Hello and welcome back everyone. I have with me a very special guest today, Dr. Amy Stein. I am super excited to welcome you on the show today, Amy. Thanks for spending the time with me today.

Amy (00:14)

Of course, thank you for having me. I always really appreciate getting more info out to everyone and I appreciate all that you do too. I’ve learned so much from you over the years and yes, and it’s all about collaborating together and learning from each other, right? And from our patients.

Ginger Garner PT, DPT (00:28)

gosh.

Oh yeah, yeah,

that is a perfect kickoff to what we’re talking about today actually. You guys, let me tell you a little bit, folks, whatever, identify, I try to, I end up saying you guys and realize, ooh, is that inclusive? I need to be inclusive here. So, all right, folks, let’s learn a little bit more about Dr. Amy Stein here.

She is an amazing pelvic health PT, author and advocate for endometriosis awareness. She has years, more than years, decades of experience under her belt, helping patients reduce pain, reclaim their lives. And she is so passionate about empowering everyone to take charge of their overall health, but through the lens of pelvic health, which is so incredibly important.

but let me tell y’all what she’s been doing to get to this point. She is the founder of Beyond Basics, which is in New York City. And it’s been a long time since I saw you in person there, like on your home turf. It’s been a minute, even though I saw you not too long ago last year, but.

Amy (01:43)

Yes.

Ginger Garner PT, DPT (01:48)

Amy has served as president of the International Pelvic Pain Society. She lectures internationally. She’s been featured in documentaries. She’s been on shows like ABC’s 2020. She has written the books, you guys, pelvic pain, heal pelvic pain and beating endo, how to reclaim your life and a video as well. Just lots of media projects. She’s the co-editor of Healing and Urology as well as a featured author

and many other medical textbooks. Like the list is long. But her award-winning books, her videos are helping people heal from pain, improve function and take back their lives. You’re a tireless educator and advocate. So thank you for being here, Amy.

Amy (02:36)

Thank

you and to you too, you’re tireless educator as well. So we need to stick together.

Ginger Garner PT, DPT (02:43)

yeah, yeah, it takes a village. also I want to at some point talk about you have a new line of products. So we’ll save that for a little bit later, but I wanna hear more about those projects too. So, all right, question out of the gate because I like to just dive right in to the kind of the deep end of the pool is how, was there a specific moment

or patient experience that highlighted for you kind of the pervasiveness of medical gaslighting in people with endometriosis.

Amy (03:21)

Was there a moment? That’s a good question. I would say there were lots of moments. So I can’t remember one specifically, but I do remember one of my first patients with endometriosis. She’s actually one of the testimonials in my book, Heal Pelvic Pain, and she…

I do remember her coming in and this is like 2002 or 2003. This is a long time ago. So I’ve learned so much from my patients as well. But I recall her saying that she was told to have wine and do yoga. I recall her saying she’s too anxious. It was in her head. And yes, so that’s how.

Ginger Garner PT, DPT (03:59)

Yeah.

Yeah.

Hmm.

Amy (04:18)

That is one of the patients that sticks out that, you know, that whole journey went. So it’s very emotional. Yeah, I was just going to say it’s so emotional for the patient when they’re experiencing that, as well as all the other symptoms that they’re experiencing. And at that time, really not knowing where to go. And she did have one of the more

Ginger Garner PT, DPT (04:24)

Yeah, that’s such a… Go ahead.

Amy (04:48)

well-informed doctors at the time, one of the Nijat brothers. And she was, I think she found me though through a urologist, not through the endosurgeon.

Ginger Garner PT, DPT (05:01)

Hmm.

Yeah, I think that highlights a really important point, which is you have these moments that like personally catalyze you to do things like write a book, right, on Endo and beating that. Because we need to break that cycle. You mentioned that she didn’t find you from her, you know, Endo surgeon, it was from a urologist. So,

I think that answers the question about, or partially does. So I still am gonna throw the question out there to you, which is why do you think medical gas lighting persists so strongly in endometriosis care? Even with, you know, there’s increasing awareness of the condition, it’s still not enough, but why do you think it persists?

Amy (05:54)

I think it still persists mostly because of not being fully educated on the integrated approach to endometriosis. My book, Beating Endo, talks quite a bit about how you have to do the integrated approach. I haven’t known any patients with endo that haven’t had to incorporate something else in the book. Usually it’s more than one thing, but…

Ginger Garner PT, DPT (06:03)

Mm-hmm.

Mm-hmm.

