Hello everyone and welcome back. I am super excited to ⁓ have a second time guest back on the show, Dr. Susan Clinton, welcome.

Dr. Susan Clinton (00:09)

Welcome. Thank you. Thank you. It’s my honor to be here.

Dr. Ginger Garner PT, DPT (00:13)

Yeah, we had such a great conversation ⁓ first round. And for those of you who didn’t get a chance to hear that interview, pop back over to the previous season and give that a listen. But before we jump in, I just want to tell you guys a little bit about Susan and her background, what she does. And of course, we’ll have all these links in the bio that we mentioned throughout the episode. So Dr. Susan Clinton ⁓ is amazing. That’s not her bio, okay. But I’m just going to say that first.

She is an award-winning PT, mentor, educator with over four decades of experience. She specializes obviously in pelvic health, women’s health, integrative physiotherapy, empowering clients and practitioners alike to transcend limitations and ⁓ get the results that you deserve and that you want. She’s the founder of LTI Physio.

She leads coaching programs, mentorships, educational initiatives that help women embrace health and vitality while guiding healthcare providers to build sustainable, fulfilling careers. And that’s, I think, a key word, sustainable. She’s a sought after speaker at conferences, workshops, and podcasts. And she shares cutting edge thoughts in those ⁓ regions and areas to…

introduce an approachable way, an inspiring way to treat. But beyond her clinical expertise, Susan’s an international instructor, co-host of the Tough to Treat and the Genius Project podcasts and co-founder of the Global Women’s Health Initiative. Her passion for advancing healthcare is matched by her love of dancing, hiking, and supporting international women’s health initiatives. Welcome.

Dr. Susan Clinton (01:59)

Thank you. My honor to be here.

Dr. Ginger Garner PT, DPT (02:01)

Yeah.

All right, you guys, buckle up. Let’s talk about gut health and endo. A lot of people know the word endo belly. So I think that’s a really good place to start. mean, what’s the connection between gut health and endometriosis from a clinical perspective? And I think it could be maybe harnessed in the word endo belly and kind of expanding on that. tell us a little about that.

Dr. Susan Clinton (02:26)

Yeah, I think endo belly got its origin or its quote moniker ⁓ because there was an effort and a push to get people to understand that ⁓ endolegions can occur anywhere and not just around the uterus. As we all know, we’ve been fighting that battle for a long time and getting people to understand and open up and better ways of like.

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

Yes.

Dr. Susan Clinton (02:52)

finding it, better ways of dealing with it, and better ways of understanding it when it presents clinically. ⁓ it’s kind of a, endo belly to me has kind of become a catchall term, much like low back pain or knee pain or, you know, bladder pain. There’s many, many reasons for it. And I think when we think about it, probably the most interesting thing to think about from a person with endo,

is the fact that we have the lesions set up scarring, right, along the bowel. And that could be the stomach, it could be the small intestines, it could be the large intestine, it could be the rectum, could be, you know, all of those areas. And oftentimes those, the scarring and from the lesions kind of can pull pieces of our bowel together, you know, making these obstructions and things like this.

Dr. Ginger Garner PT, DPT (03:25)

Yeah. Yeah.

Dr. Susan Clinton (03:48)

The other thing about the endolesions in the small intestine is they become this nice little dark cave that things can slip into and stay there. So a lot of times people will get not really misdiagnosed, but if it’s, they’ll be diagnosed with SIBO, small intestinal bacterial overgrowth. That’s a big word for saying that we just have stuff in our intestines that’s not, should not be there. And it’s kind of rotting.

Dr. Ginger Garner PT, DPT (04:09)

Mm-hmm.

Dr. Susan Clinton (04:16)

So we want to get that out. So they give them the medication to do that. And generally what ends up happening is it comes back and it keeps coming back because the issue isn’t so much, yes, there’s that problem that first aid that needs to be solved, but with the underlying component of it. And then also on the flip side, following any type of surgery for anything, there’s always scarring.

Dr. Ginger Garner PT, DPT (04:31)

Yeah.

Dr. Susan Clinton (04:41)

And so even with excision surgery from the best excision, you know, wonder gods out there, they also know that scarring is a possibility. And this is, I think some of the things we’re gonna talk about a little later on this is kind of, can we do about that? We do about it pre when we find it and what can we do about it post surgery when they’ve been given the green light that you’re all healed, but you know, the way the body heals is through

Dr. Ginger Garner PT, DPT (05:00)

Yeah.

Dr. Susan Clinton (05:11)

creating scar tissue.

Dr. Ginger Garner PT, DPT (05:13)

That’s right. I

think that’s a commonly misunderstood aspect and that people may be looking for a definitive finger on a hot point button of this is exactly what’s going on in the gut when you have endo, but it is much more ⁓ broad in that, just like you were saying, if it is a small intestinal bacterial overgrowth or something like that, we got to get down to the root cause of it.

Dr. Susan Clinton (05:17)

the

Dr. Ginger Garner PT, DPT (05:42)

also needs to account for everyone who has surgery, even if it wasn’t endo-excision and if it was an appendectomy or something, everyone’s going to develop and heal by scarring. And so that means 100 % of people who have surgery will scar because they must heal, but it’s just a matter of how those adhesions or how that scarring does impact you. And when you’ve had endo, I mean…

Dr. Susan Clinton (05:49)

Exactly.

Dr. Ginger Garner PT, DPT (06:07)

How many patients do you see with gut dysfunction in endo? I would say in my patient populations, it’s 100%. Yeah.

Dr. Susan Clinton (06:14)

Yeah, 100%. I think so.

We can’t have this and not have it affect the systems that the GI system is part of. And that is part of our ⁓ flight and fight and run from the tiger type system. part of our, it tells us when we’re hungry. It tells us when we should be afraid. It tells us that we’re not getting enough sleep and…

Dr. Ginger Garner PT, DPT (06:23)

Mm-hmm.

Yeah.

Dr. Susan Clinton (06:41)

It tells us a lot of different things that direct communication back and forth with the brain is really not so much our brain that is thinking and creating and doing, but all the other parts of our brain, the part of our brain that senses fear and distress and worry and the part of our brain that is running the survival system in the background. Those are the parts of the brain it really communicates with. And then when it gets loud enough, course, our, whoever we are brain.

I like to call it the iBrain versus the old brain. When iBrain starts getting a lot of information that really iBrain shouldn’t have to be dealing with. So we end up with a ⁓ GI system that’s really oversharing.

Dr. Ginger Garner PT, DPT (07:11)

Yeah.

I like that phrase. Yeah, that brings up another really good point. Another little truth bond to drop here is that after you have excision surgery, and even before, there’s many, many things we can do, and we’ll get into that in terms of what you can do for gut health and endopre-excision. But post-excision surgery, because the mind-body complex didn’t necessarily get the memo that the lesions are removed, you can still have that fight-flight-freeze

Dr. Susan Clinton (07:24)

oversharing way too much.

Dr. Ginger Garner PT, DPT (07:52)

fawn, not rest and digest ⁓ reflex that needs to be retrained because just like Bessel van der Kolk’s book, The Body Keeps the Score, ⁓ it doesn’t necessarily let go of those patterns and those dysfunctional ⁓ practices that the body has. So it means that you really do need follow-up with pelvic floor therapy after excision surgery as a gold standard.

