Hi everyone and welcome back. I am with an incredibly special guest who, gosh, I think we’ve tried to do this interview a couple of times, but life happens. And actually that could be the title of this episode. Yes, life gets in the way, endometriosis gets in the way, all kinds of things get in the way and that’s why it’s incredibly important.

Kimberly Kushner (00:16)

Life got in the way for sure.

Dr. Ginger Garner PT, DPT (00:26)

that this episode is finally happening. So welcome to the vocal pelvic floor, Kimberly Kushner.

Kimberly Kushner (00:32)

Thank you so much for having me, Ginger. I’m so thrilled to finally be here.

Dr. Ginger Garner PT, DPT (00:37)

Yeah, I am too. So all y’all out there listening, I’m gonna do a little bragging first on her and then we’re gonna jump into the total, like, I’m dating myself here, like, Rolodex of questions I actually have. That’s as long as my arm. Okay, so Kimberly Kushner is a naturopath and clinical nutritionist with over 13 years of clinical practice, combining her professional expertise

with really incredible personal insight into chronic health conditions. The reason is she has a 24 year journey with endometriosis, POTS, and we’ll explain all that in a moment and more. And she’s applied her knowledge of holistic medicine to develop effective natural management strategies based on her personal experience. Currently in today,

present time, she’s focusing on comprehensive holistic care for women with endo, drawing from, again, her professional expertise and her lived experience. She is a fellow mom of the special club, which is the three boy club.

Kimberly Kushner (01:51)

The wild, wild club.

Dr. Ginger Garner PT, DPT (01:53)

That is wild. It is so wild. ⁓ There needs to be multiple books written on that. ⁓ So combining that, being a mom of a three time boy mom, which is incredible, and her healthcare background, ⁓ her patient care approach is super compassionate and deeply informed by her understanding of the intricate connections between nutrition, hormones, and emotional wellbeing. So welcome, Kimberly.

Kimberly Kushner (02:20)

Thank

you. Thanks, Ginger.

Dr. Ginger Garner PT, DPT (02:23)

Yeah, absolutely. Okay, so as we’re getting started, I always do this at the end, but I just want to make sure we’re going to circle back so you’re going to help be my accountability partner here to remember to let everyone know where you can be found. So that’s my kind of…

Kimberly Kushner (02:36)

So you can

find me, the best place to find me is actually on Instagram and my Instagram handle is Endonaturopath or you can visit my website at Endonaturopath.com I have a few things here and there on YouTube also, Endonaturopath but yeah, Instagram’s probably my most, yeah, the best place to find me.

Dr. Ginger Garner PT, DPT (02:42)

Okay.

Thank you.

Okay, fantastic.

Yeah, you’ve got some great posts there. I was just perusing those. And of course I follow you anyway. in the last few weeks, I’m just seeing all your really amazing things that are connecting the dots. And that is what this podcast is going to be about. That is what this episode is about, is connecting the dots between things that were previously thought to exist on their own. But speaking frankly,

Kimberly Kushner (03:26)

Mm-hmm.

Dr. Ginger Garner PT, DPT (03:28)

because women’s health has historically been ignored, under-researched, under-attended. Women are gross recipients of medical gaslighting on a regular basis and just dismissal of their symptoms. The lines between these things, it’s almost like a criminal profile with the strings between the sticky notes and the push pins on the bulletin board. They haven’t been connected and it’s time to connect those things. And so that’s what I want to talk about.

Kimberly Kushner (03:52)

Yes.

Dr. Ginger Garner PT, DPT (03:59)

⁓ But before we jump into that, I want to know your origin story. What drew you to specialize in women’s health, especially underdiagnosed and attended conditions like endo and things like pelvic congestion syndrome?

Kimberly Kushner (04:07)

you

Yeah.

Yeah. So it’s, my own personal story and my, my own journey actually. So everything started back when I was about, I was 11 when my period started and they were excruciating. ⁓ they were extremely traumatizing as such a young girl going through this. I went away to boarding school and I navigated it all kind of on my own in a system that wasn’t very compassionate or understanding. And, you know, we were,

kind of just taken to the conventional, nothing wrong with conventional medicine, but they were not equipped to deal with what actually was going on with me. so I’m a US citizen. currently live in Australia. My husband’s Australian. ⁓ My mother is actually Indonesian. So I grew up in Bali and I was in boarding school in Australia. So yeah, so I was in, so I was in Australia and I was

Dr. Ginger Garner PT, DPT (04:52)

Where were you located at that time?

Kimberly Kushner (05:11)

going through the Australian medical system. And I think my first colonoscopy and gastroscopy was done in grade 10, because I had such severe bowel symptoms, had an emergency appendectomy at 15. So a lot of very jolting, traumatizing medical experiences from such a young age. And lo and behold, I was diagnosed with generalized anxiety disorder. But at the same time, I was severely anemic.

Dr. Ginger Garner PT, DPT (05:19)

now.

Mm-hmm.

Kimberly Kushner (05:41)

nutrient deficient and eating all this incredible food at boarding school, which was terrible by the way, and only further compounded my issues. ⁓ It took me 12 years to get a diagnosis. It was a long journey to get there. Every sort of test at the time was clear. ⁓ But when I had my laparoscopy, I had ⁓ endo on my bowel.

Dr. Ginger Garner PT, DPT (05:47)

Mm.

Kimberly Kushner (06:09)

my bladder, my uterus sacral ligaments, my ovaries, and on the outside of my uterus. So it was quite extensive. However, it was completely excised. ⁓ and they also said I had adenomyosis at a very big and bulky uterus. So yeah, there was lots of, you know, all your classic symptoms, very heavy bleeding.

Dr. Ginger Garner PT, DPT (06:19)

Hmm.

Kimberly Kushner (06:37)

with clots, extremely painful. ⁓ I was diagnosed with vaginismus, pelvic floor dysfunction, interstitial cystitis, you name it. ⁓ And also misdiagnosed with things like pelvic inflammatory disease, recurrent UTIs. ⁓ So I truly, truly, truly get it. ⁓ And then after my excision, I

Dr. Ginger Garner PT, DPT (06:40)

Mm-hmm.

All the things.

Mm-hmm.

Kimberly Kushner (07:05)

was able to conceive naturally not long after. So within a year I was able to become pregnant. However, during the third trimester I suddenly developed POTS and that was extremely, extremely scary. I was losing consciousness in pregnancy. No one knew what was wrong with me. Again, it was me that advocated for myself and…

Dr. Ginger Garner PT, DPT (07:19)

So.

Kimberly Kushner (07:32)

Eventually got myself the POTS diagnosis. It was a very obvious case of POTS. Sometimes it’s not as obvious but after after giving birth I was doing the whole battery of autonomic testing and that’s where we did the tilt table tests and all other, you know neurological testing cardiac testing ⁓ and that’s where I found out I had POTS so that was 11 years ago now and

Dr. Ginger Garner PT, DPT (07:40)

Mm-hmm.

Kimberly Kushner (08:02)

It’s only now that a lot of other symptoms have manifested. So pelvic congestion with ovarian vein insufficiency, it’s looking more and more like I have EDS with severe hypermobility, ⁓ almost like a cranios cervical instability type of picture with my neck, ⁓ multiple vascular compressions, thoracic outlet, jugular vein compression, all the things, all the very EDSC hypermobile.

Dr. Ginger Garner PT, DPT (08:20)

Mm-hmm.

Kimberly Kushner (08:32)

features. ⁓ And yeah, so that’s a bit about me and my personal journey with my own health stuff.