Amy (06:24)

I don’t know if I’ve had one patient where I haven’t had to integrate even more than the PT, like the diet or more mindfulness meditation or taking care of their sleep health or any of those things, how important it is. I also unfortunately am still seeing that like the surgeons, some not all, but some surgeons, they’re surgeons and they’ve

want to do the surgery and it’s going to do everything and heal everything and I just, it doesn’t work for most people. So that’s still unfortunate that that’s happening because I think they know that there is an integrated approach that needs to be happening.

Ginger Garner PT, DPT (07:03)

Mm-hmm. Yeah.

Absolutely, yeah. It.

It always lands a little sideways, although the comment is very well-meaning when someone says, refer almost all of my patients to pelvic P.T. post-op. And I want to ask the question, the next question is, why not all? Because I don’t know anyone who doesn’t need therapy, even if it wasn’t endo, that has had abdominal surgery, right?

and an abdominal surgery that is really small incisions, but quite as invasive as this is. And I know there’s a movement external to the endometriosis movement of getting pelvic PT and or OT in the acute care setting, which for the listener, you’re like, what’s acute care? It is when you’re in the hospital and you’ve had abdominal surgery.

we believe as advocates, as PT advocates, as pelvic PT advocates, that you should have someone visit you in patient, in the hospital to do post-op care for that abdominal surgery. And so I think you and I are on the same page that there should be 100 % referral after any abdominal surgery, but particularly with endometriosis, those things just don’t go away because you have a whole range of

deficits and things that occur that aren’t necessarily written out nice and tidy in the brochure of surgery. And just to give the listener a little example, it’s like if someone comes in and they’ve had surgery but they didn’t get to pelvic PT, I think it should be pelvic ortho, we should talk about that too, then they may be guarding in the same way, the tissue is guarding in the same way as it was before.

Amy (08:54)

So I…

Ginger Garner PT, DPT (09:14)

And the tissue doesn’t get the memo, the tissue still has the issue, right? So if you’re listening to this and wondering, how and why should 100 % of people with endo have a referral to pelvic PT? It’s because of that, right? That’s just one example. And I know Amy, you can give me a ton of examples of why that is true, but you were getting ready to say something just earlier. What was that?

Amy (09:40)

I was actually gonna make two comments. One is I think it’s essential that 100 % of patients also, and I know you know this, go to pelvic floor PT pre-op too because of one, peeling away, we all talk about the layers of onion and peeling away those layers of onion to optimize the surgery.

Ginger Garner PT, DPT (09:56)

Mm-hmm, yeah.

Amy (10:09)

So before you go into the surgery, making sure that at least as like, as what we do here, we try our best and we try to make sure that the nervous system is as calm as it can be. Obviously you are experiencing pain or discomfort, but making sure that’s as optimal as possible. teaching the patient those strategies pre-op, which also will help.

when they have the surgery and the symptoms that can happen right after surgery too. Like learning that slow diaphragmatic breathing, making sure that they’re prepared for, there will be constipation because of the anesthesia, so making sure they’re prepared for that. And then the things that they can do,

Ginger Garner PT, DPT (10:56)

Mm-hmm.

Mm-hmm.

Amy (11:05)

post-surgical even before they come into PT. My co-author though of Beating Endo, Ira Sorbuck, she sent patients to us one week post-op because, she used to say, know, be weary of the abdominal wall, because we just did surgery in the pelvic area, but.

Ginger Garner PT, DPT (11:09)

100%.

Mm-hmm.

Amy (11:30)

You know, we’ve had patients that have had leg pain, the back pain post-surgical. Again, not everyone, but why not address those sooner rather than later and teach those patients, you know, ideal sitting postures and standing postures and then walking them through like, yes, your doctor told you to stand up and move, but that doesn’t mean go for a 30 minute walk day two.

Ginger Garner PT, DPT (11:34)

Mm-hmm.

Right.

Mm-hmm.

Amy (11:57)

It means just going to get yourself some water and trying to incorporate that slow breathing, that slow 360 breath with your walking and maybe with a gentle exercise that feels good. Some yoga positions can be really helpful. All these things helps to optimize the surgery regardless. And then post-op, obviously really addressing the tissues that need to be addressed.

So my second thing I was gonna say was I do a lot of talks internationally. And one of the things I do say to the physicians are you guys, the orthopedic surgeons refer to us typically before like knee or shoulder surgery, but definitely after. And the first things that they tell us are they should say talk about breathing, but you know, that’s in the future.

Ginger Garner PT, DPT (12:57)

Thank

Amy (12:57)

But

they talk about scar mobilization and range of motion. And that’s exactly what should be happening in the abdominal pelvic region. We need to get those tissues mobilizing gently, obviously post-op, and then range of motion, and again, in those ribs, in the pelvic floor. yeah, so trying, just like you mentioned, to get those physicians referring

ASAP and ideally pre-op.

