Integrating Functional and Pelvic Floor Therapies for Endometriosis With Dr. Bri Wyatt

Speaker 1:
0:03

Welcome to EndoBattery, where I share about my endometriosis and adenomyosis story and continue learning along the way. This podcast is not a substitute for professional medical advice or diagnosis, but a place to equip you with information and a sense of community, ensuring you never have to face this journey alone. Join me as I navigate the ups and downs and share stories of strength, resilience and hope. While navigating the world of endometriosis and adenomyosis, from personal experience to expert insights, I'm your host, alana, and this is EndoBattery charging our lives when endometriosis drains us. Welcome back to EndoBattery, grab your cup of coffee or your cup of tea and join me at the table.

Speaker 1:
0:47

I'm joined at the table today by Dr Bree Wyatt, who is a distinguished doctor of physical therapy and a pelvic floor specialist based in Southwest Florida. With her extensive expertise and commitment to holistic health, she also holds a certification as a functional medicine practitioner. Dr Wyatt is the proud owner of Holistic Health, physical Therapy and Wellness, which isa, leading wellness center in Bonita Springs, florida, dedicated to providing comprehensive and integrative care to her patients. Please help me in welcoming Dr Brie Wyatt. Thank you, brie, so much for joining me. I'm so happy to see your face again after we met at the summit and got to know each other a little bit. So thank you for joining me today and I'm happy to have you on.

Speaker 2:
1:31

Yeah, it's good to see you again.

Speaker 1:
1:33

I know it was. It was a whirlwind of a trip to be at the summit and to me and sit by the pool and have conversation and that was so fun to just connect with people in that way. But what's interesting about your story and we can get into that in a little bit is that I feel like a lot of people are on the search for different modalities to help with either pain or with symptoms or within their journey, and that doesn't exclude you. You have a good background in multiple things. Do you mind telling us what those things are and where this passion came from?

Speaker 2:
2:06

Yeah, so I am a doctor of physical therapy primarily, but I kind of began this journey as a functional medicine practitioner just because of my own health issues. So I was in physical therapy school at the time and I just suddenly had chronic, just debilitating pain. No doctors could figure it out Kind of similar to what endometriosis patients go through is. I went to doctor after doctor after doctor who just kept telling me everything's fine, there's nothing wrong, and I ended up about two, three, four to seven years of just having my gallbladder removed and then my appendix removed and still being unwell.

Speaker 2:
2:50

I really kind of left traditional medicine and found myself working with a functional medicine practitioner who ended up helping heal me. I had breast implants put in seven now eight years ago and I was just extremely sick from them and I didn't know why all my organs were shutting down and I just didn't feel well. And so I'm now, as of this month, one year since my explant surgery and that was kind of the driver for functional medicine. But I also saw how it could help so many patients that I was working with. So I see endometriosis and adenomyosis patients all the time in my office and I just found that it was just such a good blend with pelvic floor therapy to really help this population of people.

Speaker 1:
3:40

Now this isn't to say that, like people who have severe endometriosis don't see a surgeon, but this is like another modality for you and for others to be able to find symptom relief or even help clear up some of the things that maybe are going on within the system. Can you explain what side of functional medicine that you practice in?

Speaker 2:
4:03

Yeah, and just to agree with you, I still refer patients to excision specialist surgeons. My role is not to cure individuals of endometriosis. So from a functional medicine standpoint, when we're looking at endometriosis, we're really trying to do a deep dive of what's causing all these different symptoms. And I think the tricky thing about endometriosis is it is multi systemic, it affects every body system. You know that we have, and sometimes it's difficult to kind of weave through all of it and figure out what is primarily endo driven and what is driven by something else.

Speaker 2:
4:42

You can see bloating in endometriosis patients, but they could also still have a bacterial overgrowth issue where, if we can kind of get rid of that, we can make the bloating not so severe.

Speaker 2:
4:56

Or we have individuals who have blood sugar dysregulation, who are taking all sorts of supplements and things and we don't even know where their hormones are at.

Speaker 2:
5:08

I think everybody assumes that it's always a problem with too much estrogen, but I've done testing with patients and it comes back and they have no estrogen. And so functional medicine is really trying to get at what is going on with the patient in front of you, specifically because there is no blueprint for how to treat an endo patient. It's not the same thing for every single person and sometimes I think, especially with social media, it can seem that way where it's like, oh, you have endo, take this, this and this and do this and you'll be fine. And that just is really kind of giving false hope to people, where they think, oh, if I just purchased this one supplement, it's all just going to go away. And I really like to make that clear with my patients that we're really just looking to try to individualize your specific symptoms and improve your symptoms as much as possible. We're not going to just cure it overnight with this one little capsule.

Speaker 1:
6:10

Right, right. Which is where I think a lot of us struggle, because if you've fallen into that category of taking supplement after supplement with the hopes that it's going to cure or completely eliminate symptoms, it's that false hope and that's where I think we do get a lot of our kind of disassociations with foods and medical things and sometimes it causes stress on us mentally, emotionally and even physically, and so just being aware of that it's not necessarily going to cure, but it is going to maybe help support your system. That, I think, is key. It's not a one size fits all.