Dr. Susan Clinton (08:20)

Exactly.

100%. And I would even say that surgery is something that can actually strengthen that signal, even though it’s to take, and of course we need to get the lesions out. We need to do that. I mean, we know that that is so important, but it doesn’t automatically just say, now everything is fine because now that whole system is going and wait, and then we got put to sleep and then we had surgery. There’s still that. Yeah.

Dr. Ginger Garner PT, DPT (08:29)

true.

Right, and the distension of the gut and what

if there was a bowel resection? ⁓ I mean, goodness gracious.

Dr. Susan Clinton (08:52)

Hmm. And what’s the extra

gas because they weren’t moving so good. There’s a lot of things that can happen post-surgical. And I know that, you know, so people are always kind of like, why are they making me get up and move when I just had this big surgery? Because we don’t want you to get, you know, gas and distention in areas that are sensitive. Yeah.

Dr. Ginger Garner PT, DPT (08:56)

Mm-hmm.

So much more painful when that happens. So

much more pain and you’re not gonna let you leave if you don’t have normal bowel and bladder function. You’re not leaving the hospital anyway. So that is a good first point is that you gotta get up and move right after surgery. ⁓ Yeah, definitely. Can you, go ahead.

Dr. Susan Clinton (09:20)

Right, right.

So, thank you.

And then, yeah,

yeah, no, I was going to say, and then the other part, you know, thinking about, you know, initial, you know, work, you know, in the, in, in the hospital and like even the days beyond is a comfortable, you know, ⁓ compression device around your belly. Really important for helping heal. You know, we put, when we heard our, if we have knee surgery or ankle surgery, they put compression wraps on there, right? They put ice, they put compression wraps on there.

Dr. Ginger Garner PT, DPT (09:33)

Mm-hmm.

Yeah.

Dr. Susan Clinton (09:58)

We don’t do that around the belly as much as I think we really should. I think any post-abdominal surgery should have some, and I’m not talking about the big binder with all the, you know, with all the clips and all of the stuff. We don’t need that, but something nice and easy that can just Velcro on and around and give that tissue some support so that it can heal. But also that helps replace the pressure, which we need in our, in our, in our belly, you know, in our.

Dr. Ginger Garner PT, DPT (10:22)

Hmm.

Dr. Susan Clinton (10:27)

from our rib cage to our pelvic floor, there’s a certain amount of pressure that needs to be in there in order for things to move through the way that they’re supposed to. If we let ourselves expand out like a lake, we’re not gonna have the ability to move things through. that nice compression would be super helpful in the surgical days.

Dr. Ginger Garner PT, DPT (10:46)

Yeah.

The other thing I think that comes into play too, and I just want to ⁓ dispel a massive myth. I had a patient last week and ⁓ she came in and she very, very likely does have endometriosis, family history of strong family history of it, all the things that go with it from pots and hypermobility, cetera. And she had gone to her GYN just to discuss the

possibility to which the GYN said, and you probably know what I’m going to say already, Susan. ⁓ You can finish my sentence for me practically. She said, ⁓ well, when you hit menopause, it’s not going to matter anyway. Your endometriosis is going to go away, right? And so one of the other things I wanted to mention is A, that is categorically false. Okay, it’s not, your endo is not going away because you have hormonal changes and you have less estrogen.

Dr. Susan Clinton (11:42)

Yeah.

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

That is a total myth, it’s false, and I think there’s a lot of maybe unintentional medical gaslighting out there about it, but there’s a lot of dismissal where you just get gaslit and ⁓ your symptoms are ignored just because you’re getting perimenopausal or menopausal. So one of the things I wanted to talk about a little bit was looking at the role, explaining the role, talk about the role of the gut microbiome and hormonal regulation and pain perception and how all that goes together when you have endometriosis. That’s such an

Dr. Susan Clinton (12:01)

Mm-hmm.

Now, it is. So the difference between what I think where a lot of the clashing and kind of curiosity and misunderstanding comes from is a lot of times people who have endo in their belly are diagnosed with irritable bowel syndrome. There’s a distinct difference between what’s happening and the sensitization, the pain. ⁓

Dr. Ginger Garner PT, DPT (12:17)

a critical intersection.

Amen, yeah.

Dr. Susan Clinton (12:44)

all of the things that are going on with endo that aren’t really happening with IBS. are things that are similar and things that are very different. In both cases with irritable bowel syndrome and endo, it’s the hypersensitivity of the lumen, whether it’s in the stomach, the small intestine, or the large intestine. There’s always natural changes. They stretch, they relax. That’s how things move through the GI system.

And when we have a hypersensitivity of that system, every time they get a normal amount, I’m talking about normal amounts of food, normal amounts of gas, in this situation, it’s very painful. So other people can walk around and eat and drink it, maybe say, ⁓ maybe I overate or, ooh, I’ve got some gas, I need to expel it. But they don’t feel every little thing going on in their belly like they do.

Dr. Ginger Garner PT, DPT (13:38)

Yeah.

Dr. Susan Clinton (13:39)

The difference between that part of IBS and endo is that IBS has ⁓ kind of almost like a rhythm to it. Like they may wake up feeling better in the morning unless they didn’t get any sleep the night before. And generally by midday to the end of the day, they feel worse. With endo belly, it starts and it stays. And it doesn’t really calm down ever unless we do something to intervene there.

Dr. Ginger Garner PT, DPT (14:03)

Mm-hmm.

Dr. Susan Clinton (14:08)

So it is also a lot stronger. You know, it’s a lot more painful. And here’s the biggest thing that happens is that

All the literature is pointing towards this now. So I feel very comfortable in saying, and certainly I haven’t ever met a client who has IBS and trust me, it’s not pleasant itself. That hasn’t, hasn’t been set up by an adverse event. could be an infection. It could be death of a loved one. could be stress, three years stress in a bad situation environmentally.

Dr. Ginger Garner PT, DPT (14:34)

Mm-hmm.

Yeah.

Dr. Susan Clinton (14:45)

There’s always something that sets us up. And though time and time and time again, these women are, this is the story they tell me and I’m gonna kind of group it together. I hate to do that because they all have individual stories, but it’s always, I really don’t have anything that I’m upset about. Nothing has happened in my life. This just happened.

Dr. Ginger Garner PT, DPT (15:10)

Yeah.

Dr. Susan Clinton (15:11)

I started one day with it bothering me and it got worse and it got worse and it got worse for no reason whatsoever. It came out of the blue. I’ve traced it back. I’ve looked at it. We’ve, you know, we’ve talked about it. There’s just really no reason for it to start. But then we have to look at that clinical picture is, well, what are your periods been like? And, know, tell me about the rest of your history and all the other things that are going on.

to kind of pull that together. With endo, we have this low grade inflammation going on all the time because the endolesions produce their own hormones. And they’re the kind of hormones that make us a bit more inflamed, right? They produce estrogen, but it’s not the estrogen strain that we need. It’s the different strain of estrogen and the metabolites create this inflammatory response in the GI system because that’s where tabloids are collected.

Dr. Ginger Garner PT, DPT (15:47)

Mm-hmm.

It’s not the TV we want.