Ginger Garner PT, DPT (13:30)

Yeah, absolutely. So if you’re listening to this with thoughts of having surgery or thinking you have endo, that is the one thing that you wanna make sure that you do set up one or two visits preoperatively because, for example, I’ve had several patients in the last year go in and have specific issues from the functional nutrition side of things where the bowel prep is very

endocrine dysregulating for them. It’s actually estrogen disrupting and endocrine disrupting. Many bowel preps can be. So I want to work directly to make sure that the things that they’re ingesting aren’t actually making their symptoms worse as they go into surgery because I have some people with some significant reactions to that. And so those prehab sessions are critical.

it always should raise an eyebrow if someone says to you, you don’t need that. When both of us are sitting here as endotherapists with decades of experience collectively saying, yes, you do. And so make sure you get prehab, all right, that’s the take home message there. And then make sure that you get in immediately as soon as you can post-op because we need to break that cycle. And one of the biggest things that

I think is underestimated is, I know it’s one thing that I love to emphasize because it’s empowering. And I think that endometriosis has historically been, it might as well have been associated with hysteria, right? If you look up the diagnosis of that, and maybe it was, maybe a lot of women in the early 20th century were, it wasn’t even a diagnosis, but from a patriarchy perspective,

a huge access to proper care, human rights problem. But beside that is the point I was trying to make was if someone doesn’t understand the difference between post-op normal pain, right? And maybe holding tissue, holding tension in their psoas, right? Or they’re splinting or they’re guarding.

because maybe they’re not staying ahead of the pain, if that’s something that we can educate about and say, you might have a hip flexor that feels a little snarky and causes you pain, but movement can help that versus it being something that is more acutely needs rest. Like, well, this is post-op and you’re so soon out of this, you needed a certain amount of rest. And I think a lot of people are fearful. They don’t know what they can and they can’t do. And that is one thing that if we can empower

you you without information, then you know how to differentiate between, this is normal post-op pain or, hey, this is something my PT can help me with, you know, and I don’t have to lay in bed and splint or be fearful that I’m hurting something or undoing something.

Amy (16:38)

That is a big issue. The kinesiophobia, fear of movement, that’s a big thing that we see with our patients with endo or not with endo.

Ginger Garner PT, DPT (16:43)

Yeah.

or otherwise, yeah.

And so many patients talking about endo and PT specific, there’s so many myths and you mentioned some of them to begin with, meaning patients can be told it’s in your head or this is normal or you’re a woman, got, like this is part of being female or this is part of having a period, just total BS actually. So how do you think,

Amy (17:10)

deal with it.

Ginger Garner PT, DPT (17:18)

how do you see physical therapy validating the reality of their pain while also working on solutions to move forward?

Amy (17:26)

Right. I think, yeah, so one thing is trusting you as a practitioner. That’s a big thing that if they’ve already kind of lost trust in other practitioners because they’ve been gaslighted, they really have to learn to trust you. And then once they trust you, it’s still, you know, some patients, like you click right away, some, and I’m thinking of one right now that…

you know, it’s still kind of up and down. Like there’s been so much gaslighting for her that it’s, you know, even with me and not, you know, I’ve been doing this for 25 years. We have our, you gotta figure out what works best for the patient too. So that’s really important. having, again, having them trust you, what did they like to do?

Ginger Garner PT, DPT (18:00)

Yeah.

Yeah.

Amy (18:25)

versus what you think is really important. That’s really important. Yeah. Because if they don’t like doing yoga and I do have some patients that don’t like it, it’s their not their jam. They’d rather sing, which I know you do both. Yeah, they’d rather just, you know, belt it out. And singing is a sport. And that can help in so many other ways. So.

Ginger Garner PT, DPT (18:28)

That’s a big one. Yeah.

It’s not their jam and that’s good. That’s okay.

Yeah.

Yeah, yes, singing is a sport!

Amy (18:54)

But movement is important and trying to figure out what they like to do, that nature walk or walking down Fifth Avenue, you know. Not my thing, but yeah. So I don’t know if I fully answered your question, but.