Speaker 2:
6:50

Yeah, and it's really educating patients and saying that we need to reframe the way that we think about it. I'm not taking this to get rid of my endo or make my endo better. I'm taking this. I'm doing this to support my system, to support my body so that it can do what it needs to do. And when you think of it that way, it applies to basically every disease everyone is facing, and you're just trying to support your system, to allow your body to do what it needs to do. With endometriosis, obviously there's a lot of different things going on. Your it's kind of like your body is burning up a lot more energy just to get through daily life, and so I find those patients do need more nutrition, more vitamins and minerals than the average individual. But when we're taking that extra zinc, that extra magnesium, it's not to make the endo go away, it's to just give yourself the extra support that you need so that you can feel a little bit better each day.

Speaker 1:
7:55

Yeah, oh and that's something that I feel like we can sometimes look over kind of in the trenches is that we need to be able to support our whole bodies and not just like one systemic issue. You know, our bodies are complex, it's not just one issue.

Speaker 2:
8:14

Super complex, and that's the most difficult thing is when you have someone coming into your office. You can't just look at them like they're a uterus.

Speaker 2:
8:24

And I think that's what's so important about the change in how we define endometriosis is we used to think of it as a very uterus-centric disease, and I think it's been so great to see that change, because you think of all of these people who still see it as such a uterus-centric disease, where they're still trying to just take the uterus out or just treat only the uterus, and it's just not that way. That's why you see patients who struggle with systemic symptoms like fatigue and nausea and lightheadedness and all of these things, because it's not just a uterus problem.

Speaker 1:
9:07

Right, that's so true, as those of us who have had our uteruses removed can attest to, it is not just a uterus problem. You know, and I think too and maybe you can speak to this a little bit too in supporting our bodies post-expert excision how we do that from a functional standpoint. Because for someone like me who has had a hysterectomy and have my ovaries removed and things like that, what are some ways that we can help support our body with functional medicine?

Speaker 2:
9:41

The tricky thing about post-operative patients is they don't feel well, they're tired, they just went through a big procedure. So I think the most important thing is just trying to get nutrition into those patients, which sometimes that's getting a really good, high quality like bone broth or you know, getting some really good sources of protein that are really easy for someone to digest and to eat, because most people, you know they don't feel like eating a big piece of meat postoperatively, so you really do. I think, personally, the biggest thing to do is to plan to have those things on hand, knowing that you're going to come out of surgery probably not feeling like you want to eat three full meals a day, yes, but trying to then say, okay, what do I typically reach for when I'm feeling a little bit more run down and my body is recovering? For a lot of people, that may be more of their like brothy foods, their shakes, their smoothies. So trying to have things on hand where you can sneak in some protein, some omega threes, things like that into foods that are easier to eat.

Speaker 2:
10:51

I know one of my favorites I have a fish oil in my office that I sell that is really super delicious and you can just mix it into like Greek yogurt, and so you're getting your omegas that are good for inflammation, but then you're also getting your protein. With the greek yogurt it's still like more of a liquid consistency which is really easy to get down, and so there's a lot of strategy involved to getting good nutrition into patients post-operatively right. So really I think planning is the biggest thing finding some foods, trying them out before surgery, make sure you like them and then that way you have it ready to go at home and hopefully it makes you a little bit more successful in your recovery.

Speaker 1:
11:33

My recovery consisted of me wanting chocolate. That was my problem, though. Like woke up and I was like give me the cookie, give me the chocolate, which is funny because I'm not. I was never really that person before, so it was an interesting change for my system. It wasn't something I was used to, but I've had to fight through that. I've come around to not craving that as much. When you have patients that come into your office, how do you address not only the functional medicine side of things but what you do as a PT, Because I feel like there's room for those two to kind of marry together in a good and useful way that can help your patients. What are some ways that you address those things?

Speaker 2:
12:21

That's probably the most common question I get as a PT is how do I structure my sessions? Is one of them a functional medicine session, one of them's a pelvic PT session? And the answer to that is really it's all intermixed together. So when I have a patient in front of me and I'm going over just their overall history, I'm just diving deeper into it. I'm not just asking about their musculoskeletal system, I'm asking about their stress, their sleep, their diet. You know what are the different supplements they're taking, what medications are you on? Do you get outside? How is your social support system?

Speaker 2:
13:00

I kind of weave all of those things into it, because functional medicine is a very full body, multi-system thing where you're not just looking at the musculoskeletal system anymore and only the musculoskeletal system. You're looking at that entire person and what makes that person who they are today. And so when a patient comes in, I'm going to still do an external internal assessment of the pelvic floor therapist, but I also am spending some time feeling the digestive system because I do visceral mobilization and work on the organs. I'm feeling the reproductive system, I'm looking at their nervous system, but then I'm also diving into is this person really well nourished? Are they getting everything they need to in their diets? Have they grown up on a farm next to a bunch of pesticides? Their whole life have they been dealing with mold in their home? You know things like that Because sometimes I find with my patients with endo sometimes it can get really easy to just say, oh, it's because of the endo.

Speaker 1:
14:06

Right.