Dr. Ginger Garner PT, DPT (08:39)

So ⁓

it’s a huge personal clinical epiphany or aha or turning point or just existing on the planet that shaped how you approach chronic pelvic pain today. And whole body, because it’s a whole body disease.

Kimberly Kushner (08:48)

yeah.

Absolutely.

⁓ absolutely, absolutely. And this is what I’ve been kind of seeing a lot on my social media. It’s never, never just endo. It’s never just endo. You know what I mean? Endo, it’s almost like endo is just like this significant feature of a much bigger issue at play. And unfortunately, in many people like myself, it coincides with the immune dysfunction, whether it be autoimmune disease or mast cell activation.

Dr. Ginger Garner PT, DPT (09:09)

Yeah. ⁓

Mm-hmm.

Kimberly Kushner (09:29)

plus the

Dr. Ginger Garner PT, DPT (09:29)

Mm-hmm.

Kimberly Kushner (09:29)

more hypermobility type vascular issues, and then of course the POTS.

Dr. Ginger Garner PT, DPT (09:36)

Yeah, yeah, and I have seen clonal manifestations and experienced to a certain degree that myself having endometriosis, ⁓ the overlap of other things, autoimmune driven like multiple sclerosis, reactivation of Epstein-Barr, Lyme, like all of these other things.

Kimberly Kushner (09:49)

⁓ yeah.

Yes.

Dr. Ginger Garner PT, DPT (09:56)

coinciding where they may have gone through that as previous diagnoses. Whether or not they were the actual diagnoses or endometriosis was a driver, we just don’t know yet. But there is this clinical bucket that all of these things get thrown into.

Kimberly Kushner (10:06)

Thank you.

Dr. Ginger Garner PT, DPT (10:12)

But because women’s health is not a priority really in any country, we end up with these giant gaps where someone comes in and they think they have like, I had a patient today come in, sit down. She’s been diagnosed with interstitial cystitis, but I don’t really think that’s a driver. think endometriosis could be a driver, but even below that, there’s mast cell activation syndrome. So there’s MCAS.

Kimberly Kushner (10:16)

Yeah.

Yeah.

Yes.

Yeah. And that will flare your IC symptoms anyway. Yeah.

Dr. Ginger Garner PT, DPT (10:41)

There’s a histamine problem. Totally.

And no one had ever even mentioned MCAS before, ever. She’s on all of these other drugs and she’s had all of these giant interventions, but no one’s screened her for endometriosis. No one’s asked about MCAS. And yet she has these dermatological features, you know, of histamine. ⁓

Kimberly Kushner (10:48)

Yeah. Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (11:03)

dysfunction. So it’s just incredible. And so I would love to like bring all that together, like scoop it all together, you know, like random things on the bar and your kitchen bar and put them in the same bucket and go, these can be related. Do we entirely understand how or why? Not yet, but it’s important that I think women realize that if they have like,

Kimberly Kushner (11:09)

Yup.

Yeah.

Absolutely.

Dr. Ginger Garner PT, DPT (11:28)

rosacea and other histamine issues or they have EDS on top of that or something else that they’re not separate buckets. They can in fact go in the same bucket.

Kimberly Kushner (11:39)

Yes, absolutely.

Dr. Ginger Garner PT, DPT (11:42)

So when it comes to like your background with, you’ve got an amazing background in naturopathic medicine and nutrition, which is kind of a cornerstone, I think, of naturopathic medicine by default. What are the most overlooked nutritional factors you see and have experienced when it comes to supporting people with endo or this kind of…

Kimberly Kushner (11:54)

Yeah, absolutely.

Dr. Ginger Garner PT, DPT (12:07)

this big bucket that we’re talking about with pelvic congestion, EDS, MCAS, et cetera.

Kimberly Kushner (12:09)

you

Well, I think looking at the nature of these conditions, something that underlies all of it is chronic and systemic inflammation. And whether that then leads to immune dysfunction, in most cases it does. We know that there’s a new study that’s come out that shows the links with endo and autoimmune disease. I mean, that’s not breaking news to me. That’s something we’ve seen in clinic over and over and over again. But it’s great that we’re seeing hard evidence now, right? ⁓ So yeah, things that…

Dr. Ginger Garner PT, DPT (12:35)

Yeah.

Mm-hmm.

Kimberly Kushner (12:43)

then can predispose us to more chronic inflammation, like your essential fatty acid deficiencies, omega-6 to three ratio imbalances, antioxidant deficiencies, zinc, vitamin C, you know, as we, and it’s so hard because when, and I get it, when you have limited spoons, when you’re chronically unwell and your energy is depleted, it’s hard to desire.

Dr. Ginger Garner PT, DPT (12:54)

Yeah.

Kimberly Kushner (13:11)

And even, know, from an appetite perspective, from an energetic perspective, it’s hard to desire to want to make these things, to eat these things. You’re not excited about any of it. So by default, we end up consuming a more processed diet, which is depleting us of these really important nutrients ⁓ and can then further perpetuate the problem. So yeah, it’s just unfortunate, but it’s the reality in most cases.

Dr. Ginger Garner PT, DPT (13:16)

Mm-hmm.

I can’t tell you how many times I’ve had patients come in and it was today. mean, that was literally my clinical experience today. I had multiple, actually my entire day was new evaluations to have women come and sit down and they said this exact thing and it totally echoes what you just said. To have someone sit down, which they said today, this person said today, I have no idea what to eat now.

Kimberly Kushner (13:51)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (14:04)

I hate eating.

Everything’s bloat. Everything bloats me. It feels like a vat of acid. That’s what this person said, a vat of acid. And yet the diagnosis didn’t, that she had received elsewhere, didn’t match any of her symptoms. It really matched the symptoms that we’re talking about. And yet,

Kimberly Kushner (14:20)

⁓ well. Yeah.

Dr. Ginger Garner PT, DPT (14:23)

she had been completely dismissed. Nutrition had never been discussed. No one had ever noticed that her pain was in her abdominal area and her lower left quadrant. you know, the lower left side around the sigmoid colon, it was like, oh, you know, it’s just, I C it’s just, I C but there’s something bigger, you know, going on. And again, you brought up another really important point about, you know, inflammation, systemic inflammation being a huge driver. And, you know, this

Kimberly Kushner (14:34)

Hmm… Yeah.

Mm.

Yeah.

Dr. Ginger Garner PT, DPT (14:52)

person was sitting in front of me and had obvious histamine responses on her skin at that very moment. And yet it’s amazing that even though she had been prescribed a big kind of pharma antihistamine, it’s almost like pieces of the puzzles were still not being put together. She was on a drug as an antihistamine, but nothing had been addressed in her diet in terms of removing foods with high histamine. So can you talk a little bit about that? Why is there such a disconnect?

Kimberly Kushner (14:58)

Hmm. ⁓

Yes.

Yes.

Dr. Ginger Garner PT, DPT (15:20)

And maybe it’s because our medical system in the US, you can speak to the way it is in Australia. ⁓ Our medical system, yeah, they’re taught to prescribe the most expensive interventions, drugs, surgery, invasive things, and never in the 10 years she’s been suffering from this, and really her whole life, ⁓ has anyone said, by the way, there are foods that are high in histamine that you may, yeah, exactly.

Kimberly Kushner (15:25)

Yeah, which is very similar.

could be triggering you. yeah.

