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Why Aren't You Taking Fish Oils?

Posted: Wednesday, December 18, 2013 at 12:04:22 PM EST by Alyssa Tait

There is really only one good answer to this question.

But in order to get to that answer, we need to understand what  omega-3s are.

Omega 3 fatty acids belong to a group known as essential fatty acids. This means exactly what it sounds like: our bodies cannot function effectively without them. (Compare this with essential amino acids, the building blocks of protein that we must take in for growth and repair of our cells).

Here is a very summarised list of potential effects of low essential fatty acids:

Reproductive problems, dry, scaly skin, depression, anxiety, learning difficulties, behavioural problems, coronary artery disease, inflammation.

Our bodies are very versatile, and can often make substances from other substances. For example, if you don’t get enough vitamin B3, your body can make it from the amino acid tryptophan. However, the important point about essential fatty acids is this:

Your body is unable to make essential fatty acids.

This means that the only way you are going to get these substances (which, don’t forget, are essential to human health) is to take them in through your diet. The only meaningful sources of omega-3s in the diet are oils from cold water fatty fish, including salmon and sardines, and flaxseed or linseed. There are also small amounts of omega-3s in dark leafy greens. (You can imagine how small these amounts are, as leafy greens are not exactly what you’d describe as oily).

So that’s easy! You eat salmon (or its less effective cousin, tuna) three times a week already. Safe!

If only it were that simple!

Eating other fats and oils interferes with the amount of omega-3s that reaches your cells. There are two major fatty acids that compete. One is called arachidonic acid. This is a non-essential fatty acid, the major source of which is meat. The second is the other group of essential fatty acids, the omega-6s. Omega-6 fatty acids are found in all nuts and seeds, and all oils made from nuts and seeds.

That’s lucky, you might think. You don’t eat almond oil, or sunflower oil, or sesame oil, or peanut oil, and only eat nuts occasionally.

Even if this is the case, you may be getting a lot more omega-6s than you think. Anything marked “vegetable oil” will almost certainly be high in omega 6s. This includes “blended vegetable oil”, all margarines and soft butter blends, and also the increasingly popular rice bran oil. It also includes any packaged items that contain vegetable oil. Have a look at the packet – even when they’re baked, not fried – you might be surprised to see that many packaged foods contain vegetable oil.

Furthermore, the trans fats present in any oil-containing food that has been heated at a high temperature also compete with omega-3 in the body.

So getting enough omega-3s is not just about eating omega-3 rich food regularly.

Doing that is rarely enough. It is much more so about reducing the competitors to omega-3s in the diet, including vegetable and seed oils, margarine, nuts, seeds and any food containing these, such as muesli. In fact, reducing the omega-6-rich foods can have an enormous impact on cellular levels of omega-3.

Reducing omega-6 intake to just 2.5%  of daily calories can increase tissue levels of omega-3 by over 50%(that's without taking any fish oil tablets!) On the other hand, we may need over 3000mg of omega-3 EPA and DHA to counter high intake of omega-6s in the diet. This is not a "one-size-fits-all" approach.

It’s worth doing a close study of your diet to see whether the balance of omega-3s to omega-6s is as good as you think it is. There is a website where you can go to find the “omega-3 score” of a huge number of foods. This is a score that takes into account both its omega-3 and omega-6 content – in other words, that which adds points and that which takes points away!

Go to www.fastlearners.org and see whether your diet consists of foods in the positive or in the negative.

 If your diet is made up of a lot of the positive foods, it increases the likelihood that your tissue levels of omega-3s are good, but it doesn’t guarantee this. The only way to really know what your tissue levels are like (which depend on your lifetime eating habits) is to have a blood test done through a functional laboratory. I can order this for you here at Equilibria.

And that brings us to the answer to the question.