Speaker 2:
14:07

And sometimes I find someone does have something else going on. But because endometriosis can present in so many different ways, it's really easy for that to just be the scapegoat. But I've had plenty of patients come in who also are dealing with mold. Where they come in they've got this weird rash on their neck and I asked them have you been working in a, an office or at home, and is there mold? Oh yeah, there was a big water leak and there's mold in my office and you know, this just started. I don't know what it is and I just assumed it was my endo flare and really it's. It's not their endo flare, it's just their bodies battling something else which quite frankly it's. It's like tipping the scale, so much your body's already, you know, dealing with endometriosis on a regular basis. So, to answer your question, they kind of blend together and I don't plan sessions, it's you come in that day and I just kind of see where it takes me, because if I have a plan, it just it just falls apart. I never know what's going to happen.

Speaker 1:
15:09

Well, I think it's hard to plan with the patients when you don't know their whole history. I think that's the problem that a lot of us get into is, some providers will have a plan of how they're going to treat or assess before they even know most of your story or where you're coming from and I would assume you know you're in Florida you're going to have more mold issues than maybe some other places. Right, it's the nature of Florida, but what are?

Speaker 1:
15:37

some of the challenges that you run up against when you have these patients come in. Is it believing that these things could be beneficial, or is it that they're solely focused on endometriosis, that they don't want to look at a bigger picture? What are some of those challenges that you might come up against in doing both the pelvic floor PT and the functional medicine side?

Speaker 2:
16:04

Well, the biggest challenge I have with the functional medicine side is I am somewhat limited by my PT license and what I can and cannot do, which is always a constant barrier. But I would say the biggest limitation really is just time how much can I cover in one session? I have the luxury of being an out-of-network provider, so I do see my patients for a full hour but I'm always trying to pack in as much as possible in that one hour because I just want to continue to move that patient along and get them feeling better and better. So it is always a challenge of what can I fit in this one session, in this one session. And then the other challenges and this is everybody who comes across functional medicine is I cannot force the patient to do the work.

Speaker 2:
16:51

Functional medicine is all about lifestyle changes and choosing what goes in your mouth, what is around you, what you choose to put on your skin. And that is really difficult because I am not going to be there to spoon feed you to. You know, tell you don't do this, don't do that. I try to lead by example. I, you know I try to have healthy foods in my office and you know I'm always like giving out organic teas and things like that, and it's a fragrance free zone and I try to do all of these things to lead by example, but at the end of the day I am not you. I can support you as much as I can, but at the end of the day I can't force you to do anything and I think that is a challenge.

Speaker 2:
17:43

And as a provider, we also have to meet patients halfway and recognize we can't tell them to just throw out every bad thing in their pantry. We have to start with like little little steps, baby steps that someone can actually achieve. Because if you throw too much at a patient right off the bat in this space, it's really overwhelming and then they just shut off completely. And I've seen people who come from other functional providers and it's just too overwhelming. It was like take these 20 supplements, don't eat this, this, this or this, and also throw out all of this stuff that has chemicals and pesticides and parabens and it's just too much at once where it just seems completely unrealistic to somebody.

Speaker 1:
18:31

And then they just don't do it Right. Well, and I and I definitely can see that, you know, because I think a lot of people, especially if you were raised in the time that I was, where functional medicine was not a thing, where I was growing up, it wasn't something that we talked about, it was very Western medicine related. And so for someone to come at you full force, get rid of this, get rid of that, get rid of this, do this, do that, do that it automatically gets that defense mechanism up, and I do think that can have maybe some adverse effects to what you're trying to overall accomplish is I think we have to be really careful about how we say things and how we convey things, because, although they can be important, if they're not conveyed properly can be harmful.

Speaker 2:
19:18

Oh, totally, and I come from a disordered eating background.

Speaker 2:
19:22

So when I was in college I struggled with anorexia and so I always try to be really careful when I'm telling patients how to change the way that they eat, because you don't want it to come off as really restrictive, where you're sending someone down that path where they may end up looking at everything and feel like they can't eat anything and then they're not eating anything.

Speaker 2:
19:46

Because I do, unfortunately, see a lot of disordered eating patterns in patients who have more autoimmune and you know many conditions where they they have reactions to certain foods, where they can't have gluten or dairy or or high oxalate foods and all of this. And when you tell people you can't have this, this, this or this, you have to keep in mind how restrictive that is and it can lead some people to some very disordered eating patterns. I'm very mindful of that because I struggle with that myself and so when I have patients I don't just start from scratch and like start all over and say, don't eat any of that. To me that's very triggering to my brain and how we should look at food and, I think, our environments too.

Speaker 1:
20:32

You know, we think about what's in the air and what we're putting in our house and the things that we're cleaning with and how that can have an effect on us. And, yes, I think that we're more aware of that now than we ever have been. But I do think that we companies are getting trickier with how they present things too, so it gets a little overwhelming to look at every little thing. So making sure that we can look at things from an overall health perspective is so helpful. When you're talking to your patients about all of these things and how they correlate with endometriosis, how do you convey that? How do you convey that maybe the scents that are in your house or the foods that you're eating could be contributing to the endometriosis symptoms?

Speaker 2:
21:19

I always like to describe endometriosis as an inflammatory condition.

Speaker 2:
21:23

I think that, to me, helps patients understand more of how all of these things interconnect, and that's why I do like the shift in our prior definition of endometriosis Now that it's not so uterus focused.