Ginger Garner PT, DPT (19:09)

Yeah.

that way, I

well, you think physical therapy is a lifeline because if you are listening to them, so talking to everyone listening, your PT, your pelvic PT, and I’m speaking specifically to PT because there are so many overlapping orthopedic issues that it…

It’s just to be frank, it would be hard to cover all those things from a pelvic OT perspective. I think that it does help to have that orthopedic PT background when you’re treating this. So that’s just something to think about. It doesn’t mean that pelvic OT can’t be a part of your team, however. They can be a vital part of your team, but you are gonna have some orthopedic issues that overlap. And I think that if your therapist is listening to you on that, no matter if they’re a pelvic OT or PT, they should hear those things from you and go,

gosh, pelvic girdle pain, that sounds like a hip impingement or something. Maybe I should get them over to the ortho pelvic PT or vice versa when you hear things that maybe OT may be better suited to. But as a listener, I just want you to know and feel that that therapist should be that lifeline for you, should be listening. Because if they’re listening, then they can be that…

a person that helps bridge the gap in places where you felt let down or dismissed. They should be listening to your story, to your patient’s story.

Amy (20:52)

The quarterback. That’s also what they say. You need a quarterback.

Ginger Garner PT, DPT (20:54)

Yeah, yeah, that’s good. Yeah,

exactly. Because your story, speaking to the listener, is like that’s all they need to hear is your experience and your story. And from there is that jumping off point to say, okay, this is what you need, which may mean more than just, you know, one person as their therapy provider.

So guess that’s kind of a natural segue to talk about whole person, multidisciplinary, like to come full circle back to what you were saying with it takes a village care, right? Like it takes collaborative care. And holy cow, we have a lot of failures in our system in the United States when it comes to collaborative care.

So what barriers have you seen, in building these care teams for Endo, and what do you think we can do to address them?

Amy (21:58)

Barriers still are what I mentioned earlier, it’s in your head. You need to do more yoga, you need to drink more wine. So that’s still happening. And I think that’s a big thing that still needs to be addressed. You’re like you said earlier, you’re a woman and you should just deal with this. Well, that’s not okay. So make sure that you’re

Ginger Garner PT, DPT (22:08)

Yeah. Yeah. Yeah.

Amy (22:28)

talking to your provider and saying, no, I really want to figure this out. Listening to certain podcasts like this can really help guide you in the right direction. And then honestly, your provider isn’t fully listening to you, you may need to get a second opinion.

And then there are practitioners like for example myself that I’ve been doing this so long and I really listen to my patients and what works. So I have like a whole Rolodex of what works and who works for the patients. So I have practitioners that I specifically refer to, which a lot of the doctors, don’t have that extensive of a…

Ginger Garner PT, DPT (23:12)

Yeah.

Amy (23:23)

Rolodex. Do people know what a Rolodex is? The younger generation? Yeah. I know. Your context. I have a great list of contexts. Digital content. But a lot of, you know, a lot of

Ginger Garner PT, DPT (23:24)

Mm-hmm.

I know, I think since we’re both Gen Xers, we might’ve just dated ourselves, but I don’t even know what you’d call it now.

Yep, exactly. All your digital contacts.

Amy (23:52)

Doctors do respect that they understand that you do have those digital contacts, but then some just are like, yeah, whatever, whatever works. And they kind of brush it off, but in the end, that’s what’s needed for the patient. And you were saying earlier about the orthopedics, that’s so important. Like even myself, my business partner in our downtown office, she has her CFMT, which is certified.

functional manual therapist and I’ve learned a ton from her, but I haven’t taken all of those courses. So I’ll refer to her for like a foot issue or maybe like a neck issue that I can’t seem to help with our patient. She also has taken a ton more visceral courses, visceral manipulation courses.

Ginger Garner PT, DPT (24:32)

Yeah.

So important.

Amy (24:51)

Yeah, that I’ve taken a bunch too, but you know, if I get stuck in a certain area, then I may refer out for that as well. having that list in your digital context is really important and trying to figure that out with your provider too. Example, I had a patient seeing someone that

helps with mindfulness meditation and does quite a bit of tapping which can be very helpful to calm the nervous system and They weren’t meshing for they were in the beginning and then they weren’t so then I was like, okay, that’s okay you sometimes people can grow out of grow out of each other Maybe it’s just not the right fit now. So then I refer someone else and she was

Ginger Garner PT, DPT (25:23)

Mm-hmm.

Yeah.

Amy (25:47)

totally thrilled with that and has been helping her. She’s had like more increased central nervous system things going on and it’s helped quite a bit.