Dr. Susan Clinton (16:06)

to be taken out with a trash. And then if we have a ⁓ situation where we’re not moving things through well, those metabolites are just sitting in the system with chronic constipation or the struggling that we’re having with the pain trying to move things through. And when that happens and we get those things hanging out in the system, it’s very distressful for our brain.

Dr. Ginger Garner PT, DPT (16:06)

Mm-hmm. It’s created. Yeah.

Mm-hmm.

Dr. Susan Clinton (16:32)

So we have, and we’re not getting the gut manufacturers all the serotonin we need for our brain to be healthy. Pretty much all of it. There’s a little bit that it doesn’t, but pretty much all of it. So when our GI system is in trouble, then all of a sudden our brain is in trouble. And when that happens, we have our, it’s kind of this thing everybody talks about willpower. I should have the willpower not to eat this stuff, but I know it makes me feel worse. And what is that stuff?

It’s highly inflammatory foods, sugar. Because if you’re not sleeping and you’re in distress, you’re going to eat that stuff because new gut bacteria that you’re growing is there for a reason because the brain has to have glucose to survive. So under stress, it’s got to have more of it because in evolutionary times, or if we think back, you know, just even a thousand years, not even 2000 years, ⁓

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

Yeah.

Dr. Susan Clinton (17:32)

You know, what happened is, you know, when you got into a moment of stress where you had to like run for your life or, you know, something was happening, we also had a period of time where we could recover. And under this situation, there’s no recovery time. Yeah, the assault is ongoing. The armies may ebb and flow, but the war is on. And the war is always there. So the brain…

Dr. Ginger Garner PT, DPT (17:46)

no recovery.

Yeah.

Yeah.

good way

to describe it.

Dr. Susan Clinton (18:01)

Yeah, the

brain is having to deal with the chronicity of that. And so it produces a hormone called cortisol, which I know everybody hears about and talks about. And cortisol is really important because without it, we’d be Gumby on the couch. We would never do anything. We need cortisol. It’s how we wake up in the morning. It’s how we have the energy to do the things we do during the day. ⁓ It’s that kind of like alert thing for us. But when we…

Dr. Ginger Garner PT, DPT (18:13)

Mm-hmm.

Dr. Susan Clinton (18:27)

are under stress all the time from like a chronic thing like endo, the cortisol, ⁓ we have too much of it. And it can be one of those things that creates that low grade inflammation. And what it does to the gut is it also creates a system where we have this barrier. If you think about in your gut, along the lining of your gut wall, your lower intestines, your small intestines, your stomach, there’s these barriers.

that keep all the stuff in, that’s the waste product, to go out of the body. And it pulls all the nutrients out and it creates the waste as it goes through. ⁓ But what happens is that barrier begins to break down. So we get holes in the barrier. So think about defenses. So that barrier is a defense for the body as we manufacture waste.

as we pull the harmful metabolites out and the different things that we don’t need and we absorb all the good things that we do need. Well, if we start getting, know, fissures and fractures in that defense wall, then a lot of that other stuff is going to get out too. And when it does, goes into the bloodstream. And that’s where we get all the stuff that people really hear about too, which is joint pain, widespread skin and muscle pain.

Dr. Ginger Garner PT, DPT (19:47)

Mm-hmm.

Dr. Susan Clinton (19:51)

⁓ that neuronal nerve pain. Why nerve pain? Because if you have something in the bloodstream, the bloodstream sits right next to the nervous system. So we don’t have a nerve without having an artery and a vein next to it. And so that stuff affects the nerve and makes the nerve jumpy. And it goes to the spinal cord as well as up to the brain. So it over shares in the brain, but it’s also in the spinal cord. So now we’ve got all of this kind of muscle tightness and

know, response system going on out in the body, including, you know, what we like to call mass cell activation. That’s just simply saying the, these cells to flight inflammation are being turned on for the wrong reason.

Dr. Ginger Garner PT, DPT (20:26)

Mm-hmm.

Yeah, which is so,

so common in endometriosis to also have MCAS. ⁓ Like you just said, Susan, mast cell activation syndrome or short ⁓ MCAS. I think it’s also important to go back to one other point you made about you were talking about the barrier and the holes in the barrier, which many people know as leaky gut or intestinal permeability, that as that happens or you have chronic constipation, it’s difficult for things to move through because you’re in a sympathetic fight or flight.

Dr. Susan Clinton (20:42)

Okay.

Dr. Ginger Garner PT, DPT (21:06)

whether or not you excision doesn’t matter, you’re gonna have to work through that, is that if you have trouble, ⁓ then you also end up having an issue with, and you had mentioned this, but I wanna point this out for the listener because it draws together the endo-hormone aspect and the gut microbiome is that then those metabolites accumulate, and that is also what changes

What makes periods worse? You get worse hormonal systems. If you’re perimenopausal, hold on, it’s gonna be rough. Your symptoms are gonna be much worse. So if you’re wondering, do I have intestinal permeability? Do I have a gut microbiome issue? Do I have too many of those ⁓ unexcreted estrogen metabolites in the system? Well, how are your cycles? Are they worse? Do you have more symptoms? Like you said, are you having more pain? Do you have more endo belly?

So it could come from any of those aspects, more pain, more gut issues, and more kind of hormonal issues at the same time. It’s not a good trifecta.

Dr. Susan Clinton (22:12)

No, it’s not. And in perimenopause, mean, you know, if you think about what really happens in perimenopause is that we are, we have fluctuating hormones, ⁓ estrogen and progesterone and testosterone. They fluctuate and they change. If we’re taking, if we’re making cortisol because of this low-grade inflammation, trying to get through and trying to do these things, the way that we make that extra cortisol is we steal it from the group that makes

the androgen hormones. So we already are at a deficit going in. And then when we go into perimenopause, we’re at a much more of a deficit because we weren’t making them as well anyway, because it was being stolen to make another, to make the cortisol rather than making the progesterone where the estrogen and the testosterone come from. So if you think about it that way, if you can remember back to the pandemic, there was a ⁓ windshield factory

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

Right, right.

Dr. Susan Clinton (23:11)

that needed to make respirators because we needed them for the ICUs and what was happening. And so they basically had to take everything down, change it up and retool it so that it would put out respirators. And our bodies do the same thing. When we’re under stress, need, you know, we can have the adrenaline rush, but that doesn’t last.

You know, there’s some other chemical things that go on too, but the adrenaline is what most everybody knows. Like, yeah, I’m great in a crisis. And then it’s after that I’m terrible. And it’s like, because that crashes and we’re supposed to rest, but we don’t. So then we have to bring cortisol on to do it. And so our engine changes from being like a really good protein glycogen type of engine to run the body and turns into having to run on sugar.

Dr. Ginger Garner PT, DPT (24:04)

Hmm, good explanation, yeah.

Dr. Susan Clinton (24:06)

Like, yeah, and

it’s not a matter of willpower. And it’s not a matter of being overweight or not underweight. It’s a matter of how badly you feel when you eat those things. And, know, and I’m not saying drop everything and do fruit basket turnover because if you do, that can be stressful too. But can we find the trigger foods that make this a bit worse and start there? so to me, it’s like looking at a, I can’t think of a good example, but.

Dr. Ginger Garner PT, DPT (24:16)

Mm-hmm.

That’s so key.