The only reason to not be taking omega-3s as a supplement is that you are confident of your tissue levels of omega-3s, and you are eating a diet that will maintain them. This diet would consist of a high intake of oily fish – probably daily – and some flaxseed. ALA from flaxseed has some benefits, but does not convert well to the required EPA and DHA. The enzyme that aids this conversion can be slowed down by lack of zinc, magnesium, B vitamins and vitamin C.

If, like most of us, maintaining this diet at times becomes a little too arduous, you should be taking omega-3 supplements, ideally from fish oil or algae rather than flaxeed. Your skin, your brain, your heart and arteries, your memory and your hormones will thank you.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Adhesions: A Cry For Help From Your Episiotomy Scar

Posted: Saturday, August 16, 2014 at 5:27:31 PM EST by Alyssa Tait

I suspect we underrate the negative impact of episiotomy scars.

My last post was about scar tissue after surgery and how it can cause real problems, both in the short and long term. I used the examples of an orthopaedic surgery scar and a Caesarean scar. Both of these are considered major surgery, and when you really stop to think about it, it makes sense that they require some rehabilitation. (As an aside, nutrition has a big impact on healing of scars, and should be a major focus in the first three months after any surgery).

But what about perineal scars from childbirth injury? These include scars from episiotomy, OASIS (obstetric anal sphincter injuries), and all types of tears to the vagina and perineum, whether first-, second-, third- or fourth-degree. Won’t these types of scars benefit from rehabilitation too? Of course they will – in fact, I think we need to be much more proactive about this.

When the obstetrician gives you your six-week postnatal “clearance”, this is just the beginning. In fact, many women see their GP and have no perineal or vaginal examination at their six-week check-up. If they do have an examination, the aim is to ensure healing is adequate and there are no signs of infection. This quick check is not designed to confirm your tissue is back to its fighting best!

Many women I see, when they see their doctor for their six-week check, have not started having penetrative intercourse again yet. This is perfectly natural; not everyone feels ready by this point. However, when they are given the “all-clear” by the doctor, it comes as a rude shock when they first try to have intercourse two, four or six weeks later – to find that it’s horribly painful and not at all what they were expecting.

For some women, this initial pain with penetrative intercourse eases up quickly; for others it is mild or not significant in the first place. However, for a significant number of women, this pain is severe, persistent and very disruptive of their intimate relationships.

Pain with sex after childbirth is quite common, and in a way should come as no surprise. Think about this: you break your ankle and it is immobilised for six weeks in a cast or moonboot. Finally the day comes when it can be taken off. With joy and enthusiasm you throw your weight onto it – in fact, you don’t just try to walk, but jump off a high step and throw yourself into an exuberant set of dance moves. OUCH! It’s excruciatingly painful, isn’t it? Of course it is. Your body is not designed to go from zero to a hundred in the blink of an eye after a significant injury.

Well, an episiotomy or perineal tear is a significant injury to your vulva. While it might be mild and you get away with token, short-lived discomfort, you may be like many women I see for whom it is actually quite a hard road back to enjoyable, pain-free intercourse.  I often describe penetrative sex to women as being what a marathon run is to an ankle sprain. You wouldn’t jump straight into a marathon once your ankle sprain heals! But for some reason, women expect (or society expects us!) to be straight up for sex after the perineum heals postpartum. As I mentioned, some women have no ongoing problems. But if you find that the low-level discomfort (or strong pain) doesn’t get better and better each time you try, you need to get going with some perineal rehab!

The longer you leave this, the harder it is. A number of women I have seen with post-partum vulval pain and painful sex were so sensitive in the area of the scar they could barely stand light touch, let alone entry of their partner’s penis. This is more likely to occur the longer you leave it, and may involve sensitisation of the nervous system (where the brain, spinal cord and nerves become hypersensitive to touch and normal sensations become interpreted as pain: this is called central sensitisation).  The pelvic floor muscles become both tight/overactive and weak – not a good combination!