Speaker 2:
21:37

I do like that it's more of an inflammatory full body focus, so that you can really wrap all of this together and say you know, I know that this may not seem related, but it's one more thing that's inflaming your system, and when this inflammation gets to a certain point, that's when you're going to be more symptomatic, you're going to have a lot more pain, and so if we can just lower all of these different inputs to this overall level of inflammation, we can get it a little bit lower where you start to feel that that difference and I think that's that makes a lot more sense to people when you think of it more of of like you only have so much in that cup before it overflows. And if you have so much inflammation coming from the foods that you're choosing to eat and the toxins that you fill your home with, you've already got this endometrial process that's creating a little bit of inflammation.

Speaker 2:
22:37

You're going to overfill that cup and you're going to have more symptoms. We're not going to make the endometriosis go away by controlling all of these other things, but we can at least lower that overall level of inflammation.

Speaker 1:
22:51

Do you see some of the patients that have that are in major flare-ups, really struggling to get out of bed, who are struggling to just function in life? Do you feel like if you, if they apply some of these things to kind of deescalate maybe their system being overwhelmed, you're seeing a significant improvement on symptoms?

Speaker 2:
23:13

Some patients it's pretty quick. For example, I have a patient who actually struggles with more disordered eating. So when we were navigating food that was something we really had to think about. But when we started to eliminate gluten from her diet and minimizing dairy very specific dairy she can have it was pretty immediate the improvement. She could tell that it was impacting her symptoms. But I always tell people it is not the same for everybody. Not everybody with endometriosis needs to stop eating gluten and stop having dairy.

Speaker 2:
23:49

There are a lot of nutritional benefits to whole grains and dairy products. So you have to kind of figure out what is the benefit and what are the cons to it. For some patients they get so much benefit from it that you can get those same nutrients through other foods where it's just more beneficial to just remove it and substitute it with something else. But sometimes you see immediate improvements.

Speaker 2:
24:16

Today I had someone on day three of their period come in and just doing the visceral work to her uterus and her ovaries and the fascia and the abdomen. She walked out and was like I feel so much better already and that's without any kind of take the supplement, do this, do that. That's just by improving blood flow, trying to lower inflammation in that area. Uh, we did some nervous system exercises in the office. You know, just just looking at the entire body and what can I do to just calm down the system and this inflammation? So sometimes it's immediate improvements. But some patients are tricky and you have to keep diving and digging for different solutions. I had one patient cinnamon was really causing issues with their symptoms and I still am like why was that the case? But you just never know with individuals what works for them and what doesn't, until you try it. There is no list that says, oh, these are all, the, all the foods that bother patients with endo.

Speaker 1:
25:20

Yeah, it's so different for everyone. I mean, it's interesting, just like sitting down with a bunch of my friends that have endo and all of us are different in what we can eat, like some have some similarities, and then other people like myself and I've said this so many times I feel like a broken record, but like beef and eggs for me for some reason have become very challenging to eat and I have a response. But gluten I have no issues with, you know. So it's really interesting. And then other friends who are like I know it, gluten's my issue, I can't have it. So everyone is so individualized. I feel like when you're looking at doing functional medicine as a support tool for yourself, looking at someone that's not going to pinhole you in a specific group or this is what I do for every patient that comes in someone that's going to look at you individually and say what is it that we can help you with? As you know, that's key.

Speaker 2:
26:15

And I would say the three main ones tend to be, you know, the dairy, the gluten, the red meat.

Speaker 2:
26:20

But it's not the story for everyone and I also tend to be more in the camp of I don't like to do food sensitivity testing. Number one I think it's really expensive, yeah. And number two if someone has a leaky gut scenario where almost everything is inflaming them, sometimes everything that pops up on that test is everything that they've been eating, and then once again we end up at that test is everything that they've been eating, and then once again we end up at that scenario where that patient feels like they can't eat anything and then it leads to really disordered eating patterns. So I personally like to just eliminate for a little bit and incorporate other foods that still work. So you still feel like you're adding, you're not just always taking away, and then I just see how someone's symptoms are. I find that's a lot easier and more cost effective for patients, because I don't want them spending $300 on a food sensitivity test and then they look at it and I'm like, oh, I don't really know, yeah.

Speaker 2:
27:20

I don't really agree with this.

Speaker 1:
27:22

Yeah, I feel like I've heard a lot of people say that it's not overly accurate most of the time, so it's a great perspective to have on it. When you talk about supplements, what is your approach with supplements and how can they help certain people, specifically with endometriosis, because I know some patients are really sensitive to supplements. I myself am not great with supplements due to kidney issues and things like that, being aware that you know I can't take a lot of supplements. What are some benefits of supplements and how do you approach that?

Speaker 2:
27:53

I would say the benefits really is that we unfortunately live in a world where our foods just don't have the same nutrients, vitamins, minerals in it that they did before. You know, a lot of things are being bleached from the soils and our plants don't have what they used to have. So for some patients it's really a struggle to get what they need from their foods, or they don't like a lot of foods that have what they need, so now they're really struggling to get what they need. So, like a good one is iron right. So because of the heavy bleeding, a lot of patients really struggle to get iron, and not everybody likes the foods that are really high in iron, right. You think of all those like organ meats and red meat, all of that. A lot of people. It's extremely off-putting, they're not really feeling like eating it when they need it anyways, and so they just don't get enough of it in their foods. Because I always tell people I want it from food when possible. I would much rather someone get it through food than take it through a supplement. But it's not always possible, and not only with that, but the form of the supplement can make a big difference for some people.