Ginger Garner PT, DPT (26:00)

think that is important if I can pull out a thread of what you just said. And so I would say your homework as the listener is to literally make a list. It might be a spreadsheet, like what works for you? Is it a Trello card? I don’t know. Like, you know, whatever your chosen tech is, but literally make that list because you will find that you mentioned tapping, like…

eye movement desensitization, retraining, EMDR, or even hypnosis, whatever that works from that processing perspective. Because if you have endometriosis, you just didn’t breeze into this. You probably spent at least a decade pursuing the right care. That means you have a lot of things that need to be processed. so, NPT, you will hear that, right? You will see that, you will feel that, and you will know, and you need that list of

practitioners that you can go to because they won’t all fit really even literally on your schedule or maybe it’s the wrong season to be doing a particular therapy is what I’m hearing is important from your perspective, Amy. And I would totally agree with that, that it’s essential because you may have to circle back and go to that practitioner that maybe that was the wrong timing and see them again later or just like seeing someone else for visceral mobilization, for example.

And because our listener may not know what visceral manipulation and mobilization is, and I know you and I have both had training in it, I think it’s an essential part of rehab. Amy, how much, you know, how important do you think VM is in terms of endometriosis recovery?

Amy (27:46)

I do think it’s essential that the pelvic floor physical therapist at least has some training in it because that’s a lot of what’s going on with patients with endometriosis is the internal organs are restricted or they’ve been irritated. So they irritate the muscles and the tissues around it, which is called

a visceral somatic reflex where the viscera visceral and the somatic, which is the muscles or tissues around it. They just have been talking to each other for a long time and one’s irritating the other or vice versa. As you mentioned earlier, like an irritated psoas that’s just irritating your descending colon and making it harder to go to the bathroom, for instance.

So it’s really important, especially for endometriosis, that the physical therapist has some background in visceral manipulation. Obviously, we also need the soft tissue with the muscle trigger point type therapy too, and all the orthopedic things that we’ve been already mentioning, but it’s ideal. If there is no one in your town or neighboring town,

then at the minimum starting with a pelvic floor physical therapist and then taking it from there. Maybe they know someone that can help some massage therapists also do some inside my end massage is not exactly the same, but you know, there’s other massage techniques that help with the abdominal organ and muscle mobilization.

Ginger Garner PT, DPT (29:36)

Yeah. So good take home point there is to make sure that multidisciplinary care, there’s not only mental health to just help you process what you’ve been through with medical gas lighting and the trauma of surgery and also like just fiscal trauma, like economics and knowing how expensive it can be to seek treatment, all of the missed work.

If you don’t have disability or insurance or you had to take out a second mortgage or whatever it is, that’s a lot to process. In addition to making sure you have someone who can at a minimum do that visceral mobilization care. Not that we’re saying that’s the only thing, but I wanted to point it out because I am not seeing it become like household talk.

or language, right? It just seems like every time I mention it to a patient, they’ve never heard of it, no one’s ever mentioned it. And the previous half a dozen therapists they saw never did anything with that. So one question I have, I don’t know, I wanna get your insight on this is what advice do you have for practitioners who wanna push back against that status quo of dismissive care?

Amy (30:53)

for practitioners.

Ginger Garner PT, DPT (30:57)

Yeah,

so the practitioner you’re sitting that maybe, you know, you’re listening and you’re a pelvic PT, right? You’re listening to this interview right now and you’re feeling that pushback, right? It could be, I’ll bring up a hot topic. Here’s an example. You have been through estrogen suppression. You’ve been on some kind of medication and it has thrown you into either, you had a surgical menopause, right? You had a hysterectomy, you had something.

Amy (31:07)

Yeah.

Ginger Garner PT, DPT (31:27)

that happened and you as a provider know that somehow estrogen is important in this whole endometriosis issue that is estrogen mediated and that we need to be able to manage that in a healthy way. But you as a provider are getting dismissal as a practitioner or as a patient, you know it’s important, right? And you’re getting pushback from your GYN, right? You’re having perimenopausal symptoms.

or you have a nutritional trigger or something that just flares you and you don’t exactly know why, but your practitioner is like, yeah, that’s not related. And you get gaslit. What advice do you have to push back against that status quo? Because I think that is the status quo right now, unless you’re like, you know, on the forefront of the perimenopause, menopause, you know, hormone situation with endometriosis. That’s kind of an uphill battle.

Amy (32:27)

Yes. I just did a talk at actually Mount Sinai, which is one of the major hospital organizations in New York City. And I was impressed. They did a whole summit on perimenopause menopause, and they did bring this up and lots of questions as well from the OBGYNs in the audience, bringing these same questions up.

Ginger Garner PT, DPT (32:28)

We’re.

Mm-hmm.

Amy (32:57)

And it’s a tough one because you’ve had this GYN, OBGYN for since you were a teenager and they’re just doing exactly what you said. They’re saying, no, it’s not related. But then I’ll have that conversation with the patient and I’ll say, I know this is, it’s awkward, it’s not ideal, but.