A good way to start to help this is some nice perineal massage daily with olive oil, apricot kernel oil or jojoba oil. You can do this yourself, and if you like, progress to allow your partner to do it. (You may need to have an agreement that nothing sexual proceeds from this, unless you yourself wish to initiate it.) If this does the trick, that’s fine. However, often more specific therapeutic input is required. A physiotherapist trained in connective tissue mobilisation and myofascial release can help your vulva and vagina restore its natural movement, flexibility and sensation. This requires specific training, and it’s worth enquiring of your physiotherapist whether they have this specific set of skills. With the right type of therapy, you can get back your good health in this area, get rid of pain, and restore the quality to your sexual experience. Contact me to get help for this.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Adhesions: Why You Need To Play With Your Caesarean Scar

Posted: Saturday, August 16, 2014 at 6:31:38 PM EST by Alyssa Tait

Does your scar move how it should?

Try this: pick up the skin on the back of your hand, lift it up and drop it. Notice how stretchy it is? Good, healthy tissue, like a healthy body in general, MOVES. That’s right, mobility is as important for skin is it is for the rest of the body.

Scars, on the other hand, don’t have good natural mobility. Scarring, or the formation of tissue adhesions after injury or surgery, is a healing process. The priority for healing tissue is to become strong quickly to protect the injured area and prevent re-injury. Unfortunately, as part of this process, tissue becomes tight, stiff and inflexible. Scars become stuck to the tissue below, whether this be muscles, tendons, ligaments or even organs. How stuck they get depends on a lot of things: the part of the body; how deep the cut was; how well your healing process occurred (including how good your nutrition for healing was); how early you start movement rehab; how well you stick to your program; how much stretching you do, and more.

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I can give a personal example here. Twelve weeks ago I broke my ankle on both sides and had surgery. There is a scar of several inches on the outside of my lower leg where they inserted a plate. I dutifully followed the surgeon’s instructions and kept my ankle completely immobilised for two weeks, then introduced controlled movement in one plane only. Despite following the correct protocol, by the time I was allowed to walk on the leg again (at six weeks) the ankle was incredibly stiff and horribly painful to take weight or to move or twist in any way. Now, at twelve weeks, I need to do painful stretches every day for around 2 minutes at a time in order to get the movement back. As in any orthopaedic rehabilitation, this is a slow and painful process.

Now take abdominal surgery. If you have had a Caesarean section, this is exactly the same process. The obstetrician cuts through many layers to get to your uterus: the skin, the fat, the fascia (tight connective tissue wrapping) of the muscle, the muscle itself, more fascial layers and finally the organ itself. So the scar you see in your lower tummy, neat as it is, is only the tip of the iceberg.

Try an experiment. Grasp your lower tummy in your hands – thumb above the scar, fingers below. Now pick up the skin and move it around. Stretch it, wiggle it, lift it, move it every which way. Does it move easily and painlessly? Can you even lift it?

When scarring is adhered to the underlying tissues, it’s hard or even impossible to lift. The edges of skin you try to lift collapse inwards into the crevasse that is the scar, tightly bound to the what’s underneath. It’s all gummed up under there, restricting circulation and compromising your range of motion; it can be responsible for underlying muscle tension and spasm and even pain. This is a common source I see of “unexplained” pain, where all medical investigations have come up with nothing. If your pain is new since your surgery, and other causes have been ruled out, you need to get your physiotherapist trained in connective tissue manipulation to check this.

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It doesn’t feel nice to stretch a scar. In fact, it can feel quite horrible: it can sting, give you strange hypersensitive sensation and feel sore after you stretch it. But it is essential to get it as mobile as you can – and as much of this as possible needs to occur between the six-week and the twelve-week mark post surgery, because after this, scar tissue gets tighter (or stronger).

From the two-to-six-week mark, I massaged my strange-looking, bruised, hypersensitive leg with caution, trying to both remove swelling and get my nerves used to the sensation. From six weeks, when I tried “picking up” the scar, I realised how tight it had become – it was so “gummed up” I had almost no inward movement of my ankle. While this restriction is often less obvious in a Caesarean scar, it is absolutely an issue. I have seen many patients whose tight scar tissue is restricting their movement and promoting pain; in some, it’s even promoting dysfunction of the underlying organs.

