Show Notes
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In case you haven’t heard of Neko Health, let me enlighten you. Neko Health is the brainchild of Spotify founder Daniel Ek and Swedish Engineer Hjalmar Nilsonne, whose stated goal is to move healthcare from the reactive (treating illness) to the proactive / preventative (early detection). Their website describes the Neko scan as ‘a completely new healthcare experience, engineered from the ground up. Data captured across your skin, heart, blood, and metabolic health. Then a clinician to help you understand what it all means – and what to do next. All in one hour.’ Reaction to Neko Health has - to put it mildly - been mixed. Some have been concerned about the increasing health anxiety of our metric-obsessed age. Some have been concerned by the creeping medicalisation and Americanisation of the UK health space leading to overtreatment (there’s a pill for that!). Others still have been concerned that anomalous findings will result in increased pressure on the NHS, as overworked GPs swamped with already ill patients struggle to meet the demands of the worried well. On the other side there have been many gushing editorials in glossy and business magazines, lauding the founders of Neko as visionaries and this type of screening as the healthcare of the future. I was inclined to dislike it. I’m generally of the view that genuinely well individuals adopt healthy behaviours to be able to enjoy their lives to the full, not to improve markers that apparently dictate their biological age, whatever that is. I am also of the opinion that prevention of illness is best achieved by living as healthy a life as possible, and medical interventions in those without symptoms should only be undertaken if there is known high risk. That said, when you meet the sniper alley of your 40s and 50s, screening regularly identifies issues before they become symptomatic and develop into serious, life limiting illness. I am regularly invited to participate in NHS screening programmes (now I’m in my mid 50s) because my risks of the most commonly occurring serious illnesses are much higher. On balance I am for screening, but only when there is a common increased risk. My prediction was that certain aspects could be helpful but other markers may send people anxiously down a cascade of unnecessary interventions to satisfy arbitrary findings, with iatrogenic harms and no net benefit. I wondered whether the veneer of respectability of standard tests (bloods, ECG, mole mapping) would be outweighed by the AI interpretation of information gleaned by more innovative (AKA untested and unproven) sensors. At least I would have a comparator. Whilst I was honest on my pre-scan questionnaire, Neko didn’t know I’d seen a cardiologist and had a battery of cardiovascular tests (due to high cholesterol and a strong family history of cardiovascular disease). Would their results be the same? I was interested to find out.
More from MSKMag OutLoud
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