Well, I think it comes down to obviously how her providers have been educated to handle and to treat and manage this because their toolkits are limited to drugs and surgery, generally speaking. So using something like a antihistamine, which can be very, very helpful and life saving at times.

will prevent the histamine from latching onto the receptors, but it will not assist with your clearance of histamine or your endogenous production of histamine. For example, if she’s got gut issues and gut dysbiosis and she’s got excess histamine production in her gut, that’s not gonna address any of that. So it’s really important to literally, if you have an overflowing histamine bucket, to get the scoops of histamine out of there. And the antihistamine is not gonna do that.

Mass cell stabilizers may assist, but you’ve got to look at what else is going on. Is there SIBO? Is there, you know, ⁓ genetic issues that’s compromising her ability to clear histamine? Is she just eating way too much high histamine food? What’s her nervous system like? You know, someone with this type of history, I don’t know, is there trauma there? You know, is she stuck in sympathetic dominance? All this stuff. You really…

can’t do a case like this justice without looking at the whole person.

Dr. Ginger Garner PT, DPT (17:18)

Yeah, yeah. And the whole stress management piece that you’re talking about is incredible. I saw another patient earlier and this person was aware of the stress management contribution. But when I pulled out imaging and started to image the parts and the pieces of all the motor patterning, even though she had been working on stress management,

Kimberly Kushner (17:36)

Yeah.

Dr. Ginger Garner PT, DPT (17:45)

she still couldn’t control the respiratory diaphragm. It was still incredibly hard to even control the respiratory diaphragm and how it was impacting pelvic organs. And so there was this whole, was like patting your head and rubbing your stomach. It was really difficult for her to get her head around that, to manage that.

Kimberly Kushner (17:55)

Mmm.

Yes, I think that affects so many more people

than they realize. I know it’s affecting me. I know that. You pelvic floor, diaphragm, throat, the whole thing. It’s, yeah.

Dr. Ginger Garner PT, DPT (18:07)

Yeah.

Yeah, yeah, and once, you know, and the good thing is once you see it, whether it’s on the screen, you know, with imaging or you feel it, then you begin to be able to shift that. It’s just, we don’t have to fix everything at once if we just fix one thing at a time so profound, whether it is lowering the, you know, the histamine.

Kimberly Kushner (18:19)

Mm-hmm.

Yep.

Yeah.

Dr. Ginger Garner PT, DPT (18:37)

high histamine foods and leaning towards the lower histamine foods, whether it is shifting your breathing practice and what you’re doing can have a profound long-term effect. And I think that’s probably underestimated because of our social conditioning that a drug or a surgery, something invasive, A pill that you’re going to pop is going to be the thing that fixes instead of it being these more organic processes that

Kimberly Kushner (18:38)

Yeah.

Good right

Okay.

Dr. Ginger Garner PT, DPT (19:07)

are really inexpensive and easily to implement.

Kimberly Kushner (19:09)

Yeah,

on the scheme of things, yeah, for sure. And it’s kind of like unlearning, you know, when we look at the way the nervous systems wired us, we never just get that chronically unwell overnight. It’s taken so much conditioning from our nervous system trying to keep us safe. And then, you know, we’re constantly feeling like we’re in danger and our body feels like we’re so unsafe in ourselves because of, you know, chronic pain or whatever other symptoms.

that there needs to be so much unlearning to be done. it can, and you know, all those things that you said, you know, learning how to breathe properly, changing your diet, somatic therapies, manual therapies, we overlook the, maybe we overlook the significance of it because it’s not a quick fix, maybe.

Dr. Ginger Garner PT, DPT (20:01)

Right.

It takes our diligent participation and our deliberate effort. It is, especially when you got three boys.

Kimberly Kushner (20:07)

It does, it’s hard work. It’s re-learning. Yeah, yeah. But you know,

surgery, you’re literally, literally removing lesions, removing the disease tissue, reorganizing your organs. So yeah, that is a quick fix, but there’s so much more. And this is what I say to ladies all the time. I’m like, don’t expect your surgery to do what surgery cannot do. There’s still so much.

that surgery does not address. I’m not poo-pooing surgery whatsoever. I think surgery is so important, but I always say it’s your turning point, not your end point.

Dr. Ginger Garner PT, DPT (20:51)

Yeah, that’s so true. And I think that no matter what kind of support that you get, and here’s the thing, I think that women from a social perspective, because our conditions that we suffer from have historically entirely been dismissed. And then we were just gaslit. ⁓ it’s hysteria, right? I mean, that’s where hysterectomy comes from. That we have internalized misogyny towards ourself.

Kimberly Kushner (21:09)

Yes. Oh, yeah.

Dr. Ginger Garner PT, DPT (21:21)

Like, I’ll tell you, full disclosure of vulnerability, I did it to myself with my own endometriosis excision because, of course, I’m self-employed and I have to support my three kids. And that includes all the things that go with it. And so what do I do?

Kimberly Kushner (21:27)

Yeah.

Mm.

Yup.

Dr. Ginger Garner PT, DPT (21:44)

I am we can swear on this podcast. I’m just I was just a hard ass to myself, which was not what I needed. I needed self-compassion, but because I knew I couldn’t miss work because every day I miss work, I’m missing treating a patient with endometriosis and in my exact same condition that I knew that I couldn’t miss too much work that I needed to heal quickly. So what did I do? ⁓ I fully internalized that misogyny and gave myself like, you got two weeks, you got two weeks to get better and then get back into the clinic.

Kimberly Kushner (21:50)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (22:12)

to which my super compassionate, incredible surgeon looked at me and said, now, if you’re not watching YouTube, you’re not gonna see my expression on my face. He looked at me and he was like, no. You need eight weeks. I was like, I will not be able to pay my bills if I take eight weeks. Okay, how about four weeks? Can we split the difference? But I mean, I…

Kimberly Kushner (22:22)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (22:38)

You know, in living in the American health care system, in the super capitalistic driven society where it’s a now a two income society, socially women are pressured, get back to work, you don’t have time off, you don’t have time to heal. And then research, the conditions are under researched. So we are told basically, ⁓ well, a period is just a thing. Like it’s not a big deal.

Kimberly Kushner (22:46)

Yes. So, it’s so hard.

Dr. Ginger Garner PT, DPT (23:03)

to the point where we drive ourselves to be anemic. We work through incredible excruciating pain, which is a good, it’s wonderful that some countries now, what did you say? Portugal, before we press record, is it Portugal that’s providing time off? Was it for menopause or endo? Was it endo? Okay, yeah. So at least we’re starting to get a shift, but holy cow. Okay, that only took a few thousand years, right?

Kimberly Kushner (23:14)

Portugal, I believe it’s Portugal. Yeah.

Isn’t it menstrual leave?

I’m double checking.

Dr. Ginger Garner PT, DPT (23:32)

So.

Kimberly Kushner (23:32)

I

know many more countries need to follow in their footsteps.

Dr. Ginger Garner PT, DPT (23:36)

Yeah, they do. I just, to everyone out there who’s been through the surgery or you’re getting ready to go through surgery or you’re done with surgery and you need all the therapy that we’re talking about right now that follows up, just try not to kick yourself so hard. You need more time than you think to heal.

Kimberly Kushner (23:47)

Exactly!

I say that all the time and the name, just the name, minimally invasive surgery can be deceiving. Just because it’s minimally invasive does not mean it’s not a big deal. And I have women who are like, I’m two weeks post-op, why am I not feeling amazing already? I’m like, give yourself a break. Give yourself a break. They’ve, you know.