Movement is essential for good health! And this goes for scars as well. If you are before the six-week point post-surgery, ask your physiotherapist for specific, safe mobilisation exercises for your scar. If you are past the six-week point post-surgery, get your scar moving vigorously. Pull it and stretch it every which way. Just play with it! For help with getting your tissue healthy and moving again, contact me at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Minimising Pain Via Healthy Scars: How Nutrients Help

Posted: Thursday, July 17, 2014 at 4:34:24 PM EST by Alyssa Tait

Injury, trauma and surgery leave their mark.

It’s inevitable – scars are a normal part of the healing process.

Sometimes this is obvious – like Caesarean scars or the abdominal scar after a hysterectomy. These are easy to see (which doesn’t always make us happy! Scars that are painful are also obvious – like, for some women, episiotomy scars that make sex more painful.

Movement is an important part of healthy scar healing - you really need to play with your scars! However, an often-neglected factor in healthy tissue and scar healing is nutrition.

Why is nutrition relevant in scar healing?

Availability of certain nutrients has an impact on various aspects of healing and scar formation:

  • “Cleaning up” the initial inflammatory process
  • Preventing infection
  • Laying down healthy tissue
  • Manufacturing new blood vessels
  • Increasing the strength and flexibility of the scar

The “Clean-Up” and preventing infection

  • Vitamin A – immune effects for healthy inflammation
  • Vitamin C – acts as an antioxidant to “sweep up debris”; higher doses help counter constipation from pain medications
  • Zinc – deficiency results in poor healing
  • Bromelain – reduces swelling and pain, speeds up resolution of bruising
  • Protein – a deficiency results in prolonged inflammation and delayed healing
  • Glutamine – promotes healthy inflammation

Rebuilding the House: Laying down healthy tissue

  • Vitamin A and vitamin C – improves collagen production
  • Bromelain – speeds up healing
  • Glucosamine – leads to production of hyaluronic acid to hasten healing
  • Gotu Kola – a herb that increases collagen production

Getting the Plumbing In: Manufacturing new Blood vessels

  • Vitamin C and copper – help produce down blood vessels

Bouncing Back: Strength and flexibility of the scar

  • Vitamin A
  • Zinc – deficiency results in a weaker scar
  • Glucosamine – leads to production of hyaluronic acid for a stronger scar
  • Protein – a deficiency results in a weaker scar
  • Gotu Kola – a herb that improves strength of the scar

I was very aware of all of this when I recently had surgery for a broken ankle. This was a serious injury with a very decent scar. To cover my bases, I have taken all of the above nutrients each day in addition to a high protein, high vegetable diet. The body has amazing healing capacity – but it still appreciates a helping hand by having plenty of raw materials on-hand for rebuilding!

If you have had or are planning surgery, and want to really get off on the right foot, contact us at Equilibria for a tailored nutrient program.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Pudendal Neuralgia: Pain from the Nerve Downstairs

Posted: Saturday, August 16, 2014 at 7:01:12 PM EST by Alyssa Tait

A Little-Known Cause of Pelvic Pain

How well do you know the nerves of your pelvis? Chances are you don’t even think about the nerves of your pelvis – unless you have pain in the area. While most of us are vaguely aware that problems with the sciatic nerve can cause “sciatica”, it’s not so obvious that troubles with the pudendal nerve of the pelvis can cause a condition called “pudendal neuralgia”. In fact, this is so obscure that even your doctor may be somewhat foggy on it.

The pudendal nerve is a nerve that runs very close to the sciatic nerve in the pelvis. Instead of running down the back of the leg, however, it curls back around into the inside of the pelvis and runs close to the inside of your “sitting bones”. Like all nerves, it branches out into many parts. Specific branches of the pudendal nerve run to some highly important areas – the anus, the vagina and perineum, and the clitoris, or their equivalent areas in men. Not a nerve to be underestimated!