You could try to have the conversation again with a physician if you think it would be helpful. I’ve definitely had physicians that have been open to listening or speaking to me. I’m happy to speak to any healthcare provider if a patient asks and I do quite a bit. If that’s still not working, then honestly, I would try to find a different physician. And now I am seeing more like if you Google like

physician that specializes in perimenopause, menopause, or hormone replacement therapy, ideally has an integrative approach as well if you can’t take estrogen. But there’s a lot of things that could be done now. Still, if you can’t take estrogen, it works with the symptoms, so that can be helpful. There’s the NAMS.

Ginger Garner PT, DPT (34:08)

Yeah.

Mm-hmm.

Amy (34:24)

which is North American Menopause Society. They have a list of practitioners, but how would you know that if you’re a patient? It’s hard. It’s really hard still. I feel like we’re, you know, two steps forward and one step back still. Yeah.

Ginger Garner PT, DPT (34:42)

I know. We’re on the cusp. like, you know, we’re on the

edge of the cliff or the boat or whatever, jumping off and actually flying or swimming, whatever metaphor you want to use. But yes, we usually end up talking about NAMs at some point, and it will be in the, that link will be in the show notes for you. If you are a person going through perimenopause or you’re struggling because you’re on estrogen suppression and you’re having a lot of symptoms,

Amy (34:50)

Yeah.

Ginger Garner PT, DPT (35:10)

then it would be helpful to see a provider that is on that list in your area. And it’s a good jumping off point. It’s a good jumping off point. But Amy, you brought up something that I completely agree with, and I don’t think we can overemphasize it too much. And that is it also helps if they have additional training beyond just some perimenopause, menopause education that would be in line with NAMS, but also integrative.

Also, lifestyle medicine, like if they are not including that, yeah, I would totally agree. It’s not a full team, you know, until you’ve got somebody that can do that too.

Amy (35:51)

And that’s new to the forefront too. Like I’m hearing more and more about actually one of the past presidents of the International Pelvic Pain Society went to Kathy Weitzman, she’s in Colorado. She went to a school specifically for integrative medicine approach from an MD, know, as an MD. So.

Ginger Garner PT, DPT (35:54)

Yeah.

Amy (36:18)

There are people out there, it’s hard to find. There’s also integrative nutritionists, that’s another option. And a lot of, most of the time, I would probably say almost, probably 100 % of the time, but I’m not sure. They most likely know an integrative medicine doctor that they can refer you to too, if needed. So.

Ginger Garner PT, DPT (36:20)

They are.

Yeah, yeah, I think that’s

essential. All right, so wrapping up the multidisciplinary aspect of this, I think, and you can chime in, but I think our take home messages are, A, it takes a village, you gotta have a team, no one person’s gonna do it all for you. We can just box that up and put a bow on it for all relationships too. Everybody’s not gonna be your all. You’re gonna have to have a team there.

That team should include people who can talk about lifestyle medicine. Lifestyle medicine is your sleep science, nutritional science, physical activity and how you move, how you manage stress, relationships. And a big one for endometriosis is environmental pollutants because there’s a lot of estrogen disruptors out there. Also integrative, an integrative medicine person should be on your team.

You may, know, yoga may not be your jam, maybe Tai Chi is, maybe mindfulness. There’s a whole lot of practitioners out there that can cover that. In addition to pelvic PT and also someone who’s going to be perimenopause and menopause literate. And you can start by going to the NAMS website for that. Did we get it all?

Amy (38:00)

One, two things I would like to add, which is part of the integrator, is understanding the pain science also is very important. that most, or some physical therapists, pelvic floor physical therapists are aware of that. If they’re not, then they can educate, you know, they can educate themselves. There are books out there now.

Ginger Garner PT, DPT (38:11)

Huge.

Amy (38:27)

more on the pain science aspects. So that’s really important to understand too. And the other thing I wanted to mention, which like I was so happy to see in New York City, you would think there’s, you know, kind of everything right to your fingertips. Well, that hasn’t been the case. It hasn’t been the case since I started. I think we’re all learning as we go. As I mentioned a couple of times, but

Ginger Garner PT, DPT (38:55)

Yeah.

Amy (38:55)

Interestingly, like recently, just to give an example of how you keep having to keep your ear out for things, keep listening, I’ve come across a couple of GI psychologists, which I hadn’t had in New York City. I hadn’t had that in my Rolodex. And now I do. I’m like, wow. And I spoke to them to try to find out like.

Ginger Garner PT, DPT (39:09)

Nice.