Speaker 2:
29:10

I think a lot of people struggle with swallowing a lot of capsules, and not only that. I don't think there's always a lot of clarity in when to take supplements, which ones should be with food, which ones should be on an empty stomach, and it just makes it really complicated Because, like there's some that just don't usually go well with patients when it's on an empty stomach, right? For example, some of my patients, when they're doing like a high dose turmeric, they get so much GI distress if they don't have food in their system, but they don't always know when they should take it. And so I use an online little pharmacy, I use full script for my patients where I can write in with every supplement take this with food, make sure this is on an empty stomach, take this in the morning. I try to be very clear about when to take it and I also make sure that you're not adding it all at once. You're starting with one. Start for a few days, then see how you feel, make sure you're tolerating it. And then I'm usually asking do you prefer liquid, do you prefer powder? What do you prefer? Because for some people they just do better with different forms. Some people are very sensitive to the capsules themselves. Some people don't do as well with the herby approaches, and I think that's what's so cool is you could have someone who has elevated cortisol and you could either do like an herbal approach or you can do you know, some food approaches, some nervous system approaches. There's different ways that you can tackle it, Because the last thing I want is for someone to be taking like 50 supplements a day.

Speaker 2:
30:41

That's just too much. That's just too much, I know, for me. I gosh, I'm a functional medicine provider. I don't even take that many a day because I recognize that, yes, some things I may need for a short period of time to get back on track, but my goal is that, with proper nutrition I'm, I only need to be on a few things every day. Right, and I think there's a lot of people who have seen a provider and then they're not seeing them anymore, but they're still taking the same things and I don't ever see them testing their blood work to see if they're good and they can get off of it, because everything has a good level where it should be, even vitamin D. We all love vitamin D, but even vitamin D too much of it is not a good thing, too little, of it's not a good thing.

Speaker 2:
31:30

So, I see patients supplementing with 5,000, 10,000 IUs forever, and now their vitamin D is really, really, really high. So I'm always a big fan of like testing, not gassing. If you're taking supplements, you want to make sure that it's doing what it's supposed to. Your levels are actually getting better.

Speaker 1:
31:49

Right. Just because it's, you know, says it's natural, doesn't mean it's ineffective or that you can take as much as you want, because it is going to do something and they can have adverse reactions when they combine within your system. And I mean, I think we have to be so aware of what we are putting in our bodies across the board and having someone there to kind of help you navigate, that, if that's the route that you choose to go, you don't want to just throw everything in your system, especially, I would say, with endometriosis, because we tend to be highly sensitive to a lot of different things, especially if we're in a more heightened state of inflammation or anything else. At least, that's been my experience with talking to people that are in functional medicine and that I've seen in myself is that we tend to be really sensitive to what we put in our bodies.

Speaker 2:
32:42

Yeah, and honestly, usually my endometriosis patients have to start on a much lower dose than you typically would for other patients because they are more sensitive, and it's the same for whether that means medications or hormones or supplements. Really, you have to start low and then slowly build up, because you just have to make sure that person is tolerating it in the first place, and that's why I do like to try to get it through food if possible. But you'll also see patients who suddenly just aren't tolerating certain foods, and that's when you really have to think really hard about what specific foods are bothering them. Is there a histamine reaction going on? Is it they're just sensitive to that specific food? Is their nervous system so upregulated and so, in that sympathetic fight or flight response, that they're just not digesting in general? So there's a lot of really deep thinking that you have to do when you have someone in front of you who really isn't tolerating a whole lot.

Speaker 1:
33:42

Right, I feel like that's such a tricky thing for those of us with endometriosis because I know for me it's easy to just jump into. These are endo pains or this is endo related and it's not, you know, and you mentioned that before, and a lot goes into it being a whole body system, whole body thing. It's not just a reproductive disorder from that perspective. So it's a good reminder to look at it at a holistic standpoint as well and not just rush into it.

Speaker 2:
34:14

You really have to stop and say how do I feel and what do I need. If you feel like you're having a flare, you first want to ask like, but how do I feel? Like, do I feel really stressed? Maybe what I need is to focus on my stress and, you know, put more in my day. That really makes me feel more at peace. Maybe just looking outside or laying outside, being in nature it's so easy to just say, oh, I'm just having another one of my flares and leaving it at that. But I try to put more power in my patience of no, like you can do certain things.

Speaker 2:
34:54

There's always something that we can look at to say well, what do I need at this point in time? Do I need to rest, like maybe I just need to actually rest and slow things down? Or do I need to rest Like, maybe I just need to actually rest and slow things down? Or do I need to focus more on what I've been eating? Have I not had any protein recently?

Speaker 2:
35:11

And maybe that's why I feel this way, because they've done a lot of research where patients with endometriosis they just need more and more nutrition.

Speaker 2:
35:18

Yeah, their body's going through so much, they need more. And when you think of it that way, sometimes when we stop and think about why we feel the way we feel, it's like, oh my gosh, you know, I only had 20 grams of protein this whole day and maybe that's what I need. And I think it's a little bit more empowering when you put it that way Because it's something you can do. You can say, yes, I can just really, I can get more protein, I can do that. But when you always blame endo as a whole, you almost feel more powerless, you know, and more defeated, like, oh well, I can't do anything about that. And that's where I like to reframe it Specifically. If I'm prepping one of my patients for surgery, if they have both of those things they're about to have their endo excision and now they're empowered and they know how to nourish their bodies and take care of their bodies I am more confident that they're going to come out of surgery feeling really good.

