Show Notes
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When was the last time you ate something without some input from a medical device? For me it was 2010. I was diagnosed with Type 1 diabetes aged 22 whilst seeing the GP for a UTI - which is quite undramatic as Type 1 diagnoses go. Since then, every meal starts with either a blood test or a look at the app screen of my continuous glucose monitor (CGM) and an injection of insulin. It is very easy to get this dose wrong given that some of the factors that can affect your blood glucose other than what you’ve just eaten include: stress, the temperature, illness, alcohol, certain medications, the stage of my menstrual cycle, and exercise. This doesn’t even come close to being an exhaustive list. And so that is why one day, over a year ago, I inputted the word ‘FURY’ to my CGM after it alarmed on and off for a few hours whilst I tried to work, and a few weeks after that my consultant said “regular states of fury do suggest this might be impacting your mental health”, and a few months after that I ended up being approved for an insulin pump, for which I attended an education evening this week. There are two means of delivering insulin to a Type 1 diabetic: multiple daily injections via a pen, or by an electrical device that attaches either directly to your skin or via a tube and cannula. The pump more accurately mimics the pancreas by drip feeding the dose of insulin over a period of hours. Cleverly, pumps now also communicate with CGMs and can (alongside occasional human input) use a rising or falling blood glucose reading to help keep you in range. One does not simply get an insulin pump. Some Type 1s prefer the idea of pens to being stuck to another medical device. Others have to meet the eligibility criteria for funding. The criteria where I live involves a specific HbA1C blood test reading that suggests your blood glucose control could be better (which I don’t meet), considering pregnancy (nope), or that regular hypos are impacting your mental health. Well just ask 7 out of 10 of my post-prandial patients about that while I shove precisely eight Haribo Goldbears down my neck. I qualify. What that criteria doesn’t take into account though is what I was seeing in my own diabetes management. The slow creep upwards of my HbA1C alongside a level of burnout that’s impossible to quantify on a blood test but is directly related to sixteen years of mental arithmetic and option weighing before and after every meal, sleep and bout of exercise. I’m not in crisis, I’m just tired, and unspectacularly getting worse at this full time job of sixteen years. And yet the thing that might help is not widely available. Which is, funnily enough, a theme running through this month’s MSKMag. In his article The Biggest Wins in the NHS are Cheap, Luke Kellaway explores why lower cost, efficiency-boosting programmes get reduced funding versus costly, complex interventions. Just as prevention and glucose management doesn’t shout the way a crisis does, neither does a smoothly running MSK pilot that reduces waiting times. Meanwhile, Chloe Wearmouth issues a plea for more thought to be given to Paediatric services where all manner of presentations and specialties are shoehorned into one catch-all Paeds department in The Forgotten Child of MSK. Benoy Mathew shares insight of a presentation that can drastically change a patient’s outcome if we sit on it too long. Read The Diagnosis that Keeps Getting Missed: Adult Hip Dysplasia and avoid hip replacements in the young. In her article Beyond the Bump: Reframing High-Grade AC Joint Injury, Angela Cadogan highlights the value of looking beyond simply strapping up the ACJ and getting on with it in her advice-packed piece covering ACJ rehab. And finally, a philosophical viewpoint from Matthew Low in Off the Treadmill, Into the Field, which asks us to stop thinking about the body as a fixed thing that occasionally breaks, and start thinki
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It always struck me as bizarre that sports medicine and musculoskeletal specialties deal with pain and dysfunction from head to toe in the human body, yet offer little health literacy or inclusion of the pelvic floor. Traditionally considered taboo and someone else’s remit, men and women with issues affecting the pelvic floor have largely suffered in silence. Thankfully, change is afoot, and healthcare is finally evolving. There is much more awareness, inclusion, and understanding of this unique body area and the role that it plays. For anyone playing catch up, the pelvic floor is a group of muscles spanning the base of the pelvic outlet in layers. While both men and women have a pelvic floor, the pelvic outlet is wider in females than in males and it also contains an extra orifice – the vagina [1]. That’s right, we went there. We said the ‘V’ word. Because just like vulva, or vestibule, the vagina is simply an anatomical term. It needn’t be embarrassing or taboo. Some of you will be long enough in the tooth to remember when the word ‘breast’ was taboo. However, with healthcare campaigns for breast cancer and breastfeeding, this term became an anatomical norm. We need to do the same for the pelvic floor and its related anatomy and physiology. What does the pelvic floor do? In both men and women, the pelvic floor serves to control the bladder and bowel (maintain continence), empty the bladder and bowel (voiding and defecation) and support sexual function (arousal and climax). In women, the pelvic floor also plays an important role in pelvic organ support. Remember that extra orifice I mentioned earlier…well this area is high risk for connective tissue laxity and defects meaning that the pelvic organs (bladder, uterus, rectum) can descend into the vaginal cavity causing symptoms of heaviness, pressure and a sensation of ‘something in the vagina’. What are the signs and symptoms of pelvic floor dysfunction? If the pelvic floor is not doing its job, any of its roles can become compromised. This may manifest in leaking from the bladder or bowel, inability to fully empty the bladder or bowel, pain ‘down there’, sexual dysfunction (compromised erection, dyspareunia, pain with climax) or heaviness and pressure in the vaginal region (for women) [2]. A full list of sex-specific signs and symptoms of pelvic floor dysfunction can be seen in Table 1. Table 1 - signs and symptoms of pelvic floor dysfunction in men and women Who gets pelvic floor dysfunction? Pelvic floor dysfunction can affect any man, woman or child, however it is particularly problematic for women, especially during transitional life events, such as pregnancy/childbirth and the menopause [1]. One in three women will experience pelvic floor dysfunction [3] and for those that engage in sport, the prevalence of symptoms varies according to the load demands of the activity. For example 61% of netballers leak urine [4], up to 43% of female rugby players leak [5], and 32% of gymnasts experience incontinence [6]. Structural changes associated with vaginal childbirth and aging, as well as lower levels of oestrogen to lubricate and bulk out the tissues can increase the odds of experiencing pelvic floor dysfunction. However, even young adolescent females can leak urine due to the load demands of their sport. For example, in athletics and gymnastics, stress urinary incontinence (the involuntary leakage of urine during activities involving high levels of intra-abdominal pressure) is commonly experienced. Yet no-one is doing anything about it. No one is screening. No one is signposting. No one is educating these younger athletes that pelvic floor symptoms are not to be expected and normalised. Or that they simply indicate that the sporting demands exceed the load capacity at the pelvic floor. If this was any other area of sports or MSK practice, would we settle for a load capacity that does not meet the demands of the sport?! Why is this relevant to every therapist, no matter their di
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com
This is a free preview of a paid episode. To hear more, visit mskmag.substack.com