Dr. Susan Clinton (24:36)

It’s like you have all of these things wrapped around it, like maybe a ball of yarn, all these things, but it’s not a continual piece of yarn that makes a ball. It’s all these pieces that wind together to make the ball of yarn. So if we think about what can we do and how do we notice it, it’s like which thread are we going to pull on? So we can pull on one, maybe get rid of the extra sugar in the coffee.

Dr. Ginger Garner PT, DPT (24:49)

Mm-hmm.

Dr. Susan Clinton (25:03)

But then we also need to pull on what is my morning routine look like? Am I getting some sunlight in my eyes and on my skin to get some better vitamin D3 to help me feel better? The next one we might could pull on is am I stopping during the day and really taking a breath and really, really reframing what’s going on around me versus allowing this to roll into disaster every day? So

If we can do all of those things, you know, just pieces at a time, we’re going to get a lot better faster than if we keep chasing down, okay, well I took away all the foods and now I don’t feel better in a second. Cause you’re still not sleeping. You’re still stressing out over everything. still got, you know, you’re, know, unfortunately having bad, bad communication with healthcare providers, all kinds of different things that are going on.

Dr. Ginger Garner PT, DPT (25:47)

Yeah.

Yeah, it really does. ⁓ I think sometimes we talk about those aspects of ⁓ lifestyle medicine, basically is what you were describing, lifestyle habits and choices, which has turned into this entire field called lifestyle medicine where there are six pillars and you’ve described most of them with movement, exercise, healthy relationships, getting, we haven’t touched on this, but of course it does include getting rid of the fake estrogens that are in.

They’re in shampoos, they’re in soaps, they’re in foods, they’re in nearly everything and then pulling those, getting those things out. Yes, all the Xenoestrogens. When we talk about all those things, I think that the way, it’s important to emphasize because our medical system currently, and we can only speak for the US because that’s where we are, is so focused on the curative drugs and surgery primarily because…

let’s face it, they do save lives, but they’re also massive money makers, okay, in a for-profit system, that the stuff we’re talking about now gets categorized as softer, like the softer stuff. The lifestyle medicine, like you can do that, but it won’t help. And in fact, these things are the game changers. They are what keep you out of needing more drugs or more surgery because you’re mitigating the very root causes of

Dr. Susan Clinton (26:59)

Mm-hmm.

Dr. Ginger Garner PT, DPT (27:25)

What’s driving the whole problem to begin with? So it takes us to the next question, really, then, you know, kind of shifting to like a next segment, which is what should you be looking for if you have endometriosis, if you even consider that you could have endometriosis or adenomyosis? What does good clinical care look like when you’re getting pelvic floor therapy, pelvic floor PT, pelvic floor OT? That is also integrative, because not every practice is going to be that way.

⁓ You know, what are some of the things that patients should expect? For example, they go into a pelvic health or orthopedic, know, PT, OT, et cetera, to assess for gut related contributions. What should that patient expect? What should the listener expect to have the questions that should be asked, et cetera?

Dr. Susan Clinton (28:10)

Mm-hmm. I love this.

I love this because I think a lot of this can be driven by the person. And this is so informative. You know, how do you speak to your health care providers so that you make sure that they’re the right fit for you and that your needs are going to be met versus just expecting that they understand all of this stuff? ⁓ The first thing that I would want for these people is for them to actually be listened to.

Dr. Ginger Garner PT, DPT (28:24)

Yeah.

Dr. Susan Clinton (28:40)

to hear the story and to really be present with them to hear the entire story. And that they’re asking these questions about their pain, about their sleep, about their movement history, about their support system. They’re asking these questions about their food, about their hydration levels. They’re asking these questions about what has been going on in your life recently.

Dr. Ginger Garner PT, DPT (28:42)

Yes.

Dr. Susan Clinton (29:08)

What are the patterns? Have you noticed any patterns around if you’re more stressed? How do your symptoms respond? What actually has helped, even if it’s for a little bit? what have, you know, I realize that nothing helps, but something helps a little bit. What are those things? And really helping them, helping you as a person be able to see all of the pieces.

To me, we have this out in the world, this pyramid, Maslow’s hierarchy principles that you can’t be up at the top and enlightened and all these things if on the very basic level your needs aren’t being met. And that includes even living in a neighborhood where it doesn’t feel safe to go to sleep. I mean, there’s so much. Turn the news on and everybody feels bad.

Dr. Ginger Garner PT, DPT (29:56)

Yeah.

Exactly.

Dr. Susan Clinton (30:07)

right now, I mean, everybody feels bad. So we have to kind of like look at all of that. And then again, like you mentioned, tell me about your house. What kind of lighting do you have in your house? What products are you using on your body? Without shame, I mean, people, know, because we now, thank goodness, we now can access good, healthy products and they’re not a luxury item anymore. Right?

Dr. Ginger Garner PT, DPT (30:32)

That’s right, they’re

affordable now, yeah, yeah.

Dr. Susan Clinton (30:35)

They are very

affordable now and they’re in affordable places that people would go to. So I always take a hike through Aldi, Gordon’s Food Service, Dollar Tree, some of these places because I want to know what’s out there. And, you know, I just pick up stuff and read labels and I can tell you over the last 10 years, it’s amazing what’s in these, they call the discount stores and the discount markets.

Dr. Ginger Garner PT, DPT (30:52)

Mm-hmm.

Mm-hmm.

Dr. Susan Clinton (31:03)

And so it’s not unattainable anymore. You know, what products are you cleaning your house with? ⁓ You know, things like that. So, and it’s, and I know a lot of people will say, well, is that really in the, you know, the physical or the OT scope? And it’s like, yes, of course it is. So is the idea that if we treat somebody who’s older, they have a lot of throw rugs in their house. The first thing we’re going to say, and this person has fallen a couple of times. The first thing we’re going to say is that,

Dr. Ginger Garner PT, DPT (31:07)

Thank goodness.

Absolutely.

Dr. Susan Clinton (31:32)

This is a risk factor for you. You can’t tell people to remove them, but this rug puts you at high risk of slipping and falling or tripping. So we need to kind of like, I would like for you to be able to be informed enough to ask questions and even be able to say, well, what do you think about me changing my diet? And if it’s not in their purview to really spend time with you doing that, what I would…

Dr. Ginger Garner PT, DPT (31:35)

Yeah.

yeah.

Mm-hmm.

Dr. Susan Clinton (32:01)

hope is that they would say, let’s get you to somebody who really understands gut health and food.

Dr. Ginger Garner PT, DPT (32:05)

can.

Absolutely, they need to be. So our take home message for that ⁓ wonderful, lovely, awesome, fantastic listener is that if they’re not asking you about these things, it may not mean that you don’t go back to them, particularly whatever the pelvic health reason is, but they should also be able to then upfront say, hey, but I know someone who’s trained in lifestyle medicine or integrative medicine.

Dr. Susan Clinton (32:18)

you

Dr. Ginger Garner PT, DPT (32:35)

They’re just down the street. It could be a health coach. It could be another PT. It could be an OT. It could be a nurse practitioner. It could be anyone. ⁓ Mental health also are trained in these fields that they can thoroughly go over these things with you because I can promise you, know both of us can promise you that if they’re not asking these questions, there’s no way you’re gonna fully manage your endo successfully. Like you have to address these things.