Issues with the pudendal nerve can create pain in the lower pelvic areas, anywhere from the clitoris to the anus. Sometimes the nerve is trapped, being “held” or “bound down”. This is known as Pudendal Nerve Entrapment, and is due to tightness in the ligaments or fascia (connective tissue, like “cling wrap” around your muscles) near the nerve.

However, the nerve can be irritated without actually being entrapped. This situation is known more generally as Pudendal Neuralgia. The most common causes of this are prolonged or repeated pressure on the nerve (e.g. from cycling) or prolonged or repeated stretch to the nerve (e.g. from giving birth vaginally). It can also occur due to damage during gynaecological surgery or due to pressure from a tumour. Commonly though, it is due to a myofascial syndrome. This basically means tightness or overactivity in the muscles that the nerve runs close to: the pelvic floor muscles and the obturator internus muscles.

It can be hard to diagnose pudendal neuralgia. While it tends to cause burning pain in the pathway of the nerve, worse in sitting than standing, it can only be clearly diagnosed by having a pudendal nerve block. Sometimes, it is labelled less precisely by your doctor as "generalised vulvodynia" because it causes vulval pain. All the confusion in diagnosis aside, the symptoms of pudendal neuralgia can often be helped enormously by specific physiotherapy treatment.

No, we’re not talking general back exercises or stretches here. The type of physiotherapy required for pudendal neuralgia usually involves internal muscle and connective tissue treatment – that is, via a vaginal exam or a rectal exam. This is done by a physiotherapist who not only has specific training in the pelvic floor area, but specialised expertise in manual therapy treatment in this area. Don’t see your knee physio about this one! Ask questions to make sure your physio has the exact skills required. Physios with experience in this area have the skills to make this as comfortable and dignified as possible for you, while providing effective treatment.

If you have had your pain for a while, it may also be important in pudendal neuralgia to work on retraining the circuits in your brain. Persistent pain is often  a sign that the brain has got into faulty patterns, which need to be retrained.

Pudendal neuralgia is a condition I’ve been treating for several years, and is a special interest area of mine. In fact, I am so interested in this area that in September 2013 I’m travelling to Canada in order to do further specialised training on the manual therapy treatment of this condition, where physiotherapists refine their skills on each other! I wouldn’t ask you as my patient to have anything done I haven’t experienced myself!

If you think you might need help with Pudendal Neuralgia, contact me and tell me your story.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Nutrients in Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:12:00 PM EST by Alyssa Tait

Part 1: Magnesium

Chronic pain is complex; no one can deny that. Anyone who is experiencing chronic pain can think of their pain as a giant puzzle. There are many pieces that make up the picture, and an often-overlooked piece is the nutrition piece. Nutrients, which trigger certain (normal) physiological functions, are one part of this nutrition piece, and magnesium is a single one of these numerous nutrients that play a role in the process of persistent pain.

What is the role of magnesium in the body? Magnesium is a cation that plays numerous roles in various body compartments.

It helps maintain the internal “balance” (homeostasis) within the cell, so is imperative in cellular function. Magnesium has a “calcium channel blocking” action.

It is present in high amounts in the extracellular compartments, influencing excitability of nerves and nerve conduction. It has a role in skeletal, smooth and cardiac muscle function.

It is a cofactor for many enzymes, including those involved in the production of brain and gut neurotransmitters, thus influencing both gut and brain function.

Magnesium seems to be linked to various pain disorders and has some potential to help them:

One study showed a statistically significant link between low serum magnesium levels and myofascial pain syndrome. A 2012 study showed that magnesium supplementation helped to prevent migraine. Magnesium reduced pain in primary dysmenorrhea in a 1992 study. Furthermore, a 2007 systematic review of randomised trials found evidence for decreased postoperative analgesic requirements when magnesium was given.

Is there any evidence for the efficacy of magnesium administration in chronic or persistent pain?