Yeah

Amy (39:23)

their approach and now super excited that I have this available for my patients as well because I didn’t have it for almost three decades that I’ve been treating patients. I’ve had people I refer to for mindfulness, but this is an area that’s specific to GI. So point home, take in, take in home points is to keep your ears open.

Ginger Garner PT, DPT (39:36)

Yeah.

Amy (39:53)

and keep trying, don’t give up, keep trying, keep listening and trying to understand what can be helpful for you with your healing journey.

Ginger Garner PT, DPT (40:07)

Yeah, yeah. And for many people, think that root resource can start with PT because you just listening to us as two PT’s jabbering back and forth with each other, we’ve already listed a pretty comprehensive multidisciplinary team. We’ve kind of defined it. So I think that if you are listening as a patient,

good starting point should be your pelvic PT or your OT, you can say, all right, here’s who should be on your team. Let me help you find those people. Because it’s a lifelong thing that you have unfortunately experienced or inherited to have endometriosis. And so that team will be very useful at different points along the journey. Yeah.

Amy (41:00)

Agreed.

Ginger Garner PT, DPT (41:02)

So as we shift this whole narrative to move from just managing and coping to empowering patients to thrive daily in spite of the diagnosis, I think that

Are listening to patients, are patient stories, listening to you, speaking to you directly as the listener is important. You want to have your therapist listening to you, suggesting that multidisciplinary team. And is there anything else that in terms of like advocacy, right? Because I know you’re so passionate about advocacy. Are there any actionable tools for listeners dealing with medical gas lighting right now?

practical steps they can take. And you mentioned one already, which is you can either take up that conversation with the GYN who’s not really listening about your perimenopausal symptoms, right, or menopausal symptoms, or you can quiet quit or, you know, and find another provider, whatever that is. Do have any other actionable items that they can do to advocate for themselves? Like, what would be some green lights with a practitioner that they should be on the lookout for?

Amy (42:22)

well, one other thing that I’ve had patients do in the past, is actually talk about like your podcast or take my book physically to the physician and say, Hey, you know, I was looking through this book and it is talking about mindfulness. is talking about the environmental concerns, that I should be addressing.

Ginger Garner PT, DPT (42:35)

Mm-hmm.

Amy (42:50)

asking the physician, do you think of this? Or do you have a GI psychologist that you have that you could refer? sometimes even pelvic floor PT’s, the pelvic floor PT isn’t working for you, you may need to find another pelvic floor PT. Right now in New York City, we are having a bunch of orthopedic practice saying they’re doing pelvic.

Ginger Garner PT, DPT (42:56)

Yeah.

Amy (43:18)

floor PT and they’re just not and it’s frustrating for the patient or they’re not doing the full comprehensive pelvic floor PT I should say.

Ginger Garner PT, DPT (43:19)

Hmm. Hmm.

Right. Gosh. Yeah, I’ve had

some of the same things happen where an ortho practices, okay, so listeners, there’s a yellow flag, maybe a red flag. If you go to an ortho PT, you need to ask them about, and they’re saying they’re doing pelvic PT. Yeah, and that goes both ways. Like if someone’s pelvic, but they say they’re doing ortho or they’re ortho saying they’re doing pelvic is just ask them about their levels of training.

Amy (43:38)

There’s a yellow flag.

Great.

Yes.

Ginger Garner PT, DPT (43:56)

what they’ve actually done. think that’s a really good actionable item.

Amy (44:00)

Yes, definitely actionable because like one practice or a couple of practices that I’ve recently, this is more recent that it’s kind of become a bigger thing. They don’t even have treatment rooms for the patient. Like they have two, they have five pelvic PTs and one treatment room or two treatment rooms. So it’s definitely eye opening and don’t give up on the pelvic floor PT if you don’t think it’s worked.

Ginger Garner PT, DPT (44:19)

Wow.

Good point.

Amy (44:29)

because that’s the thing we’re seeing here quite a bit that, you know, that pelvic floor PT just didn’t have the expertise in endometriosis that another one may have. So that’s something also to look at. I would say with regard to any healthcare provider, they really need to listen to what you’re saying. And if you feel like they’re not really listening, then again,

call them out on it or like you said, what did you say? Quiet, quiet quit.

Ginger Garner PT, DPT (45:04)

quiet quit. If you’ve

had enough stress and you can’t take one more conflict with a healthcare provider, quiet quit.

Amy (45:12)

quiet quit.

I like that. Yeah, because maybe that is okay, this isn’t working out. me try it. Let me find a Let me talk to another endometriosis surgeon or specialist and like we in our practice, we do do phone consults, like free phone consults. And that could be helpful. Sometimes it’s not enough. So I know that some places

Ginger Garner PT, DPT (45:15)

Yeah.

