting. Lots of times it is. but sometimes they make mistakes and keep persevering when those things happen. So I’m quite alert at looking for that now and making sure that people are getting that full panel done.
So, and it has been identified several times because too many physicians will only look at hemoglobin. So if you are that person and you are struggling with fatigue and aren’t able to participate in rehab, which is what a lot of people come in and they’re like, I’m just so tired. What’s your hemoglobin? You know, it’s like 11-ish. It’s okay. It’s borderline, but nobody ever checked ferritin or TSAT or anything else.
That’s your little, you know, pearl for the anemia crowd is make sure they check all of those things. It’s really important. So that’s another short story.
30:47 Dr. Holly Tanner: Yeah. And you and I like to talk about social media and the potential harms, whether it’s interdisciplinary or patient-facing information. I do feel like this conversation has been coming to light more, and it’s always helpful because of the patriarchy. Thanks, Barbie movie. No. It’s really important that men deliver these messages.
And I’m seeing more male physicians getting on TikTok and saying, “hey, why don’t we actually care about women’s pain during procedures?” And they don’t have an answer. They’re just at least asking the question.
And I’ll make this brief, but I recently had a, I had a urine biopsy because the lining was a bit thick and they want to make sure everything was okay. And I was told by one of my friends who’s an OB-GYN, like, it’ll be kind of crampy. You might want to bring a hot pack or something. I was told by the lovely nurse practitioner, it’s going to be a little crampy.
It was horrendously painful, horrendous. And I consider myself as someone who has pretty decent pain tolerance. I wouldn’t say I’m very sensitive. I can usually breathe through things and get through it. It was awful. And I shouted. “Oh my gosh. Ow, this is terrible.” “Oh yeah. Sorry.”
And of course I said, “get back in there and get as many as you need. Cause I’m not doing this again, you know, like get good samples.”
It was awful. And I had to sit in my car for like 30 minutes because my nervous system was so upregulated and, and I had, you know, cramping for days and, and yeah, I mean, you recover from that very serious acute pain during the procedure. The cramping is what comes later. It doesn’t cramp. It is brutal, intense pain.
And so now when people come in and they say, you know, they’re talking about their histories and I’ll say, did you have any biopsies? And they’ll say, yeah. And he’s like, was it painful to go? It was so painful.
And I asked myself, do we not have enough medical intelligence at this stage of the game to, I don’t know, give someone a little Valium, a little, you know, nitrous, you know, because sure, they know up the cervix, but they’re not doing anything further.
And so you think about all these procedures that people go through, And there’s just sort of this acknowledgement like, yeah, it’s going to hurt. Yeah, this is just what women do. We just suffer. We just tolerate the pain. No, uh-uh.
How are we going to manage everyone’s pain better? What is it going to take to learn to advocate for ourselves? Why are fellow women looking at us and saying, it’s going to be a little crampy? That can’t be the experience that the majority of the folks undergoing these procedures are telling them. Its just to me, it’s almost comical but it’s horrific and it’s not okay, right. But just just to say oh yeah oh that was a little crampy.
You know what’s a little crampy? Just about anything else! So I think we have so far to come with even just these procedures and mammograms can we talk about mammograms for a minute. Why are we putting the tissues through that level of harm and making people not want to go because they know how uncomfortable it’s going to be? Do we really not have the tools or is it just more expensive? Does it take more time?
So that conversation is really important. And again, I think social media is one of the ways that it has been a little bit more illuminated and that’s a good thing.
34:35 Dr. Ginger Garner: It is. It is. And I am really thankful for that. And you mentioned something that’s really important, because the questions do have to be asked. Obviously, women are going to ask the questions. We’re going through it. But it being brought forth by men who are providing this care and going, why are we putting women through such unnecessary pain when a man will be fully numbed up for a vasectomy?
But then during birth, do you know how many people I’ve had come in? Women have come in and say they were stitched up with nothing. right? Nothing. That would never happen, right? That would never happen in in men’s cases. And it doesn’t because we know it doesn’t.
But it happens all the time from the way episiotomies used to be done without even consent, just cutting perineums left and right. So those messages coming through social media are so important that, you know, bring awareness to women.
Asking for that pain relief or pain management before they go through those procedures. And then, so I want to encourage everybody to do that. Ask those questions. Don’t just let them tell you it’s going to be a little crampy. Just dig a little bit deeper there and ask for better pain management.
I would say second, it would be important to talk about the darker side of social media. And we had mentioned something earlier that I want to come back to before we, I think, hit record. And that was the whole lack of nuance and lack of personalization and thinking that if you put something up on social media, that it’s poo-pooing everything or, you know, saying you must do it this way or you must do it that way. As if it’s simple, as if it’s simple, solutions are simple.
Let’s talk about that for a second because that happens left and right to the point that I have, you and I both, I know, have left entire conversations and groups on Facebook because of this happening. So it is pervasive enough that I think it’s important to talk about.