Speaker 1:
36:14

Right, and I would say post-operatively, it's just as important. So, like going through surgical menopause, making sure that I'm getting my protein is just as important as it was prior to surgery, and sometimes even more so, because when you're at a deficit with your hormones, it's been proven that it can decrease your muscle mass and your bone density. So we have to be so aware of the food that we're putting in to make sure that our bodies can help support what we're going through. I have found that struggle post-surgery, post-hysterectomy to be the case, not just prior to surgery.

Speaker 2:
36:53

Yeah, and I work with a lot of post-menopausal women where they're really struggling. And when we look at how is your sleep and how much protein are you getting, what does your nutrition look like? There's other factors there as to why they don't feel good. We can't just blame it on the hormones, right, but we have to recognize that the hormones improve when we improve other areas. So when our stress levels are really high cortisol, our stress hormone it has the same precursor to our sex hormones, and not only that, but you see these women trying to build muscle and really just working so hard, but they don't have any protein in their systems to even do that. So we really have to take this like really big approach, for how do we optimize everything to get someone to their goals, whether that's someone who's postmenopausal or someone who had surgery and now no longer has their ovaries to help support that? And you know hormones is a whole different topic so different.

Speaker 2:
37:57

Yeah, but I mean postoperatively. It's so important to just start with the basics. And am I getting the proteins, fats, carbs that I need, and are they really good sources that I'm getting them from? You know, we don't have to make it super complicated. It's like when people ask me, well, what's your favorite gluten-free pasta? And I always hold up a spaghetti squash, I'm like this is my favorite. I don't get all the. You know I don't have to get fancy and like make my own gluten-free pasta or buy like a gluten-free pasta that someone else has made. I just turn towards foods that naturally don't have gluten in it, because I personally can't do gluten.

Speaker 1:
38:40

It turns me up.

Speaker 2:
38:41

But people are always shocked when I say that and they're like oh, that doesn't count. And I'm like why not it should? I mean, it looks like spaghetti.

Speaker 1:
38:48

Yeah, and it's quite delicious, honestly.

Speaker 2:
38:52

Yeah, I love it. I do too. I get more than pasta.

Speaker 1:
39:02

I kind of do too. I love spaghetti squash. What are some of your successes in doing this? Because you wouldn't be doing this if you didn't see some success in what you're doing. What are some that you're seeing?

Speaker 2:
39:08

Well, number one, I think, as a pelvic floor provider. I'm not a pelvic floor provider. I have a responsibility to connect people with who they need to be connected with, and that's why I was so thankful to be invited to the endo summit, because I met a lot of really great surgeons and that's what I was missing. In my referral team, I was getting patients who were improving, they were seeing improvements in their symptoms, they were coming to sessions and they're like I'm feeling a lot better. I feel so much better after I leave your office, but at the end of the day, I'm not making the end to go away Right.

Speaker 2:
39:40

And for some of my patients, their quality of life is so poor, their endometriosis is so severe or they have endo and adenomyosis Right when I have to recognize that I am not the hero in this story and they may need surgical intervention the hero in this story and they may need surgical intervention.

Speaker 2:
39:58

And a lot of the patients I see they're those patients that have just had ablation after ablation, after ablation, and I'm usually the first person to say you know, there are these surgeons that specialize in endometriosis and that's like all they do. And if we work together, I think we can give you a really good quality of life and get you closer to some of your goals. And for we work together, I think we can give you a really good quality of life and get you closer to some of your goals. And for a lot of those patients they always say like, oh my gosh, you saved my life, connecting me to this person and helping me understand my body more and what this disease is, because there still is so much wrong about what is out there on endo much wrong about what is out there on endo.

Speaker 2:
40:41

And we're still having to weed through what is true and what isn't, and I think that's the most rewarding thing is just empowering these women and helping them understand it a little bit more and feeling like they have more power. My mom and my grandmother both have endometriosis. I don't know if I have it. My mom didn't know she had it until she was struggling to conceive and that's when they found it and you know they surgically removed it, did IVF and you know, here I came with my brother and sister who were IVF triplets.

Speaker 1:
41:14

Oh my gosh, really. Oh my goodness, that's crazy.

Speaker 2:
41:20

IVF triplets. Oh my gosh, really. Oh my goodness, that's crazy, yeah. So you know, in the back of my mind, after working with all these patients, I'm always like is that going to be my story? Am I going to struggle with fertility and then find out I have endo as well? But for me, I see it as a as an empowerment thing. I'm going to work on my nutrition, I'm going to limit toxins, I'm going to manage my stress. I'm going to do all of these things that I can't do because that's in my in my power to do so. I can't, at the end of the day, control whether I have it or not. You know, we'll find out if I struggle. But I think when you go from there saying that you have the ability to kind of make things a little bit better, I just think it's more empowering. Yeah, not too depressing.

Speaker 1:
42:01

Yeah, no, that's so true. I mean, that approach is a really good way of looking at it You're controlling what you can control and getting the help and resources for the things you can't control. That's a really great perspective to have on how functional medicine and Western medicine and pelvic floor PT can really work well together.