Dr. Ginger Garner PT, DPT (24:06)

Yeah.

Amen.

Kimberly Kushner (24:25)

put things back together, remove things, your body needs to heal. If you saw wounds like that on your skin outside, you would give yourself more compassion and time. But yeah, it’s because everything is obviously internal and you just see little incisions. It’s totally, yeah.

Dr. Ginger Garner PT, DPT (24:35)

It shocking.

Mm-hmm.

It’s invisible. Yeah.

Well, that also describes the condition itself. Like, okay, I’m sitting here looking at you and you’re like drop dead, like fantastic, look amazing, all gorgeous and put together. Whatever you’re suffering right now is invisible. I can’t see it, right? And…

Kimberly Kushner (24:52)

Mm-hmm. Invisible.

Yeah. Yeah. You can’t see the parts. You can’t

see the pelvic. You can’t see that my whole ovarian vein’s been got 10 coils in it. Yeah.

Dr. Ginger Garner PT, DPT (25:12)

you

Right.

And I just sent out my newsletter. Like we were just talking about this before we pressed record. I just sent out my newsletter. the whole whoever cares, you know, about what I’m going through knows I just had totally rando injuries that are probably related to this that I didn’t do anything to have. That’s all invisible. Like it’s invisible what women are suffering when they have endometriosis, POTS, pelvic congestion syndrome, an EDS or generalized hypermobility.

Kimberly Kushner (25:31)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (25:45)

and all of the anxiety that might go with it because it’s not that you have anxiety, it’s that you probably received an incorrect diagnosis of anxiety because you had to suffer through the lack of social support. Yeah.

Kimberly Kushner (25:56)

Absolutely. Absolutely. Absolutely.

Dr. Ginger Garner PT, DPT (26:01)

some like more reason for self-compassion, more self-compassion, more time for healing. I just came off of a vacation. And so, and I ended up not being able to take half the vacation because of the situation that, know, yeah, cause I was not well, I had these random injuries crop up without any accident happening. And so what it taught me was next year,

Kimberly Kushner (26:04)

Exactly.

All good. ⁓

because you are unwell.

Dr. Ginger Garner PT, DPT (26:31)

one of the strategies and then I’m just going to suggest this to all listeners. If you have these conditions, please book at least one week of vacation and do not plan anything. Don’t go anywhere. Don’t make any appointments. Don’t do anything. Because if you needed to shift that vacation one week or the other, like that’s what I had to do. I had to take my vacation time that I had allotted to actually go to the ER.

Kimberly Kushner (26:40)

around it. Give yourself like, yeah.

Dr. Ginger Garner PT, DPT (26:58)

to go to multiple medical visits, to work all of this crap out that comes when you have a genetic satchel, you know, backpack that includes endometriosis.

Kimberly Kushner (27:06)

Yes.

Yeah. Yeah. Yeah.

Dr. Ginger Garner PT, DPT (27:11)

So what

are some of the ways getting back to the nutritional aspect? Because a lot of women don’t know about the connection with MCAS or histamine issues in Endo. So now, y’all go out and look for your low histamine foods, read up on MCAS and learn about it. And Kimberly has a bunch of resources on it, I’m sure, which is amazing. What are some of the other ways nutrition can help manage the hormone and vascular components that go along with these conditions? Because…

Kimberly Kushner (27:18)

Okay. Okay.

Yeah. Yeah. Yup.

Okay.

Dr. Ginger Garner PT, DPT (27:39)

That is really part of the giant invisible piece. Like we think of obvious things like painful intercourse, back pain, hip pain, all of those things that might cause us to like hobble around. But hormonal and vascular stuff is invisible. You’re like, yeah, yeah.

Kimberly Kushner (27:52)

Yeah, it’s definitely a lot less spoken about, especially the vascular

connection. And you know, this is only something I’ve been speaking up about recently because it’s something I’ve had to, again, me go through ⁓ and I want to advocate for people. okay, so estrogen, progesterone, two of our key sex hormones, they play a huge role in both pelvic congestion, vascular issues, and endo. We know that endo

thrives off estrogen, it can make its own estrogen. The endotissue itself is progesterone resistant, meaning there are faulty progesterone receptors on the endolegions themselves, and there are fewer progesterone receptors. And progesterone is really anti-inflammatory, anti-estrogenic. So yeah, it gets very tricky. So we need to always be proactively, ⁓ A, reducing our, well,

stop ingesting xenoestrogens like plastics, microplastics, endocrine disrupting chemicals, whether that be from sprays or herbicides, pesticides, whatnot. Don’t ever put plastics in microwaves. That’s something that I’m like so passionate about. Don’t drink out of a, yeah. Don’t leave a plastic bottle. Really? Yes, because you can get so many meals and things that you can heat up. I say no, if you’ve got to eat something, you know, if you’re at the point where you would need to eat.

Dr. Ginger Garner PT, DPT (28:54)

True. Yeah.

Yes. Yeah. I just told my son that. Yes, at dinner.

Kimberly Kushner (29:20)

pre-made frozen meals, like that’s where you’re at, that’s fine. I say just put it in a plate, put it in the microwave. Just do not heat it up in plastic, do not put plastic bottles in the car and let it get hot in the sun and drink out of that. So all these things will mess with your hormones. They are estrogenic, they are going to potentially worsen your endo symptoms. So in addition to avoiding xenoestrogens, we wanna proactively support estrogen detoxification and clearance.

That happens in two key phases, ⁓ through your liver, and then we excrete it through our stools, through our bowels. So we need healthy liver function, and we need to be pooping daily. We need, look at the Bristol stool chart. Yeah, exactly. You want a nice healthy poo, which is like the texture of a sausage, basically. Not constipation, not diarrhea. And a lot of women with endo will have this.

sort of alternating IBSC, IBSD kind of picture, regardless of whether they have endo on their bowels or not. So then we kind of look deeper at the microbiome and go, what’s going on there? It gets deeper. So liver support, okay, we can, there are certain herbs, ⁓ bitter herbs, digestive herbs, I use them a lot. ⁓ Even simple things that you can do at home like ginger tea. ⁓

Dr. Ginger Garner PT, DPT (30:24)

true.

Kimberly Kushner (30:45)

If you’re not histamine sensitive, apple cider vinegar. Arugula, have a handful of arugula when you’re preparing your dinner. That’s quite nice too.

Another thing that we need to support liver function is we need to look at methylation. And there’s been a bit of a buzzword with the word MTHFR. Now that’s not a swear word. That is an acronym for an enzyme that plays an important. Yeah. An enzyme that. ⁓

Dr. Ginger Garner PT, DPT (31:15)

Sometimes we use it like a swear word.

Kimberly Kushner (31:21)

plays a role in our methylation pathways, okay? So that helps with, ⁓ that plays a role in phase two estrogen detoxification. So phase one and then phase two, ⁓ methylation is a key player there. Methylation ⁓ activates folate, activates B12, so that you can use it for many, many different processes, which includes detoxification. Even it plays a role in histamine too, the production of neurotransmitters and

brain chemicals, so think mood. So yeah, MTHFR, you can check if you have SNPs or single nucleotide polymorphisms in this gene. ⁓ And that will determine whether you will function better on ⁓ activated folate or activated B12. But I usually say, you know.

avoiding your synthetic folic acid is better anyway. So yeah.

Dr. Ginger Garner PT, DPT (32:23)

Definitely. Would

you say, like the last thing that I read, so correct me if I’m wrong, on MTHFR is about half the population actually has that SNP? Do know what the stats are on that?