36:50 Dr. Holly Tanner: Sure. And, you know, I know you and I have been involved in some, you know, calling folks in or calling folks out and frequently it’s men coming into spaces where people are discussing women’s health care or pelvic health care and coming in and demanding that people tell them the answers.
You know, what is the way to do this? Well, it depends. What’s the population? What’s their history? What’s the concerns? No, no, no. What’s the answer? You know, or again, turning these spaces that are meant to be educational and collaborative into self-promotion, you know, all these really interesting scenarios.
But I think one of the things that you and I have noticed in social media is the desire to oversimplify and to plant that flag like kegels are bad. I mean, that’s just to me, one of the most obvious things that’s been coming up and what a stupid thing to say. That is the equivalent of saying bicep curls are bad, never do them.
And because it misses the nuance and the backstory, and folks will say, yeah, but that doesn’t get clicks. That doesn’t get likes. Or if I can get them to come and pay attention to me, then maybe I’ll explain that other stuff. And first of all, frankly, I think some of these people, they don’t know the nuance. They don’t know the backstory.
And the backstory is that everyone used to be given kegels. Kegels as described by a male physician. But we don’t have to demonize that either, because at that point in time, there was a lot of benefit that came out of that as well. And so if you say this one thing is bad, or you only, all you need to do is squats, that gets everyone’s pelvic floor.
Really? If you don’t examine, maybe you don’t notice that when they’re doing their squats, their pelvic floor is either staying neutral or bearing down. Like, you know, when I see these videos of like, see, it doesn’t matter that they’re three weeks postpartum, they wanna be stronger. So get them doing those leg lifts. It doesn’t matter if they’re doming.
Does anyone care about what their sweet little uterus is doing right now? Because three weeks postpartum, there’s a lot of healing that gets to happen. There is benefit from teaching people how to move their body with integrity. The integrity meaning that it’s not something that’s gonna catch up with them later on as a negative impact, or again, something that’s gonna promote optimization of their function and wellness. So it’s pretty easy to get riled up about this stuff because obviously there’s a lot of opportunity. You’re gonna have someone come into the clinic as we have and say, and I say, well, how’d you learn about rehab?
I saw it on TikTok, like, yay, you know? And then you get the people, I was teaching a class recently and someone said, “oh, this messaging that all kegels are bad is really getting in the way of me doing my good work because someone came in and said, if you talk to me about kegels, I’m gonna leave.” It’s like, ugh, right? So that’s not helpful either.
40:01 Dr. Ginger Garner: Yeah. And I think that’s a really good, like kind of takeaway message for our time together today is to be highly wary of people who do present that like, like you can do anything to rehab, it doesn’t matter, just go out and move. That’s all that matters. If it was that simple, then we wouldn’t need any specialized care, no one would need to be a clinical specialist in anything, because you could just be a personal trainer and get it all done.
Or not even that, because you hear this messaging that’s so generic, that almost anything would work, you know, to get the person better. So if you’re hearing everything and nothing messaging, like never do Kegels, right? And or anything that you do at all, postpartum is all good, then that’s a red flag. It is much more nuanced.
45:51 Dr. Holly Tanner: Yeah. And to me, that’s a form of gaslighting as well, because what happens is the patient who hears, well, I was told I just needed to strengthen my hips and glutes and then my prolapse symptoms would be better. I did those things and I’m not better. So is it me? Did I do it wrong? Did I not do it enough? And no, what you needed was individualized care. And that’s what it all comes down to, right?
We always hear, especially with these, you know, challenging situations of chronic pelvic pain or prolapse, it’s always sort of multidisciplinary, multimodal. And that individualized care is really important to help put people in these categories. Are you someone who needs a little more fine tuning? Or are you the person who just needs permission to go out and take some hikes? You know, but that, you know, finding that, that sweet spot is really important. And they need to hear that.
41:42 Dr. Ginger Garner: Yeah, absolutely. Personalization, individualization, listening to your story. If that’s not happening, then it’s a red flag. And you know that you deserve better care, better care. And if you don’t feel like you have found the answers, then you probably haven’t trust your gut, you know more about your body than than anyone else.
So I think that’s our a good closing message for you guys. Thank you for listening. Holly, thank you so much for being here today. I really appreciate it.
42:43 Dr. Holly Tanner: It’s always a pleasure, Ginger. I look forward to continued collaborations with you professionally.
42:48 Dr. Ginger Garner: Yeah, absolutely. Every time. You have such a peace and calming way about you as a teacher, as a therapist, as a person. So if you’re listening and you have a chance to learn from or work with, Holly, please do that. Don’t miss out. Make sure that you visit her at HermanWallace.com/faculty/HollyTanner, or go to flowrehab.com.
42:53 Dr. Holly Tanner: Thanks Ginger.
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