Speaker 2:
42:24

Yeah, and it's crazy when a patient has been in that mindset where everything is blamed on their endo. And let's say, they come into my office and they have extreme urinary frequency.

Speaker 2:
42:36

They feel like they have to go to the bathroom all the time. And then we work on their pelvic floor and say, hey, you know, when the pelvic floor muscles are really tight, it refers to where your bladder is and it feels like pressure and it's going to make you feel like you have to pee, even though you don't have to pee. So what we're going to do is we're going to calm down this pelvic floor tension and it's going to make your bladder symptoms better. And then, when they see their bladder symptoms start to get better, it's like maybe it's not all my endo Cause I think a lot of patients are like, oh, I have to pee all the time. I have leakage, I have this, it must be. Endo is on my bladder.

Speaker 2:
43:13

And when you get in that mindset it's not going to go away unless you surgically remove it. And because of that a lot of patients don't seek out pelvic floor therapy. They don't think of it as oh well, if I work on my pelvic floor, maybe that symptom will get better. Or, you know well, maybe if I work on my digestive health, maybe my bloating will actually get a little bit better.

Speaker 2:
43:35

So I think the way that we think about things can really reframe how hopeful you can feel, but hopeful in a good way, not overly hopeful where it's like hi, I'm Dr Y, I'm going to make your ender go away, but hopeful in a sense. We're like okay, I think I can get better. I may not be 100% at the end of this, but I think I can improve my quality of life and feel more in control of my symptoms, and that's more the narrative that I try to give my patients is I want you to see how did you feel when we focus on nutrition and we focus on getting more of those good sources of protein, iron, all of that before you started your period. How did that period go? And for a lot of people they're like you know what? Yeah, it was better, it was a lot better and it's just more empowering that way to think about it.

Speaker 1:
44:28

Yeah, it's so true. I wish you know. I look at my story and I didn't really know much about pelvic floor PT prior to my surgery. I wish I would have had it prior to my surgery, not just after my surgery, and it was really, honestly, the reason I went. I didn't think I needed to go. I didn't think it was like an exclusive offer have surgery, get pelvic floor PT. It was like I felt like it was like if you need it, but I would say almost all endo patients need a pelvic floor PT. I'm glad that I have found someone that has been on my side for that and has helped me through a lot of it.

Speaker 1:
45:06

And I was in a lot of pain, even postoperatively, and I was like was this a success? I knew it was. I was better than I was before, but I was still in a lot of pain, like walking was hard, sleeping was hard because we put so much stress on that. And then I would say, because of that, when I started getting help for my pelvic floor, I noticed my stress going down. I noticed my ability to eat better. I noticed I was able to have better clarity within my thought process. I think you have such a great balance of working with so many different people, as well as your own skill set to help people kind of navigate the ins and outs of this journey, because it's not linear at all.

Speaker 2:
45:47

Your story as far as how you felt after surgery is something that I hear all the time, where everybody has that oh no moment where they're like, oh, oh, my gosh, did I make the right decision? And to have a professional at the end of it to say, yes, you're going to be okay, but we still have you've had surgery. Like it's normal to have rehab after you've had surgery. We're going to work on the scars. We're going to work on your pelvic floor because it's it's really tight. We're going to work on your pelvic floor because it's really tight. We're going to work on your nervous system. We're going to try to optimize your nutrition.

Speaker 2:
46:20

Now, when you have someone who says you just had surgery, this is just your rehab for surgery, you're going to be okay, it immediately takes the weight off your shoulders and that, a lot of times, will already get you feeling better Because you're not having this. Oh my God, did I make the right decision viewpoint where you've got someone who's supporting you and saying, yes, you did the right thing? We're going to keep pushing you to get better? Right, it's just there's more hope there and overall, it's just so much better for our nervous systems to have someone on our side to support us, instead of feeling like you're all alone and you're like, oh my God, I don't know.

Speaker 1:
47:02

I don't know what to do. I don't know if I made the right decision. Yeah, I love that you're able to bring the functional medicine side of things into this in a way that's not threatening to people. It's a way of supporting their system. It's a way of supporting their bodies and their healing and their overall health, not as a curative measure, and I think that's so important, because I think in the endometriosis community we see a lot of functional medicine being relayed as a curative measure or it can solve all your issues. It can solve every little thing that you have. You don't need to see anyone else when that's just not simply the case. As we've said before, it's a very complex thing. So I love that you are conveying that message in a supportive effort, not in a curative effort.

Speaker 2:
47:44

And that's when my flag goes up, when I see someone saying that it will cure it oh, if you do this program with me for $15,000, it will make it go away, right, that's when my flag goes up and I'm like okay, what, what are they doing? Are they doing surgery and functional medicine together?

Speaker 1:
48:04

Are they?

Speaker 2:
48:05

you know, because it's so easy when you're someone in pain to see that and just think, oh my gosh, this is what I need. And I always tell people you should always be a little cautious if it seems outrageously priced, because you see a lot of things out there that are just so expensive and that's why when people ask me, do you charge two different? No, I understand that functional medicine can be very expensive, but I just interweave it into sessions because I want it to be affordable and it shouldn't be this unattainable thing that has to cost so much money. But yeah, especially with social media now and like different health coaches and individuals popping up, you do have to be more careful. Now I find sometimes I'm looking at people's profiles and I'm just trying to figure out what their medical background is and I have no idea.