Dr. Susan Clinton (33:01)

Exactly. And I think in a way that’s going to be sustainable, because we talked about that earlier, Ginger, you and I, ⁓ doing fruit basket turnover is not really the ideal situation. I think the ideal situation is for me, as I’ve kind of watched the scope where we are right now, is pelvic health therapy, health coaching, and whatever else you can do to

Dr. Ginger Garner PT, DPT (33:09)

Yeah.

Dr. Susan Clinton (33:30)

even the playing field against the war. So it’s like plants, if you have fungus on a plant, ⁓ yes, we may need to pull the plant out, but we still have to treat the soil because there’s fungus all over the soil. And there’s, and there’s all the breakdown of the soil in a way that isn’t going to produce another plant, even if we remove the bad plant. So all of this is ripening the field for healing. And it actually,

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

Mm-hmm.

Mm-hmm.

Yeah, yeah.

Yeah. Yeah.

Dr. Susan Clinton (34:00)

especially the nervous system work. And I track that with my clients through heart rate variability as part of their autonomic profile. And just about every wearable, you see mine here, gives you that morning HRV reading, which is the one that you wanna watch for trends and get that up. It doesn’t have to be crazy strength training in the gym. If all you can do is walk for five minutes,

Dr. Ginger Garner PT, DPT (34:06)

Mm-hmm.

Yeah.

Dr. Susan Clinton (34:26)

then I would say walk for five minutes and see if you can walk another two minutes later in the day. And let’s build from there and get it going just a little bit. If you can’t get rid of all the food in the house, what’s the one thing that you think bothers you the most? What can we replace that with? keep, and just kind of, so starting with those simple, you know, we know where you want to go, the vision, the goals, this is where you want to be, and it may involve surgery. ⁓

Dr. Ginger Garner PT, DPT (34:32)

Mm-hmm.

Yeah.

Dr. Susan Clinton (34:54)

but there’s so much that can be done. And then all of the things that they’re gonna teach you, how to do a gentle bowel massage or abdominal massage. What does rotational movement look like and can you do it? Do you know how to let your belly go so it’s not pressing in on insides that hurt? And can you begin to learn to develop pressure away from pain so that you can actually have a better bowel movement? What’s happening with your pelvic floor? it because it’s so painful or you’re

Dr. Ginger Garner PT, DPT (35:06)

Yeah.

What’s?

Dr. Susan Clinton (35:23)

muscles around your back passes, know, tightening up so much, they can help you learn to relax those. And so there’s the physical part of that, of like the touch and the movement and that stuff that’s very helpful. But in the lens of like looking at your entire, you know, ⁓ foundations of your health is really important.

Dr. Ginger Garner PT, DPT (35:43)

So, know, the, the, ultimately the 40,000 foot view here is it’s about longevity. Whether or not someone had endometriosis, even though this, you know, is about endo belly today that we’re talking about, it really is about longevity because after the surgery, after the therapy, after the healing, you want longevity. You want to be able to do the things that you love to do when you’re 70, 75, 80, 85.

One of the things you touched on was kind of my next question, which was manual therapy techniques. This is something that you should expect when you go into someone well-versed in treating endo belly, right? In treating GI dysfunction and endo and the whole hormone connection. They should be well-versed. And I know you and I are both huge fans and trained in visceral mobilization, but let’s talk about that for a second.

What should they expect as a part of manual therapy techniques and movement interventions that support gut function?

Dr. Susan Clinton (36:40)

Yeah. So first of all, just as far as the examination goes, you should expect to be moving, stand up, bend over, turn around, you know, looking at your spine as it’s supple. Does it have issues? What’s going on? Weakness in hips, back, you know, wherever that’s going on. What, you know, just a full movement screen. And then, you know, really looking at, you know, we’re going to be talking Valley. I’m sure you’ve talked to public floor about this already on one of your podcasts.

but they should be well-versed to put their hands on your belly and to be able to feel it and to be able to feel how much of this going on in your belly is from the muscles around your belly. Are they tightening up in response to the pain or are they doing the opposite? Are they, they’re tight, but they’re like stretching out and you have this like big balloon because they’re trying to move away from the pain. And so they need to, you know, are they looking at

Dr. Ginger Garner PT, DPT (37:14)

Mm-hmm.

Mm-hmm.

Dr. Susan Clinton (37:39)

and feeling what your diaphragm is doing through the ribs and watching your breathing patterns and how that might be affecting the pressure system in your belly. And then of course, being able to palpate various regions of your belly to know, it feels like there’s really tightness here. This feels like it’s not really in the muscle. It feels like down into the belly, we can work on gently moving this around. And the mobilization of the GI system is very kind.

Dr. Ginger Garner PT, DPT (37:43)

Mm-hmm.

Dr. Susan Clinton (38:09)

It should not be harsh, it should not be heavy. It should be waiting for the system to tell it what to do and allowing the system to make the change. And oftentimes the touch is very quiet and very easy. We don’t have to touch hard to create change because we know that the power of us touching somebody’s belly, any part of the body, everybody loves to be touched, right? This is why we wear this skin sheet that we have.

Dr. Ginger Garner PT, DPT (38:36)

That’s

right.

Dr. Susan Clinton (38:36)

Because

whatever happens on our skin goes right into our brain. So the work on the belly should be easy and comfortable because we’re trying to get the brain, we’re trying to have a communication or a conversation with the brain so that the brain is, oh, this is nice. Wow. This this feels, if I can feel bad all the time, maybe I can feel good too. Right?

Dr. Ginger Garner PT, DPT (38:57)

Yeah, exactly.

Yes, and that’s a good take home walk away is that it should feel better. ⁓ Now that allows you as a person with endo or you suspect that you have endo, I think you’ve gotten some tools already that allows you to communicate with other providers better. Maybe it’s a gastroenterologist or your GYN or your…

dietitian or nutritionist or whomever that may be and your therapist because your therapist obviously should be looking at these things we’ve mentioned already. But what are some yellow red flags that ⁓ our listeners should be aware of that indicate a gut related issue? We kind of touched on it at the beginning, but you know things like if there’s a digestion issue, if there’s gut dysbiosis, like what does it look like? What does it feel like? We know that it can manifest as

feels like back pain. So someone may come in and complain of back pain. So what are some of the yellow red flags that you have seen in your experience of patients come in? And it seems like it’s a musculoskeletal issue, but it’s actually a good issue.

Dr. Susan Clinton (39:51)

Thank

Yeah. And here’s the thing, they’re probably not separate. So ⁓ they did a study in 2008 across Australia and they looked at 38,500 women of all ages, all sizes, all ethnic backgrounds, just all of it and cross matched them all the way. And 87 % of the women who had low back pain, chronic low back pain.

⁓ also had gut issues, gut problems. And they, you know, postulized all of these different theories. They’re all things we know today. If we have gut problems, our abdominal wall is not working efficiently. It’s just what happens. It’s either bloating out or distending out, or it’s holding on tight as it can be. And so we definitely want to look at that because what’s the number one thing that people give chronic

low back pain patients as an exercise is planks. And that is going to put pressure on the GI system that’s already in trouble. It probably isn’t the best exercise to do. So if you have low back pain, it’s like, how can we bring the system on and what’s the diaphragm doing? The diaphragm is likely over-contracting and a chronic inspiration pattern to hang on as a postural control muscle. So…

Those are things that they should be looking for. Even if you have gut problems, they should be asking you about your back. And they should be asking you about your hips and your legs because all the nerves that go down into the legs come out of the back. And all the nerves that go into the gut come from the chest wall, the thorax, that part of your back, that spine. And the diaphragm innervation all comes from your neck. So.