Kimberly Kushner (32:36)

Yes, it’s very prominent, but there are different combinations. So whether you have, you know, your heterozygous or homozygous, ⁓ yes, but…

Dr. Ginger Garner PT, DPT (32:42)

Mm-hmm.

Mm-hmm.

So is it about half the population has heterozygous, which means one good gene, one quote bad gene, or do you think it’s, yeah.

Kimberly Kushner (32:55)

Well, are two key ones. Yeah, there

are two key ones that we look at. ⁓ C677T and A1298. ⁓ And the C6 one is the more impactful one. So if you have mutations in that.

Dr. Ginger Garner PT, DPT (33:15)

Yes.

Kimberly Kushner (33:15)

SNP, you’re going to be

a poorer methylator, but I don’t know the exact exact numbers. Yeah, but you can test that.

Dr. Ginger Garner PT, DPT (33:20)

Okay.

Yeah. I guess,

yeah, I think the reason that, and I, when I counsel my patients on this, I want to bring that point up so that they, again, don’t think that there’s some kind of unicorn, that no one else has it. Yeah. A lot of people have it. And then that means they’re going to need kind of, I call them almost pre-digested, like the methylated B12 and folate, not folic acid, because a lot of people don’t know that. So can you go into that just a little bit more about the B12 and the folate?

Kimberly Kushner (33:35)

No!

Yes.

Yes, the pre, yeah, exactly, pre-digested. It’s just activated. So it skips the step that that enzyme, the folate, in inverted commas, the folate enzyme is supposed to activate. So your body doesn’t need to do that work. ⁓ But some people feel better on folinic acid as well. So folinic is one step before the folate. So it’s kind of an intermediate.

Dr. Ginger Garner PT, DPT (34:11)

Yeah.

Kimberly Kushner (34:22)

so they can try that too. Because some people may get too stimulated on methyls.

Dr. Ginger Garner PT, DPT (34:24)

Well, that’s good to know.

Okay. Have you found any connection between difficulty with supplementation on B vitamins? Because I know I have seen this in a lot of patients and I think it’s curious and I want to get your insight on this from your unique perspective with people who have a hard time processing B vitamins. So let’s just say you’re low in B12 or whatnot, but

you can’t take it because it creates a lot of nausea or other side effects. Have you seen that happen and how do you approach that?

Kimberly Kushner (35:05)

Yeah, so like a B12 lozenge or B12 drops could be better. If like a vitamin, like an oral tablet or like a pill is making them feel sick. ⁓ And do smaller doses, like start maybe 100 micrograms at a time, drop dosing or get a lozenge and cut it into quarters and just suck on that. Yeah. Yeah.

Dr. Ginger Garner PT, DPT (35:11)

Okay.

Mm-hmm.

Yeah.

Have you seen that ⁓ a lot where supplementation, whether it is maybe they’re looking at aromatase inhibitors or now we’re getting a little bit more geeky and we can explain all this to our listener, but whether it is, ⁓ you know, methylated vitamins or a B complex supplement or

Kimberly Kushner (35:45)

Yeah.

Dr. Ginger Garner PT, DPT (35:54)

whether it’s aromatase inhibitors that they take them and they immediately get nauseated or have GI symptoms. Too much too soon. Okay.

Kimberly Kushner (36:00)

Yeah, probably too much, too quickly. Yeah, yeah. And

you need to support their liver.

Dr. Ginger Garner PT, DPT (36:10)

Yeah.

Kimberly Kushner (36:11)

So the things that I said earlier can be helpful too.

Dr. Ginger Garner PT, DPT (36:14)

Yeah. So can

you explain a little bit of that process? Because we’ve been talking about estrogen metabolism, but for the listener, even though they probably heard it, you know, in other podcasts, if they’ve listened to this series regularly, I think it’s worth repeating, like the importance of what your body can do or doesn’t do. Because you mentioned, again, the liver has to be able to metabolize it, but then you have to be able to excrete it.

And then in some cases, supplementation like with aromatase inhibitors, like whether it’s with DEM or that kind of thing, or cruciferous vegetables or something like that may be necessary. Explain a little bit of that for the listener, because I think a lot, like if, I don’t want to say conventional or traditional medicine because there’s so many gaps in it. I think it’s like, I almost want to say it’s, know, it’s pharma driven medicine, not holistic medicine.

Kimberly Kushner (36:49)

Yes, we love Crucifer.

Yeah.

Dr. Ginger Garner PT, DPT (37:08)

wants to just completely ignore that estrogen metabolism is an issue. And then they’ve got all their endo is worse, right? All their symptoms are worse. Can you explain a little bit about, you know, aromatase inhibitors and why those are important and why estrogen metabolism is important?

Kimberly Kushner (37:12)

Yeah.

Yes. Yeah.

Yeah,

so when we look at the way that our sex hormones are made, ⁓ there’s an enzyme called aromatase and it converts our androgens, like testosterone, into estrogens. Now, this can be upregulated. So you have excess conversion of testosterone into estrogen. And this is often the case. You some people have really low test and really high estrogen. You even see this in men. ⁓

But you can use substances that can down-regulate or inhibit that enzyme so that there is less conversion into estrogen, whilst simultaneously supporting the clearance through phase one, phase two, and phase three. So that’s really important to do also. you know, white button mushrooms can help too, ⁓ omega-3s, sulforaphane.

That’s why I’m like, eat your cruciferous veggies. ⁓ Yeah, and that’s all back to like things that support liver function too.

Dr. Ginger Garner PT, DPT (38:23)

Yeah.

Yeah, absolutely. ⁓ And so the good news that comes out of that is that people don’t, women don’t necessarily have to run out and pick up a supplement and you know, aromatase inhibitor based supplement. They could start with food and should start with all of these different foods, whether it’s cauliflower, broccoli, broccoli sprouts for the sephilorophane. What are some of the, yeah, what are some of the other ones that you recommend?

Kimberly Kushner (38:44)

with food. Yeah. Yeah. Yeah. Yeah. Yes. Good fats, antioxidants. White button

mushrooms is one that is like a good one. mushrooms, ⁓ good fats. So if you can eat oily fish two to three times a week, that’s a bonus. Like that’s a big win. I will have to check.

Dr. Ginger Garner PT, DPT (38:58)

Mm-hmm.

Kimberly Kushner (39:13)

on whether this is 100 % correct or not, but I believe rosemary, ⁓ there’s a component called rosmarinic acid, which can also assist in estrogen metabolism. In fact, I do, but in my head, I’m just thinking which pathway exactly, which section. ⁓ So herbs, ⁓ good fats, antioxidants, colorful fruit and veg, berries, and of course there are things that induce aromatase.

smoking, alcohol, that type of thing. ⁓ Yeah, so avoiding that. And I’m sure your EDCs, which are your endocrine disruptors, will absolutely mess with that too. So a lot of things to be mindful of in your environment.

Dr. Ginger Garner PT, DPT (39:47)

Yeah. Yeah.

Yeah, I think that.

It’s such an under attended subject. ⁓ When I talk to patients about that, they’re usually surprised because I think people make an assumption that if it’s on the market and being sold, it’s safe.

Kimberly Kushner (40:17)

⁓ yeah, and this is the thing, although we’re not unicorns, we’re usually the more sensitive group of people. Yeah, yeah, like more sensitive to medications, more, well I am, ⁓ especially if you have EDS, POTS, dysautonomia, you are gonna be a lot more sensitive to a lot of different things. ⁓

Dr. Ginger Garner PT, DPT (40:18)

Yeah.