Amy (45:42)

Like we’ll do a virtual visit or various other things that can be helpful that reassure you that you’re headed in the right direction or in a better direction if it hasn’t been going the right way.

Ginger Garner PT, DPT (45:56)

Yeah,

that’s so important, I think, to just underscore what you said. If you have that first encounter with your pelvic PT and you’ve had a bad encounter with another one, you totally are within your right to be highly skeptical and distrustful initially because you had someone who maybe just wasn’t a good fit.

or maybe they claim to know or do more about something than they did. So if you have that experience, you should, at the bare minimum, I know many, practices, Amy, yours included, do these free consults, which is essential. They should make it a comfortable situation for you going in. They’re going to triage you and send you to the…

Amy (46:36)

Thank

Ginger Garner PT, DPT (46:51)

person you need to be with if it’s not them, right? If it’s not you, you’re gonna say, hey, I think maybe this is gonna be important for you. Maybe it’s that, you know, GI and psych, whatever it may be. I think that you wanna feel that authenticity from your therapist to know that whether or not you see them on that 10 minute free consult or whatever it is, they have your best interests in mind to get you to the right place. And there should also be a measure, like you were mentioning, I just wanna underscore,

a measure of flexibility, right? So that maybe they do a discovery teleconsult because the 10 or 15 minutes wasn’t enough, but you just want to get information move in the right direction. So I think that your therapist, whomever you land with should be able to meet you where you are and listen to you and make you feel comfortable. I think that those are such important points. Speaking of all those ideal points,

Where can people find you?

Amy (47:53)

They can find me on Beyond Basics Physical Therapy is our website. we do do, and this is another good point, we do do quite a bit of education on our social media, beyondbasicspt. And that also can be helpful, but Red Flag, make sure that they know what they’re talking about, which can be.

Ginger Garner PT, DPT (48:12)

Yeah.

So make sure that you follow beyondbasicspt

on Instagram.

Amy (48:24)

Yes, no. There is quite a bit of misinformation out there, so you do have to be mindful of that as well. I also tell my patients, I don’t know if it’s happening as much, again, dating me, but like I used to have patients just go on forums all the time. I think that was just Facebook. I’m not a very, I’m not very social media savvy either, but.

Ginger Garner PT, DPT (48:31)

Yeah.

Amy (48:51)

And I used to, yes. And I used to tell my patients, please go off those forums because there is a lot of negativity around some of them. I know with regard to endometriosis, like Nancy’s Nook is, I believe they give quite a bit of positive feedback. And then I know you’re a.

Ginger Garner PT, DPT (48:51)

That’s probably a good thing.

Amy (49:18)

a big speaker in March at the Endo summit. they have a lot of great information at that particular summit. So there are resources out there. You do have to find them though. And then stick with them because even this podcast, GI psychologists, they come super excited. I know.

Ginger Garner PT, DPT (49:34)

Yeah.

Yeah, you’ve got a new one to take away because

there’s increasing awareness of the necessity of these type of services because women’s health, specifically speaking to endometriosis, has been entirely neglected, miscategorized, misdiagnosed. Women being given broad sweeping mental health diagnoses instead of…

than just realizing, well, maybe they have anxiety because they’ve been ignored and in chronic pain for 15 years. They don’t actually have anxiety. They’re pretty freaking resilient. Women, they just are a product of medical misogyny, actually, or whatever that might have been for them. So make sure that you check out Dr. Amy Stein’s Instagram. It’s at beyondbasicspt, right?

Amy (50:20)

Great.

Yes, and we’re on Tik Tok. I don’t know how that’s taken these days, but YouTube.

Ginger Garner PT, DPT (50:40)

Yeah, you’re on YouTube. I know, who knows what’s happening these days, but wherever you are, Facebook, YouTube,

Instagram, they are there at the same handle at beyondbasicspt and beyondbasicsphysicaltherapy.com. Amy, I believe all your books and products are also listed on there as well. Yeah, all right.

Amy (51:01)

Yes, they are. And

on Amazon and all the places.

Ginger Garner PT, DPT (51:04)

all the places. So

please go check it out. I can’t emphasize how much to you the incredible pioneering advocacy that Amy has been in our profession in physical therapy, how important it is to get care 100 % of the time pre and post-op excision surgery. And thank you guys for listening. Thank you Dr. Amy Stein for joining me today. As always, you’re amazing.

Amy (51:31)

and you too as well. Thank you for having me and thank you for getting this important information to everyone that is listening.

Ginger Garner PT, DPT (51:39)

Absolutely.