Dr. Ginger Garner PT, DPT (41:34)

Yeah.

Yeah, absolutely.

Thank

Dr. Susan Clinton (42:00)

Chronic sitters at a desk are gonna, you know, we want to get you moving. People who are moving, are you moving in a way that’s helping? Are you moving in a way that’s making your pain and problems worse? Like what is really going on here with those things? And then the other, red flags to me are things like all of a sudden having hemorrhoids, eating from your back passage and not knowing why.

Dr. Ginger Garner PT, DPT (42:12)

Mm-hmm.

Mm-hmm.

Dr. Susan Clinton (42:29)

We should always know why. So that should be screened. And endolesions can do that. You know, do that. So anything that’s like that, you know, that people may be just like, well, it’s probably this. It’s like, are things, those would be red flags I would look for. Other red flags would be like, you know, of course, you know, is it worse at nighttime when you’re trying to sleep? ⁓ Because something else could be, something else could be really wrong there.

Dr. Ginger Garner PT, DPT (42:35)

Definitely. Yeah.

Dr. Susan Clinton (42:57)

And we have you been, know, what has been done, what has been looked at. And oftentimes as everybody out there knows is that you may have been talking about this to two or three providers and nothing has been done. So there are red flags to look for. ⁓ If somebody hasn’t gone to the bathroom or they’re not going every week, we that’s to me, it’s like, we’ve got to get something going and something on board. What have you tried in the past? Have you never tried anything?

you know, that people have tried some things. The biggest thing that I see with most everybody with GI problems is the frustration. And I totally, totally understand it because the brain’s involved. We can’t treat the gut without treating the brain. And it’s not the brain, you didn’t make this stuff up. It’s not that part of your brain. It’s the part of your brain that’s running in the background back there, out of control, reacting to everything that’s happening in the gut. ⁓

But if people have, know, if their bowel movements are suddenly changing and they, you know, they were tooting along okay for a while, sorry for the pun intended, but they’re moving along pretty good. And then all of a sudden this happened. That to me is kind of like, that’s when I would start, you know, especially if it’s like very painful and you’re having a lot of distension. It’s like, you know, the problem is, as you move into perimenopause and if you didn’t have this before, it may start then. And what are they going to say to you?

Everybody in perimenopause is bloating. So that doesn’t mean that people with perimenopause, whether they have endo or not should live with that. There’s no, absolutely can be treated.

Dr. Ginger Garner PT, DPT (44:31)

That’s exactly right. That might

be common, but it’s not normal and it’s totally treatable. Yeah. Don’t accept that as an answer. Yeah. So let’s talk about that a little bit more then. I want to transition a little bit into talking about trauma because, but before we do that, I want to talk about the nutrition segue. we just set the scene a little bit.

Dr. Susan Clinton (44:40)

Mm-hmm. Yeah.

Hmm.

Dr. Ginger Garner PT, DPT (44:57)

Like if you’re running from a literal tiger, you can’t digest your food. And everybody knows that. Everything gets shunted away towards the extremities. You’re not digesting food. You’re ready for fight or flight or freeze. ⁓ Or in a social situation, it could be fawn, depends. But if you have that stress response, you’re not digesting. And if you have that constantly, that’s the problem. We get stuck in the tiger, running from the tiger loop mode where it never stops. It’s easy to then understand.

Dr. Susan Clinton (45:09)

Mm-hmm.

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

how digestion gets completely derailed. So let’s talk a little bit about, okay, you got that scenario, right? Whether or not it was the surgery and then the brain was like, my gosh, what an assault that was traumatic. We’re gonna stop gut motility and peristalsis or it’s lesions on the bowel or whatever it is. Or maybe the person just, it’s hard for them to know what to eat and how and how it impacts them.

Dr. Susan Clinton (45:34)

Mm-hmm.

Mm-hmm.

Dr. Ginger Garner PT, DPT (45:55)

Like any of those reasons could be the driver. What role, because I think a lot of people don’t understand that a pelvic floor PT, could be OT as well, but a pelvic floor therapist plays a role in supporting gut healthy behaviors in people with endo. Let’s just touch on that for a second so that you know, listener, hey, your pelvic floor therapist should be able to help you with this stuff.

Dr. Susan Clinton (46:12)

Thank

Right, so the first thing that I do with people is before we even start to mess with your diet, first of all, everybody out there, you know what bothers you. You know.

Dr. Ginger Garner PT, DPT (46:36)

Your body’s smart, you’re Yeah. Yeah.

Dr. Susan Clinton (46:38)

You’re smart, you know, you just don’t know what to do about it. And you don’t know if

you can because you’ve tried and you failed. And I hear that. So my thing is let’s start where we can, where we can make some sense. The number one thing that you can do is quietly, calmly put yourself in an environment of support and love while you eat your food. Share your food with loving care.

turn it into the best mindful session that you have done all day long. Same with brushing your teeth. Right? I know you don’t have, so, but you’re gonna do this. Stop. ⁓

Dr. Ginger Garner PT, DPT (47:11)

Yeah.

You’re really like supporting that

Maslow’s hierarchy of needs, like the base, that’s safety, right? Yeah.

Dr. Susan Clinton (47:19)

Yes. Yeah.

And tell yourself that this is good, that you’re eating something that’s going to help you fuel your body. But when we slow down and chew our food and we really chew it, it changes the gastric functions. We have, you know, they’ve done studies on this. They’ve had people chew five chews on an almond, 20 chews on an almond and 40 chews on an almond. They knew that 20 chews would be better than the five. Everybody knows that.

What they didn’t expect was how much better the 40 would be over the 20. So I am, do not think at all that I’m going to get anybody to chew their food 40 times. But here’s the thing you can do. Turn off the radio. Don’t listen to the news. Music changes everything. Find something that you like to hear. Or if it’s a book on tape that you know, that you’re enjoying, you know, just something, if you want to do that.

Dr. Ginger Garner PT, DPT (48:02)

yeah, turn that off. It does.

Dr. Susan Clinton (48:14)

But the biggest thing is just as you put whatever, if you use your hand, you use your fork, whatever it is that you use, when you put the food into your mouth, then you put your hand down onto your lap, or you put your fork down and put your hand on your lap. Every single time, do that. And if you do that, you will slow down. If you only have five minutes to eat, do the best you can for half of it.

Dr. Ginger Garner PT, DPT (48:34)

Hmm.

Dr. Susan Clinton (48:41)

Right? You’re going to meet people where you are. I get it. We’re busy. If you time yourself doing certain tasks throughout the day, you’ll figure out how delusional your brain really is. Our brains are literally, they’re delusional. That’s why I laugh about artificial intelligence because they say, oh, they’re giving delusional answers because they’re based on human brain. We’re all delusional. You can’t remember what you had two nights ago for dinner if I asked you right this second. Right? mean, we just,

Dr. Ginger Garner PT, DPT (49:08)

Yeah.