Canary in the coal mine. Yeah.

Mm-hmm.

And

I think it’s not a bad thing because when we talk about hypersensitivity, you think, gosh, well, they just need to get over being hypersensitive. But I tend to think about it like a canary in the coal mine, like when that bird would go down into the coal mine to detect high levels of pathogens or environmental toxins, that describes our population.

Kimberly Kushner (40:58)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (41:07)

that can actually notice toxins in an environment before anyone else would pick up on it, which then makes us, it’s not the hypersensitivity. We actually notice it. Our bodies notice it before anyone else’s do but the outcome is not great unless you know that the environmental pollutants and toxins exist and then you can avoid them to begin with. So you don’t have to be a canary in a coal mine.

Kimberly Kushner (41:12)

yeah. yeah.

Yes.

Yeah. Yeah.

Yeah,

that’s it. Especially with MCAS, you’re going to be so sensitive to… I mean, I can’t handle perfumes. Air fresheners, toxic scents, like, ugh, walk into a space. You know those automatic air fresheners? You go into a certain office, they’re horrible. Yeah, I know. But I totally hear you there. Totally get you.

Dr. Ginger Garner PT, DPT (41:39)

Mm.

Yeah.

Ugh.

well.

Yeah, yeah, I think that, you know, in the future, ⁓ maybe 10 years, 20 years, whatever it takes down the line, ⁓ we’ll have realized that people with these conditions actually have an ability to pick up on environmental pollutants before anyone else does. So, unfortunately, that’s good and bad. ⁓ And that ends up, that brings us to kind of the next point, which is, can you…

Kimberly Kushner (42:13)

Yeah.

Yeah.

Dr. Ginger Garner PT, DPT (42:25)

Before we talk about the dismissal and the diagnostic gaps and the things that can happen, because that’s really defined as medical gas lighting when your symptoms are dismissed and you’re just told you’re hypersensitive or something, when actually it is a real condition, but because other bodies don’t pick up on it. They don’t smell the poisonous gas until it’s way too late.

Kimberly Kushner (42:46)

That’s right.

That’s right.

Dr. Ginger Garner PT, DPT (42:48)

But then

people with these conditions do immediately, like the scent thing that you mentioned, immediately they pick up on an endocrine disruptor and their body goes, we don’t like that. Yeah, we can’t handle that. We’re just, giving you a warning early that we can’t handle it. ⁓ Currently that leads to women being gaslit now because they have more sensitive systems that are able to pick up. It’s kind of like being pregnant when you can super taste and super smell. It’s kind of a superhero. ⁓

Kimberly Kushner (42:57)

Not good. Yeah.

Yes, super sensitive.

Characteristic, yeah.

Dr. Ginger Garner PT, DPT (43:18)

you know, ability that

we don’t want, that you don’t want to have. ⁓ I think histamine is one of those things. Can you go over the connection again for the listener between how histamine sensitivity or intolerance or what we call, you know, MCAS, mast cell activation syndrome and endometriosis, how do those things end up going together and how can one feel the other, you know, vice versa?

Kimberly Kushner (43:22)

Yeah. Yeah. Yeah.

Mm-hmm.

Yeah,

so I say it for the sake of simplicity. Your estrogen and histamine will liberate and kind of trigger one another. So if you’re estrogen dominant, like in a very classic endo picture, it’s going to be triggering off your histamine. Progesterone will help counteract that. And because we’re usually more progesterone resistant or have less progesterone, then we’re not going to have that.

anti-estrogenic effect which will then help to calm down the histamine reactions.

Dr. Ginger Garner PT, DPT (44:22)

Yeah, I love the way you describe that. That makes so much sense. And then it brings up another question, which is now let’s say you have someone going through perimenopause and endo. So yeah, so let’s just say they’ve had an excision or whatever and they’re going through perimenopause or during endo they found adenomyosis and then they did a hysterectomy. So now they’re like thrust into surgical menopause, which is.

Kimberly Kushner (44:35)

yeah.

to do.

⁓

yeah. No.

Dr. Ginger Garner PT, DPT (44:48)

like its

own brand of cruelty, right? Because you just fall into this pit of surgical menopause immediately. What happens or what have you noticed as a clinician? ⁓ Do you use in, and I’m assuming that you do, that you use oral micronized progesterone and you prescribe that in a way that we do here? Yeah, and is it absorbed in the same way as someone without endo?

Kimberly Kushner (44:51)

Yes, heartbreak.

I love progesterone from Yes, Eucalyptus Creams.

Good point. ⁓ So yeah, I do love progesterone. Very different to synthetic progestins. I feel like some people think they’re taking progesterone, but they’re not. So it’s very different to synthetic progestins. ⁓ What was the question? Is it absorbed? Yeah.

Dr. Ginger Garner PT, DPT (45:25)

Yes.

so important. Yeah.

⁓ well, we have two points now because

you brought up something really important that ⁓ every practitioner should be educating their patient about, which is progestin is not progesterone. So let’s go there first. Can you describe like in a like a simple biochemical way why progestin is not progesterone?

Kimberly Kushner (45:51)

No, it’s not.

Yeah.

Yeah, so progesterone is the hormone that you make after ovulation and progestin is almost chemically, structurally a bit more like an androgen, a bit more like testosterone than it is progesterone. So it’s meant to kind of mimic the actions of progesterone to try and dampen that very estrogenic effect that’s happening in endo.

And it can be effective in some people, but in some people it doesn’t and has a lot of side effects. Whereas progesterone is literally like what you make yourself to counteract that oestrogenic effect.

Dr. Ginger Garner PT, DPT (46:43)

Do we know clear, I mean, I don’t know if we know the answer to this, this may be impossible, but do we know clearly why progestin was given as the preferential method of, calling it progesterone, you know, 20, 30 years ago?

Kimberly Kushner (46:47)

Yeah.

I don’t actually know. could probably, yeah, we could probably delve deep into it, but I don’t actually know personally. I’m sure I’ve stumbled across it once upon a time, but yeah, I think it is misleading to say progesterone. Like the mini pill is not progesterone, you know? Yeah. So I see many, I speak to many women who say, yeah, I’m on progesterone, but it’s not progesterone.

Dr. Ginger Garner PT, DPT (47:06)

Yeah, I think that’s just.

Yeah, it is.

Yeah, exactly.

That’s a great question that every clinician should be asking because I think that the distinction is not always made. And then patients are definitely not going to understand. They’re just going to say, yeah, I’m on progesterone. But as a clinician, if you’re listening, is always ask, well, what exactly is it? Just so you can distinguish between the two. And another question I think we may not know the answer to, but that it should be investigated is if we are in a progesterone resistant state,

premenopausal, what happens after excision or just perimenopause, menopause, how are women with endometriosis absorbing progesterone or all micronized progesterone?

Kimberly Kushner (47:54)

Yeah.

This is really interesting and I did a post about this. I hope you don’t mind me quickly pulling out my phone because I don’t want to get the specifics incorrect. So there was research and I believe it was to do with cancer, which showed that despite progesterone resistance, cells are able to bypass. Let me just quickly confirm this, but essentially it can be absorbed.

Dr. Ginger Garner PT, DPT (48:11)

Totally, yeah.