One study showed that giving magnesium before surgery could help reduce both muscle fasciculations (twitching or spasms) and myalgia (muscle pain) experienced post-operatively.

Central sensitisation is a key process underlying chronic or persistent pain. An experiment was done with rats, whereby a drug called fentanyl was administered to produce delayed hyperalgesia (a sort of “exaggerated pain”). This was to try to create an animal model of central sensitisation.  Administering magnesium to the rats partially offset this process, resulting in less pain.

In chronic pain, we know there is abnormal processing of sensation. This is part of the “syndrome”, if you like, that is chronic pain (regardless of where in the body you feel it). Certain receptors called the NMDA (N-methyl-D-aspartate) are involved as “gates” that help process this sensation. Activation of the NMDA receptor leads to abnormal processing of sensation – therefore increased pain. This effect – part of what is known as “central sensitisation” – has effects in the spinal cord, in an area called the dorsal horn, as well as in the brain itself. Magnesium is involved in blocking the NMDA receptor, so that process cannot take place.  This was shown in an experiment with rats with in whom neuropathic pain was induced. The rats developed something called “allodynia” (where a stimulus that is not usually painful becomes painful) and mechanical hypersensitivity (where touch or pressure feels oversensitive). Giving magnesium to the rats “fixed” the allodynia (i.e. made them not feel this abnormal pain to normal stimulus) and delayed the onset of mechanical hypersensitivity, and stopped the change that takes place at the dorsal horn of the spinal cord. Hyperalgesia and allodynia are two aspects of the pain experience that we test in women who have vulvodynia and similar pelvic pain conditions. This makes these findings especially interesting to anyone experiencing these conditions.

Another group of rats was subjected to treatment that creates hyperalgesia. In this experiment, opioid agonists were used to try to resolve the pain (drugs like morphine). The morphine didn’t work – except when the group of rats were given magnesium first, which enhanced the analgesic effect of the morphine. Morphine works in the brain – so it seems that magnesium helps the “brain side” of chronic pain.

Finally, a 2013 study gives us some nice findings on magnesium in neuropathic pain. A 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

Ultimately, magnesium is cheap and fairly harmless as long as you don’t have a kidney disorder.  It’s certainly worth using if you experience persistent pain – and judge for yourself whether it helps. Clinicians working with people with pain should also consider giving magnesium early – before the pain becomes chronic. This might save a whole lot of grief. Not all magnesium supplements are the same, however; absorption (and therefore effectiveness) varies markedly across the different forms. For help in choosing an appropriate magnesium supplement, contact us at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Pelvic Pain, Vulvodynia and the Link with Chemical Contraception

Posted: Friday, January 9, 2015 at 8:54:14 AM EST by Alyssa Tait

A Bitter Pill to Swallow?

There’s been research on the link between the birth control Pill or Oral Contraceptive Pill (OCP) and vulvodynia going on for a little while. So what’s the story? Let me take you through a brief history.

A study in 2008 found a 30% risk of vulvodynia in OCP-takers (a risk that was highest among those that started the Pill before age 18. However, this was not statistically significant, which means, in essence, there’s a strong chance it could have been caused by chance!

In 2010, a case study was presented of a woman who developed vestibulodynia once on the OCP, and whose symptoms resolved completely once she stopped the OCP. While this is interesting – and provided ground for further research – a study of a single person is not very convincing of what happens ”en masse”.

Then, in 2012, a review found that the OCP can have negative effects on various aspects of a woman’s sexuality. Some of the things they looked at included libido and painful intercourse.

In summary, the research hasn’t been very conclusive – while those of us in clinical practice working with vulvodynia became more convinced there could be a link.

Hot off the press is a study presented at the American Urological Association conference in 2013. It has found that the low-dose contraceptive Pill (i.e. the type commonly taken) can increase the risk of pelvic pain, including pain with intercourse.