Speaker 1:
49:05

Yeah, yeah, I feel that, I feel that I think it's good to be aware and do your research For sure. And that's.

Speaker 2:
49:13

That's the other thing too. Is you always? It's so hard to keep up with research, but you always want someone who is constantly trying to dig into it and look at what is changing and what's new. And even just from a pelvic floor therapy standpoint, just how we manage incontinence has changed dramatically over the past 10 years, but you wouldn't know it if you weren't involved in the research, right. But you wouldn't know it if you weren't involved in the research, right. So it is extremely important to always be doing your due diligence as a provider, to continue to research and see what else is changing out there.

Speaker 1:
49:46

Yeah, oh, that's so true on so many levels, you know, and I do look at, like some providers who I mean I had a provider who was very old school and knew some of the research coming out but really was stuck in what they learned from the get-go, and I think that that is probably why endo as a whole doesn't get as much progression as we'd like within the easily definition of the disease, you know. So I think continuing that education and the patient shouldn't have to come in and do the education for the provider, that's not how it should go and we see that a lot.

Speaker 2:
50:24

That's always how it goes. You know, I always say endometriosis patients tend to be extremely educated about their condition because they have to be, because their providers aren't. I mean, I still have a provider in my town that's telling patients you have to be vegan if you want to improve your endo.

Speaker 2:
50:42

And although I'm happy he's at least acknowledging the fact that what you eat can have an influence, it's just like I think we need to look at this again. Yeah, so, and it's hard because people are like Brie, why aren't you going to these providers and trying to educate them? And it's like well, I am. You know, we all are, we're all trying to make it just a little bit better, but it's a battle and that's why it's great to have like podcasts like this and things like that to help educate people on good resources and what is out there that actually can help improve symptoms, instead of the main resources most people have, which is their OBGYN, which they may not understand endometriosis at all, I mean, and where I live down here in Southwest Florida, pretty much every OBGYN in town it's like oh well, birth control is your only option.

Speaker 2:
51:38

Send them away and that really is how it is my patients who have endo. They're not referred from their OBGYNs down here. These patients are finding me on social media or being referred to me. So it's hard. It puts a lot more stress on the patient.

Speaker 1:
51:54

For sure. I see that across the board. That's been part of my board, that's been part of my story. It's been part of I think everyone I know has had that part of their story. Actually now I think about it, but those are all really impactful statements too. Is just doing your research and having a provider who doesn't settle at no answers, that continues to help you not to reinvent the wheel, so to speak but someone that's going to look at it from a holistic standpoint, who's going to look at? Okay, are you doing X, y and Z to help support your body, or do we need to start maybe down here and get you to a place that is more manageable, and then we can continue? I do think that food and lifestyle make a huge impact on our overall health, but also in our healing and our continued journey with life in our bodies. Especially for those who are chronically ill, we need all the support we can get. So if you can find someone that has a good understanding of endometriosis and other modalities, that's going to benefit you greatly.

Speaker 2:
53:03

Yeah, and definitely someone who you can tell is not trying to just make money off of you.

Speaker 2:
53:09

So many of my patients are always asking me oh, like, do I have to pay to come in to use your red light? Like, no, like you you're gonna. I'm gonna just use it while I'm doing all this other stuff. I'm not trying to make money off of you, it's just like this is what makes you feel good and helps relax you. You know, we're going to use it during sessions. If you want to buy your own, I'm going to show you where you can buy a really cost effective one that is high quality, because you shouldn't feel like that person's just trying to make money off of you and it's sad that we have to worry about that, but I do see that a lot for individuals who have chronic diseases, autoimmune diseases.

Speaker 1:
53:45

Yeah, I love that you're doing this. We just need more Brie Whites in the world.

Speaker 2:
53:50

I'm a triplet, but not identical.

Speaker 1:
53:52

Oh man, that's true. I didn't put that together, but now that you mention it, Before I was like can we clone you?

Speaker 2:
54:00

I'm like, well, actually.

Speaker 1:
54:04

Oh, my goodness, that's so funny. Brie, thank you so much for taking the time and just shedding some light on this. That I've always been more curious about and how to address it from every angle and looking at it as a modality and a piece of the healing, not the complete healing. So thank you so much for taking the time to kind of just shed light on this. I appreciate that.

Speaker 2:
54:31

Yeah, thank you for having me. It was great to reconnect after all these months.

Speaker 1:
54:35

Yes, I know I feel like this is good for me. The podcasts are so good for me because then I get to reconnect with all the people that I meet at the summit, and I love it. I love that I get to do that. That's one of my favorite parts about doing a podcast.

Speaker 2:
54:49

And I love your podcast, so thank you. Thank you for doing all of your hard work and connecting so many people.

Speaker 1:
54:58

I love it. So thank you for saying that, thank you for being part of the connection and sitting down at the table with me and allowing people to invest in this journey and learn more and become more educated, and hopefully they can continue advocating for everyone else as well. So thank you so much and until next time, everyone continue advocating for you and for those else as well. So thank you so much and until next time, everyone continue advocating for you and for those that you love.