Kimberly Kushner (48:37)

via a different route that still makes the progesterone absorbable and effective despite the resistance aspect of it. yeah, this is why I was like, wow, ⁓ this is really, really cool. ⁓ Yes, so there are alternative cellular pathways. So even when the traditional receptor function is compromised like in endo, so…

Dr. Ginger Garner PT, DPT (48:54)

Yeah.

I just find that…

Okay.

Kimberly Kushner (49:07)

This demonstrates that progesterone can affect endotissue even when the conventional receptor pathways are malfunctioning and reduced. So they’re alternative pathways. So despite the progesterone resistance, I’d still give it a go. You know what I mean? Because there was some research and it was to do with cancer that demonstrated that it was still able to kind of bypass that ⁓ traditional receptor pathway.

Dr. Ginger Garner PT, DPT (49:23)

Yeah. Yeah.

Kimberly Kushner (49:37)

and be.

Dr. Ginger Garner PT, DPT (49:37)

And

here’s another cool question too, like to build on this, because now we’re like diving deeper under the surface. So if oral micronized progesterone is, we still can absorb it even in a progesterone resistant state as you’re entering into perimenopause, because that’s often one of the first things that’s actually prescribed.

Kimberly Kushner (49:55)

Yeah,

Dr. Ginger Garner PT, DPT (49:59)

then one of the traditional, the current pieces of wisdom, let’s just put it that way in the evidence base would be, well, if you had adenomyosis and you had a hysterectomy and you don’t have a uterus, you don’t need progesterone. You could just, right, you can just be on estrogen and that is being pushed commonly here in the United States. Let’s talk about that.

Kimberly Kushner (50:13)

Yeah.

That’s rubbish.

Yeah. See, that’s not logical to

me. To me, that’s not logical. like, well, what if you still have endo? I have patients and this absolutely gets me fuming. I have patients who have had hysterectomies for endo and adeno without getting endo excised.

Dr. Ginger Garner PT, DPT (50:41)

Ugh.

Yes, that happens a lot. Still. Yeah.

Kimberly Kushner (50:46)

makes me so angry. And

you know, these are the patients that get told, just because your uterus is no longer present, you won’t benefit from progesterone. I like what you’re saying. And it absolutely breaks my heart and gets me so on fire. ⁓ Yeah, it’s mind blowing. just, I don’t get it.

Dr. Ginger Garner PT, DPT (51:03)

Ha ha!

So we can

safely put to bed. If you have been told, you don’t have a uterus, you don’t need progesterone, I’m just gonna give you some estrogen push back, question that quote wisdom that you’re getting. Yeah.

Kimberly Kushner (51:24)

Get a second opinion.

Yeah.

Dr. Ginger Garner PT, DPT (51:29)

Yeah, absolutely. think that progesterone is so essential for so many processes and also to counter the estrogen because the reason that they’re saying that, just to clarify, the reason that current wisdom is saying that, which hopefully will be changed soon, ⁓ is that they’re thinking that you’re decreasing the risk of cervical cancer or endometrial cancer by…

Kimberly Kushner (51:54)

I’m sorry.

Dr. Ginger Garner PT, DPT (51:56)

providing the counter to the estrogen if you have a uterus. So they’re saying, go for progesterone if you have a uterus to cut down on risk of cancer. And then they’re saying, well, right. That’s why they’re saying it is because, well, you don’t have one. So you don’t have a risk of that cancer. Well, you’re missing out on so many of the other benefits of progesterone, not just counter. Yes, exactly.

Kimberly Kushner (51:58)

Yes, yeah, yeah, yeah. But now it’s not necessary anymore.

and the fact that this woman has endometriosis.

Dr. Ginger Garner PT, DPT (52:21)

And the other problem that we’ve talked about this in the past on the podcast is a lot of quote conventional wisdom. I’m just air quoting that y’all, if you’re not watching on YouTube, total heavy air quotes here is that they’re saying, well, you don’t need any hormones at all. You have endometriosis, you can’t have anything.

Kimberly Kushner (52:40)

Hmm.

Dr. Ginger Garner PT, DPT (52:41)

Which is crazy. In a word.

Kimberly Kushner (52:44)

Yeah, well, I get

the fear of the estrogen for sure. ⁓ But yeah, I don’t know why conventional medicine doesn’t love progesterone. I mean, it’s used so much for fertility treatment. ⁓ But apart from that, it’s kind of just like this thing that’s ignored most of the time.

Dr. Ginger Garner PT, DPT (52:49)

Yeah.

I know,

I think that the clarification on the Women’s Health Initiative study from 2001, 2002 has changed the conversation on it just in the last year alone. So that hopefully it’s permanently shifting, but there’s still a lot of antiquated pockets in the country where they haven’t heard the news apparently. ⁓

So nearly 100 % of the patients that I see on a regular basis, I live in a city of about a half a million people in an area of about a half a million people. So it’s not some obscure small area. And yet most of the patients that I see, I’d say nearly all of them come in with old advice, outdated advice, outdated medical ⁓ management. Yeah. All right, so let’s… ⁓

Kimberly Kushner (53:32)

Mm-hmm.

No.

Yeah.

Dr. Ginger Garner PT, DPT (53:55)

shift a little bit towards empowerment because we’ve presented a lot of information, a lot of really key, you’ve made a lot of key points that are action items that you can take now, knowing whether or not you have MTHFR and what type, knowing that you can improve all of these dietary elements like right now in your diet.

knowing that you can kind of smack down some of that old advice that you’re getting, you know, on hormone intervention and treatment is also encouraging. So when women go in with this newfound knowledge, just from listening to this episode alone, and they get dismissed,

Kimberly Kushner (54:33)

Mm-hmm.

Dr. Ginger Garner PT, DPT (54:44)

What do you, how do you help them navigate a system that kind of seems like a T-Rex, you know? It’s a big bully with like short arms, you know? How do we and how do you empower your patients to deal with an antiquated system like that that’s still giving them the wrong information?

Kimberly Kushner (55:03)

I try to hold their hand through it. I go over and above. I try and research who they should see, the questions they should ask, who they should see for a second opinion. I always say, I know it sounds harsh, but remember that the physicians sitting across from you, they’re working for you, you know? And we often shy away from, from… ⁓

Dr. Ginger Garner PT, DPT (55:27)

Yes. ⁓

Kimberly Kushner (55:33)

And this might be something that someone who’s gone through so much medical trauma does. I do this. You rehearse the things in your head before you get to your appointment. And you’re like, so if this happens, I’ll say this. This happens, I’ll say this. But it’s seriously, it’s so hard. ⁓ I would definitely research other medical providers in your region or if you can travel, people who specialize in this stuff, because not many people do.

So there will usually only be a smaller network of people who can see patients or will confidently treat you if you have this. ⁓ And take someone with you.

Dr. Ginger Garner PT, DPT (56:14)

Yeah.

Also a good idea. Until we can really obliterate the origins of gaslighting, which come from medical misogyny, we don’t even need to mince words, it is clear if you read even a fraction of the history on endometriosis, you will clearly see that it was an offshoot of

Kimberly Kushner (56:28)

Yeah.

Dr. Ginger Garner PT, DPT (56:41)

and created by the attitudes created towards endo now exist because of medical misogyny. And so until that’s put down, which is not going to happen anytime soon, you’re still going to have to do those things. think the things you have suggested are absolutely brilliant. know, rehearsed just to overview, take an advocate, enlist other advocates, like anyone that has been on this podcast so far.

Kimberly Kushner (56:56)

break things down.

Yes.