The hypothesis of the researchers was that the OCP could possibly lead to vulvodynia via its effects on serum estradiol (estrogen), free testosterone levels, hormonal receptors, and vulvar mucosa. There were 957 women in the study (a lot more than the 177 women in the 2008 study cited above). They put these women into three groups:

-did not use the OCP (“nonusers”)

-used the “low-dose” OCP, 20ug ethinyl estradiol or less

-used the “normal-dose” OCP, more than 20ug ethinyl estradiol

Low-dose users were significantly more likely to meet the criteria for a diagnosis of chronic pelvic pain than nonusers. Twice as many low-dose users than nonusers reported pain during orgasm (25% vs 12%).

Because the high-dose users were not more likely than nonusers to have chronic pelvic pain or pain during orgasm, the investigators suggested that women with pain could be put on a higher-dose Pill. That certainly warrants consideration. So does reconsidering whether the Pill is the right contraception for you if you have problems with pelvic pain or vulvodynia. One study in 2012 found an increased pain sensitivity in women on the Pill who had a certain genetic make-up. This possibility is also currently being explored by Dr Andrew Goldstein, one of the world’s foremost clinicians dealing with vulvodynia.

For now, it seems that taking the OCP for contraception should not be treated as a decision to be taken lightly, especially if you have persistent pelvic pain – and especially if it came on after you started the Pill.

If you are wondering whether you could have vulvodynia, but haven't had a diagnosis yet, try my short Vulvodynia Self-Test.

 

 

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Coeliac Disease: could you spot this in your child?

Posted: Wednesday, December 18, 2013 at 12:15:28 PM EST by Alyssa Tait

Up to one in one hundred people have coeliac disease. The problem is, most of these don’t know it.

What signs would alert you to this in your child, or the children you treat?

A 2013 study suggests the common symptoms of coeliac disease depend on the age of the child.

Kids younger than six with coeliac disease are most likely to have diarrhoea and failure to thrive (that is, be small for age, short and skinny, with poor growth).

Kids older than six with coeliac disease are more likely to have the same symptoms an adult with coeliac disease would: “irritable bowel” symptoms. Abdominal pain and nausea are two of the key symptoms here. This is interesting, as nausea is not often thought of as a symptom of coeliac disease.

Abdominal pain was the most common symptom, being present in more than 50% of the sample of kids who were diagnosed with coeliac disease. It’s interesting to note than only just over a quarter of the kids had the symptom of diarrhoea, which people often mistakenly think of as the key symptom of coeliac disease.  In fact, in the seven-to-thirteen age group, there was actually constipation in over 10%, and in the under-sixes, it was present in almost a quarter. This makes it clear that we should not forget about the possibility of coeliac disease in our paediatric patients with constipation!

Big tummies are also the other thing to look out for, especially in the under-sixes, one-third of whom had abdominal distension.

One final note was that in this group, approximately 13% of them were IgA deficient. Note well: this means that a blood screen for coeliac disease will produce a false negative in these kids. In other words, the (correct) diagnosis of coeliac disease will be missed! This is because the standard blood tests for coeliac disease (transglutaminase antibody and IgA antigliadin) both are IgA-based. They rely on normal amounts of IgA being present in the serum. If there is IgA deficiency, the individual will not test positive to coeliac disease on blood tests even when they have it.

Finally, coeliac disease is hard to diagnose in the under-fours. This is because until four years of age, coeliac serum testing is unreliable. So don’t assume that if your four-year old patient had a negative test for coeliac disease a year ago, she is clear of the disease. If you suspect it’s a possibility, make sure you refer appropriately for testing.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Recovery From Vulvodynia: Share What Has Helped You

Posted: Wednesday, December 18, 2013 at 12:16:17 PM EST by Alyssa Tait

When you've lived through something as difficult as vulvodynia, your heart goes out to others experiencing the same.

Your insights on what helped (or helps) you can really help other women. In fact, as much as I believe a good team of health professionals is essential in recovery from vulvodynia, there is equally no subsitute from the help and support of others who have been there.