Dr. Susan Clinton (49:10)

We think things take longer than we tell ourselves these stories. I don’t have time to do this because it’ll take too long. But when we really stop and track it, we find out, you know, it really didn’t take that long. fact, I can do three things in this time. And it really helps us. So just kind of like really appreciate the time it takes you to eat and see if you can extend it by two minutes. Do something different, like, okay, so.

Dr. Ginger Garner PT, DPT (49:17)

Mm-hmm.

Dr. Susan Clinton (49:38)

Just eat your meals as you normally do, but look at your watch and see what time it was when you started, what time when you finished, and just say, I wonder if I can challenge myself to increase that time for five minutes, and automatically your brain is gonna slow you down with your chewing to extend that time.

Dr. Ginger Garner PT, DPT (49:54)

So it’s strategies like this that you’re, and we’re really talking about it, kind of a base level that pelvic floor therapists ⁓ function as health coaches as well. Not all of them are going to have that training. So it’s a good thing to ask. Like, do you have training in health coaching? Do you have training in lifestyle, know, integrative medicine, all of those things.

Dr. Susan Clinton (50:03)

Mm-hmm.

Mm-hmm.

Yeah, some of that stuff.

Dr. Ginger Garner PT, DPT (50:18)

many, many, many, many of us do. And I think that’s increasing. It’s in more educational programs for PT and OT, et cetera, and in medical schools as well, that it’s kind of come full circle that we realize that food is medicine. You touched on music being medicine, and you also touched on ⁓ regular mass media like news. ⁓ Things like that, no matter what side of the political fence it’s on, are designed to enrage you.

Dr. Susan Clinton (50:34)

and then.

Dr. Ginger Garner PT, DPT (50:46)

They’re designed to get you fired up. That is exactly the polar opposite of what we actually need when we’re trying to digest food or socially connect or just remain calm in a world that seems to never be calm anymore. And in a world that seems to glorify and give you a badge of honor for busy ⁓ and burnout too. It’s almost like, I’m so burned out and it’s a celebration or something. And so when you talk to your therapist, when you talk to your health coach,

Dr. Susan Clinton (51:05)

Yeah, exactly.

Dr. Ginger Garner PT, DPT (51:16)

⁓ They should be emphasizing these things. I already feel just talking about it, you just feel more grounded. Just feel like you’re taking time is moving a little slower. You can breathe a little deeper. If you’re listening to this at night, maybe you’ll sleep a little better. Your stress is a little lower, right? All of these things impact the gut and can, and I know both of us, and I both have seen it significantly improve the situation when someone has endometriosis.

Dr. Susan Clinton (51:22)

Mm-hmm.

Exactly. Exactly. And then as far as the foods go, like, I think everybody can look up on the internet, what are inflammatory foods? The question to me is not really, do you need to get rid of them? What are you going to try to replace them with? Because when we take things away, that’s automatically putting us in a position of scarcity and our brain starts figuring out how to get it back in. Right. Which is why none of that stuff is sustainable. If you think about

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

Totally.

Yeah.

Yeah, that’s such a good

point.

Dr. Susan Clinton (52:12)

Hey,

I don’t want to drink as much coffee because I know if I drink those three cups by the third one, it really hurts. And, but I don’t know what to do about it I’m so sleepy and it’s like, what could you replace it with? Right? Have you tried a tea? Have you tried a matcha? Have you tried something else? Is it the warm cup that you’re addicted to or is it really what’s in the cup? What is it? Like, is it? Is it a ritual for you? Yeah. What?

Dr. Ginger Garner PT, DPT (52:31)

Yeah.

It’s breaking it down in the sensory

experience, the sensory motor experience. And people who teach time management also talk about this. They discuss, I think it’s James Clear and his book on habits, habit stacking. Maybe it is the heat of the cup, it’s not what’s in it. Or if you’re gonna have the coffee, not that we’re saying coffee’s always bad, but you know it’s an antioxidant too.

Dr. Susan Clinton (52:46)

Mm-hmm.

Dr. Ginger Garner PT, DPT (53:05)

We could have a whole other podcast on coffee. Maybe it is the heat of the cup. Maybe it is a tea instead. Maybe it is that you love the quiet time that goes with it. And then you stack that with a new good habit. Whether it’s your deep breathing, it’s your mindfulness, it’s the exercise that Susan gave you to move and do a particular thing. It’s your gut massage that your therapist taught you or whatever. And in that way, know, habit stacking, are also

Dr. Susan Clinton (53:07)

Okay.

Dr. Ginger Garner PT, DPT (53:32)

rewiring your brain, which is a good segue to what I wanted to talk about last, which is the whole trauma aspect of what has happened. soon as you, I mean, people change their entire lives. Every woman that comes and sits down in my practice and has endo plans their whole life around food, right? And how they digest their food and what goes south and what goes sideways. And they find that

And many women end up underweight because they don’t know how it’s going to impact them. So they just avoid eating things when they’re out. And that creates trauma, which then negatively impacts, ironically, the very thing we’re trying to improve, the gut brain access.

Dr. Susan Clinton (54:12)

Exactly. ⁓ And yeah, the same thing around cycles and everything else too. So one of the things that can be very helpful when it comes to like the food piece besides slowing down and doing this stuff, it’s a reframing technique. We kind of call it rewiring or reframing. When you’re going to sit down to eat, of everybody kind of starts to look.

badly at what they’re going to do. I have to eat, so I’m just going to eat it. Or it’s going to make me sick anyway, so I’m just going to eat it. Right? What if you looked forward to it? What if you had one thing on your plate that you really could look forward to and you could just close your eyes, take a deep breath, and remind yourself of a time when you actually were just with somebody great, or you were celebrating around food or whatever it was, or even imagine

Dr. Ginger Garner PT, DPT (54:47)

Hmm.

Dr. Susan Clinton (55:11)

like what it would taste like before you put it in your mouth so that you can have it. So if you’re going to have a piece of an orange and you’re worried that maybe the citrus will bother you, what else could you look forward to about it though? Right? Do you look forward to the juices spraying into your mouth as you bite down? Is it going to be slightly bitter like a lemon or is it going to be really juicy and sweet like a naval orange in January or whatever it is? But you can do those

things to look forward to it. It’s also nice before you eat, ⁓ if you’re planning, I get that, but can you plan around the idea that I’m going to eat food that’s going to feel nourishing to me?

Dr. Ginger Garner PT, DPT (55:58)

Mm-hmm.

Dr. Susan Clinton (55:59)

And if I’m going to go out and I’m worried about what I’m going to eat, what can I eat here nourishing so I don’t have to worry about it there? Can we change that up? Can we reframe it? And this is where there’s a lot of there’s a lot of apps out there because not everybody has the opportunity to get to people for support like this. But one of the and it works really well for endo belly, too, is the Nerva for IBS.

Dr. Ginger Garner PT, DPT (56:07)

Yeah.

Dr. Susan Clinton (56:27)

We’ve got I’ll get the link to you ginger so you can put it in the notes, but it’s it’s basically using hypnosis To help with the pain and then it talks a lot in there about reframing Around food, you know, we don’t want people to avoid eating and most of the time if we can reframe it It’s not as bad But we hear so much shame about it all the time and then we have a something that happens that makes us have pain now we have shame and pain and there’s your

Dr. Ginger Garner PT, DPT (56:30)

Sure.