Dr. Ginger Garner PT, DPT (57:06)

yourself and so many other people, all incredible experts in the field, enlist, you know, follow their Instagram accounts, right? ⁓ Go to their website, get on their newsletter, get on your newsletter, follow your Instagram account so that you can have that information to be empowered. And then one other thing that you said, I just want to reiterate is that rehearsal of what you need to say. And unfortunately, if you’re going to be in

Kimberly Kushner (57:16)

Mmm.

Dr. Ginger Garner PT, DPT (57:35)

a system like in the US, you don’t get a lot of time. They don’t get to pay a lot of attention. So you’re going to have to be brief, rehearse in as brief a terms as you can the issue.

Kimberly Kushner (57:46)

Yeah. Yeah, unfortunately.

Dr. Ginger Garner PT, DPT (57:49)

Yeah,

otherwise they’re just going to cut you off and they’re not going to listen. But if you can go in and in one or two sentences say this is the issue, they are going to listen to that a lot better. One of the other things that I want to mention too is pelvic congestion syndrome because I don’t think that there’s enough attention to that at all. ⁓ I know not in the US and a lot of

caregivers who are doing the medical management portion of endometriosis are missing it. So what are some of the signs that you might be dealing with PCS but you haven’t received a diagnosis yet?

Kimberly Kushner (58:27)

heaviness, dragging, worse with sitting or standing for longer periods. Different to endo, it’s more postural. Okay, so if you’re sitting in a position like this for a while and you’re feeling like the heaviness and dragging, or you’re standing up and you feel that real heaviness, pressure, I felt like a torn a K around the top of my thigh.

kind of feeling. ⁓ Feelings of like when I sneeze, like pressure almost like felt like something was going to burst in there. ⁓

Dr. Ginger Garner PT, DPT (58:57)

Yeah.

Almost like

prolapse type feelings. ⁓ Yeah. Yeah. Do you think or have you seen a lot of lymphatic drainage issues with that as well?

Kimberly Kushner (59:10)

Exactly. Even Brecht told that on the roof.

Yeah, I think every almost everyone with endo will have some sort of lymphatic congestion and PCS because obviously circulation is compromised. Yeah. In the abdomen, in the legs.

Dr. Ginger Garner PT, DPT (59:26)

Yeah.

And a lot of,

yeah, a lot of women don’t realize that. So they think it’s something separate or they think they just did something wrong or that somehow they didn’t do enough of whatever the rehab was and they’re just at fault. Like it’s their fault when it may be just an undiagnosed additional condition.

Kimberly Kushner (59:42)

Mmm.

Yeah

Exactly. And

that’s what I say, the pain may not just all be endo.

Dr. Ginger Garner PT, DPT (59:59)

Yeah, definitely. So if you could speak to somebody right now, like everyone listening to the podcast, just imagine you’re speaking to them individually and they’re feeling like I know you and I have both felt at some point in our whole decades and decades journey of this. They feel broken. They feel dismissed because of their pelvic pain. What do you want them to hear?

Kimberly Kushner (1:00:22)

Mm.

this gets me super emotional. It’s, you know, it’s both of our journeys. please don’t give up. Please do not give up. There are people out there who can help you, who will listen, who will help you get to a diagnosis. And do not feel discouraged if surgery didn’t give you the fix that you were hoping for. There could definitely be other things going on and you’re not a unicorn. There are other people like you.

Dr. Ginger Garner PT, DPT (1:00:51)

Yeah.

Kimberly Kushner (1:00:59)

going through similar things, ⁓ you need connection, reach out for support in whatever way that looks like, whether it be online, in person, even if you’re bed bound and listening to this right now, do not give up.

Dr. Ginger Garner PT, DPT (1:01:17)

Thank you for saying that.

Kimberly Kushner (1:01:19)

Yeah, because it’s true, you know? It might just be you and your phone, you know? And even if that’s you right now, like, keep seeking answers. You know, even if this podcast has led you to research pelvic congestion or POTS or EDS, hopefully from there you can search for providers who can help or reach out to me. My DMs are always open.

Dr. Ginger Garner PT, DPT (1:01:22)

It is, it is true. A lot of young women. Yeah.

Yeah, absolutely. Absolutely. And that’s why we will put all of the resources mentioned in the show notes. And you can always leave a comment on when this is going to be on YouTube. is on all everywhere you find, you know, a podcast, obviously, because you’re listening to it right now. You can leave comments on any of those places, including Kimberly’s Instagram account.

The whole point is to get you to the resources that you need. Obviously, you know, I’m interviewing you and you’re on the other side of the world. There’s not a whole lot of people who are specializing in this and that’s why it takes a village. Planet Earth is like shrink, you know, it’s like shrunk down so small when you talk about who really specializes in Endo and the compassionate space in which people can offer healing. So, all right, one last question. What gives you hope?

Kimberly Kushner (1:02:17)

Yeah.

Yeah. ⁓

Dr. Ginger Garner PT, DPT (1:02:37)

about where women’s health is headed. Because we’ve talked about a lot, I mean, we’ve talked about a lot of reality, a lot of gaslighting, a lot of dismissal of women’s health, lack of research, lack of funding, that kind of thing. But on the flip side, what gives you hope where women’s health is heading, especially for women living with endo and PCS?

Kimberly Kushner (1:02:52)

Mm-hmm.

Well, hey, places like Portugal have instated this. Menstrual leave, which is super cool, ⁓ paid menstrual leave. I’m seeing some really amazing results in my own practice when we’re implementing a really patient-centered, holistic model of care, which is exciting, connecting with other incredible providers like yourself who are

Dr. Ginger Garner PT, DPT (1:03:02)

That’s right.

Kimberly Kushner (1:03:27)

doing something similar, but with whatever it is that you are an expert in, which is all super exciting.  Conventional medical doctors that are more interested in this type of perspective too, because they’re hitting roadblocks obviously from just hormones and surgery and pain medication. Yeah.

Dr. Ginger Garner PT, DPT (1:03:37)

I go ahead, go ahead.

Right? Yeah,

exactly. That there’s a lot more openness to listen, which is incredible. And really that’s all it takes to shift something is the willingness and openness to learn and to grow, ⁓ which is incredible. And I like that the endo space is growing. This will be the biggest podcast season that I’ve had so far. And I think that the awareness.

Kimberly Kushner (1:03:56)

Mm-hmm.

Thanks.

Yeah.

Yes.

Dr. Ginger Garner PT, DPT (1:04:17)

is growing exponentially and because if it’s one in nine it’s not even one in ten anymore if it’s one in nine women suffering from this that is as frequent or more frequent as diabetes so yeah so we need far more awareness like no one knows what endometriosis is and even less know what adenomyosis is and even less know what pelvic congestion syndrome is but everyone knows what diabetes is so

Kimberly Kushner (1:04:23)

Mmm.

Yeah, it’s like 200 million people.

Yes.

Dr. Ginger Garner PT, DPT (1:04:46)

We have a lot more work to do, but there’s more awareness every day and so many more practitioners. So I just want to thank you again for being on the show, coming on the show. You have such a unique perspective. ⁓ It’s incredibly valuable. And I hope that everyone listening will go give her a follow on Instagram. And that’s at endonaturopath and go to her website, endonaturopath.com

Kimberly Kushner (1:04:48)

Yes.

Dr. Ginger Garner PT, DPT (1:05:11)

You’ve got a lot of really cool things going on, programs and resources, and it’s just really valuable. So thank you so much, Kimberly.

Kimberly Kushner (1:05:18)

Thank you for having me. Appreciate it.