I would be grateful to hear about what helped you so that I can include some of these insights in a book designed to help women recover from vulvodynia.

I am interested less in particular techniques or therapies (much as I hope my own techniques have played an important role for you!) and more interested in what thoughts, concepts, paradigm shifts and approaches have been key in turning things around for you.

Please feel free to submit comments below, or contact me directly (with assurance of confidentiality) at alyssatait@equilibriahealth.com.au (please copy and paste the e-mail address)

I will take the submission of your comments as tacit permission for possible inclusion (anonymously) in a future book about vulvodynia.

With thanks!

 

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Fertility: Not So Sweet After All

Posted: Wednesday, December 18, 2013 at 12:17:30 PM EST by Alyssa Tait

The positive effect of low-carbohydrate eating on infertility

Recent research confirms what common sense should tell us. Too much sugar or carbohydrate is not good for our health overall, so it’s no surprise it’s no good for our fertility either.

The study from the recent conference of the American Congress of Obsetricians and Gynecologists showed that a low-carbohydrate diet improved pregnancy and birth rates with women undergoing IVF.

The 36 and 37-year-old women in the study had their diets analysed, and were divided into two groups: those whose diet was more than 25% protein, and less than 25% protein. By definition, these diets are lower-carbohydrate and higher-carbohydrate respectively.

The higher protein (lower carbohydrate) women had double the pregnancy rates and five times the live birth rates. It was found that this was due to better development of the blastocyst (the early stage of development in pregnancy).

Previous studies had a similar finding in women with and without polycystic ovarian syndrome. The lower-carbohydrate diet was more beneficial, despite the fact that the women did not have diabetes.

This tells us a lot: not just about how to increase chances of pregnancy in infertility, but about what kind of diet is related to good health and development from the earliest age.

For help with establishing a healthy lower carbohydrate, higher protein diet, contact us at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Polycystic Ovarian Syndrome, or Just Polycystic Ovaries?

Posted: Thursday, July 17, 2014 at 4:41:17 PM EST by Alyssa Tait

Is it possible to have polycystic ovaries and not have Polycystic Ovarian Syndrome (PCOS)?

And conversely, is it possible to have Polycystic Ovarian Syndrome, but no sign of polycystic ovaries?

As you may have guessed, (as there needs to be a point to writing this blog post), the answer to both these questions is YES.

If you have a pelvic ultrasound and you are told you have polycystic ovaries from the images they can see, this in no way confirms that you have the condition known as Polycystic Ovarian Syndrome (PCOS).

And likewise, you can well and truly have PCOS, even if the scan does not show up multiple cysts on your ovaries.

So what does it all mean? Are you supposed to have cysts on your ovaries, or not?

If you are of menstruating age and ovulating, the ovum (or egg) is produced from what is called “the dominant follicle” on the ovary. One follicle has to “win the race” to result in ovulation. If several follicles grow at the same rate, none of them win the race, and therefore ovulation does not occur. It is as though the system has “stalled” or “got stuck”. The appearance of the ovary will be of multiple cysts (i.e. polycystic ovaries). This can occur in any woman (including young teenagers) when ovulation is not occurring. So polycystic ovaries is a much broader situation than the specific “Polycystic Ovarian Syndrome” or PCOS

So what is PCOS exactly?

PCOS is a complex metabolic disorder involving hyperandrogenism (too much “male hormone” activity) and ovulatory dysfunction (i.e. not ovulating regularly), and an increased risk of insulin resistance. There is often (but not always!) overweight or obesity, and reduction in body fat is one of the most important ways of managing this genetic disorder. PCOS can neither be diagnosed by ultrasound alone, nor is it automatically ruled out if your ultrasound is clear!

And what can you do for PCOS?

Once a diagnosis of PCOS is established, nutritional therapies, lifestyle therapies and specific herbal medicines can play an important role in management. Herbal medicines should only be prescribed (and supervised) by a qualified herbalist.

To find out more, or to tell us about your situation,  contact us at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
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