Mm-hmm. It’s… Yeah.

Right. And

real fear. Yeah, real fear that our body measures and hangs on to. Which it begs to then discuss, like you mentioned, hypnosis. There is somatic work. There’s mindfulness, which is different from meditation. There is vagus stimulation. And everything that we’ve already mentioned that goes into creating it.

Dr. Susan Clinton (56:58)

Yeah.

when

There’s a couple of apps that are based in CBT.

Dr. Ginger Garner PT, DPT (57:22)

Yeah, absolutely. ⁓ So there’s such a plethora of resources out there to shift the mind, to process the trauma that you’ve experienced. even if it’s mindset on nutrition, like we mentioned, or it could be processing trauma related to maybe the medical gas lighting, because if you’ve had endo, you’ve probably been gas lit, you know, medically. ⁓ And it takes so long to get a correct diagnosis. ⁓

And that kind of brings me into my last point. We’ve touched on trauma, we’ve touched on nutrition, ⁓ the health coaching aspect, how much pelvic PT and OT can do. ⁓ We’re really taught all of this, all of this is about reframing the medical model. It’s about shifting the system. It is about looking at

Pelvic floor therapy is something more than an internal exam where you release a pelvic floor muscle and then you give them clamshells and they go back to work again. It is so much more than that. know, many endopatients, as we’ve discussed, are told their GI symptoms are just IBS or they’re incorrectly diagnosed with anxiety when really what it is is the system failed them and then labeled them with anxiety. They actually have a real concern. ⁓

We’ve talked about basically, you we’re advocating for deeper care. The patient reframes it, the client reframes it, we reframe it as professionals and listen compassionately. So what are some of the changes that you would like to see or there could be things that you’re seeing now in how pelvic health, gut health and endometriosis are treated in a truly integrative care model?

Dr. Susan Clinton (58:46)

Mm-hmm.

⁓ The changes that I’m seeing are that people are empowered and have agency over what is happening. That’s the changes that I’m seeing. And when we work in collaboration with others and they’re willing to, they’re willing, so they have to be willing to do it too. Like both of us have to be willing. It’s, you know,

Dr. Ginger Garner PT, DPT (59:20)

Yeah.

Dr. Susan Clinton (59:34)

Collaboration is a component of two or more that are willing and they have the intent ⁓ to also go sideways and talk around it and go around the tree three times before they decide to climb it. And it’s okay, all of that is good. But the biggest thing is that when people have agency over what’s going on, they are going to be a lot, they’re just gonna be calmer. They’re gonna be.

They’re going to be feeling better. They’re going to be less stressed.

Dr. Ginger Garner PT, DPT (1:00:10)

And they’re getting their self-efficacy increases so they believe that they can do things to heal themselves.

Dr. Susan Clinton (1:00:13)

Yeah. And it is them that,

so if we do it the right way, we actually work with you to find the answers for yourself. And when you find the answers for yourself, that gives deep trust, but it also builds not just self-efficacy, it builds self-empathy. And that you can’t be anything for anybody else if you don’t have that for yourself. You know, that whole put your oxygen mask on thing first means something.

Dr. Ginger Garner PT, DPT (1:00:22)

Mm-hmm.

Mm-hmm, that’s home for it.

Yeah.

Dr. Susan Clinton (1:00:42)

That’s why we tell people to stop and smell the flowers. It means something. It’s not just rhetoric. And you know, the thing that I see now is I see the people who do this work and get the agency back of their lives. The ripple effect is that they are now turning and helping others.

Dr. Ginger Garner PT, DPT (1:01:06)

That’s.

Dr. Susan Clinton (1:01:06)

And that

is how we change things.

Dr. Ginger Garner PT, DPT (1:01:10)

Yeah, to be able to take away from that experience instead of a why me experience, becomes ⁓ how can I use the horrible thing that I experienced to help lift others because others helped lift me. That’s pretty powerful. All right.

Dr. Susan Clinton (1:01:26)

Mm-hmm.

Mm-hmm. Yeah. And

the ripple effect is what does it. And that’s what I like to see. Mm-hmm.

Dr. Ginger Garner PT, DPT (1:01:36)

It is, it changes everything. Yeah.

So what’s one thing that you, two questions. One is, what’s one thing you wish every practitioner understood about the overlap of gut dysfunction and endo so that no one else has to be gaslit and told your gut health has nothing to do with your pelvic health, right, or your endo? What’s one thing you wish every practitioner knew and where can people find you?

Dr. Susan Clinton (1:02:00)

Okay. One thing I wish every practitioner knew was to, not so much know, but what I wish every practitioner would do would look at much more of a subjective timeline with this client and really find out what, because they don’t do this with IBS either, find out what happened when this, because they can all tell you when it started, what’s going on, what happened around that.

And if they don’t have anything that they can pinpoint, which they may, and it could be because my periods were so awful by the time I turned 18, every time my period came on, I got this bad pain. Now it’s here all the time. That would tell me that something’s that this is possibly endo that’s escalating. It started off cyclical around that noceosceptive input or that painful input from their period. And now it is every time they eat. So which would make me feel that way.

Dr. Ginger Garner PT, DPT (1:02:45)

Mm-hmm.

Right.

Dr. Susan Clinton (1:02:57)

⁓ and I just think, you know, just that questioning about, you know, people come in with gut stuff all the time and I don’t think they ask about their menstrual cycles. I don’t think they ask about them and they need to, like, you know, ⁓ I don’t have any problem with my menstrual cycle. I’ve been on the pill and it’s like, why did you go on the pill? Right. That’s when the story comes out. because I couldn’t even get off the couch.

Dr. Ginger Garner PT, DPT (1:03:08)

No, yeah, you’re right. Yep.

Mm-hmm. Mm-hmm.

was horrible. Yeah.

Dr. Susan Clinton (1:03:27)

Yeah, I had to

Dr. Ginger Garner PT, DPT (1:03:27)

Yeah.

Dr. Susan Clinton (1:03:28)

do it. Or things got so bad at some point that this was the answer and it worked really well for me, which is great. But that history is still there, which means, like this isn’t, and they haven’t gotten better with some of the things that makes IBS better. So they don’t respond to dietary changes nearly as much, they respond to nervous system changes more.

Dr. Ginger Garner PT, DPT (1:03:46)

Yeah.

Yes, there’s, don’t know if it was Stephen Hawking, I can’t remember who said this, that said we don’t experience the world, we experience our nervous system.

You know, so where can people find you?

Dr. Susan Clinton (1:04:09)

People can find me at ltiphysio.com and they can email me at susan at ltiphysio.com. ⁓ Find me on Instagram at SclintonPT and on LinkedIn as Susan C. Clinton.

Dr. Ginger Garner PT, DPT (1:04:28)

All right. Dr. Susan Clinton, everyone, ⁓ thank you so much for being here. This has been an incredible conversation. It’s exactly what we needed to just kind of laser focus in on the power of pelvic health therapy, ⁓ what you can do nutritionally, psychosocially, mental health-wise, sleep, movement, everything to be able to impact and improve the outcome of

how healthy your gut can be if you do have endo. Thank you so much for being here.

Dr. Susan Clinton (1:05:02)

Thank you for having me.