Lymphedema Explained & Pelvic Floor Health: Signs, Stages, & When to Seek Help

Stacey C: Welcome to another episode of U Grow Girl podcast. I'm your host, Stacey C. I hope that you have all enjoyed the last episode on K-pop. want to talk to you today about two important issues that affects numerous amount of people, lymphedema in the pelvic floor. These two topics are two completely different, but is one professional that I invited today. to help you with the treatment of these medical conditions. Have you ever heard of lymphedema? Have you ever heard of your pelvic floor? Well, today I invited a to have this important conversation. Dr. Tiana Polite Brown is a passionate therapist with the love for advocacy and client-centered care. She holds a bachelor's in exercise physiology, from the University of South Carolina, master's in occupational therapy from the University of North Dakota, and a doctorate of occupational therapy from Creighton University. Dr. Polite Brown is a lymphedema and ⁓ certified therapist, a certified women's health specialist, and a pelvic health specialist. She brings extensive experience across the lifespan, including adult,

Dr.Tiana Polite Brown: Over.

Stacey C: geriatric, pediatric, and adolescent populations. expertise includes lymphedema management, pelvic floor rehabilitation, cognitive behavior therapy, and dry needling. She currently practices in outpatient therapy and serves as a faculty instructor with the Academy of Lymphatic Studies. In her downtime, Dr. Polite Brown enjoys spending time with her family, especially her husband, Myron Brown, and diving into her comic book collection, Batman, remains her favorite superhero. While her long-term ambition is to advance the OT profession through client-centered care, her immediate goal is to become an OT clinical researcher.

Dr.Tiana Polite Brown: Yeah.

Stacey C: Please join me in welcoming my guest, Dr. Tiana Pilot Brown to the show. Welcome to the show.

Dr.Tiana Polite Brown: Hello, everyone. Happy to be here. What up, Stacey C?

Stacey C: thank you for coming. I appreciate it. All right, we're gonna get into ⁓ lymphedema basics. Can you explain ⁓ a simple explanation of lymphedema ⁓ and lymphatic

Dr.Tiana Polite Brown: I'm Yes. Happy to be here. You're fine. Yes. So the lymphatic system is considered to be an open system that runs along the closed system, which is our circulatory system. And so it is, when we talk about the lymphatic system, it's kind of known as the body's trash can. It can take everything that's been deposited that are in the tissues and take it out and through the system and supposed to be excreted out your bowel and through your urine. But ⁓ with the lymph fluid, whenever there is lymphedema occurring, which is an abnormal buildup ⁓ that fluid, and lymph fluid is considered to be a protein-rich fluid. And so it kind of sits and settles in the tissue. It doesn't move like water, but it also moves with water. And so that's why whenever a person has lymphedema, when they have swelling that they just can't get rid of, they tried diuretics, they tried exercises, they tried to lose weight. the one area of the body always seems to be larger than the other. That is where lymphedema usually is sitting and settling in the tissues and causing vascular issues, causing venous insufficiency, and just overall heaviness of the limb. And lymphedema can be in ⁓ any of the places in the body, for the most part, from what I see, lymphedema affects the upper and lower extremity. and the breast and axillary area, meaning the armpit, that usually happens with patients that unfortunately had breast cancer and then had surgery and chemotherapy and radiation to the area when it comes to ⁓ particular part of the body. And so with lymphedema, it is a chronic condition, but it is manageable with the ⁓ massage call ⁓ MLD, lymphatic drainage, using the right compression. Some medications can help some anti-inflammatories there's can help diuretics are actually a no-no when comes to lymphedema It actually makes it worse because it takes away the fluid it takes away the water out of the system and pulls it away which makes the lymph fluid which is a protein rich fluid heavier and dissipating the tissues, so it's a little bit of probably over explanation of lymphedema but That is kind of the spiel that I give to my patients whenever they come and see me and depending on their medical history, you're born with lymphedema. Unfortunately, you are born with a lymphatic that doesn't pump properly throughout the body. And sometimes ⁓ it can acquired, ⁓ which we secondary lymphedema through surgery, through some type of trauma to the skin. Sometimes it could be ⁓ acquired through different conditions like manias insufficiency, ⁓ things like thyroid issues, hormone imbalances. And so there are multiple ways that unfortunately you can acquire lymphedema, but you can live with it, but you can also manage it as well with the proper education ⁓ and management of care.

Stacey C: Okay, that actually was my next follow-up question like if lymphedema something that develops suddenly or build over time but you just answered it because you said that people can be born with it or it can come from like trauma from a surgery or Having cancer or things Okay, ⁓

Dr.Tiana Polite Brown: Mm-hmm. Yeah, usually cancer. Yes, ma'am.

Stacey C: Are there common triggers that can call someone's first flare up?

Dr.Tiana Polite Brown: ⁓ so yeah, so usually, especially when we talk about women, the lymphedema can affect anybody, but women are more commonly impacted because ⁓ the hormonal changes. And so, ⁓ estrogen actually influences the vascular and lymphatic permeability. And so the life phases like puberty, pregnancy, perimenopause, and menopause. And so with a lot of my female patients, they would say, man, after I had my cycle, I. and my body started changing, I was trying to lose weight and I couldn't. That is a form of secondary acquired lymphedema because of the changes. Unfortunately, women that are able to become pregnant and became pregnant, that huge change that you go through ⁓ during your pregnancy, through those nine, 10 months, whenever you're carrying full term, is a lot of stress on the body. and those hormones have a roller coaster effect on the body ⁓ ⁓ There are sometimes that some women they end up having swelling in their ⁓ in on lymph nodes Which is ⁓ pretty in your around your pelvic area from the baby sitting and settling in that area along with the hormonal changes That no matter what they do. They can't get rid of that little pouch area or end having swelling going into their legs and upper thighs and so it Definitely it has multiple effects and unfortunately for our patients that have any type of cancer involvement usually when it comes to the axillary area armpit area when it comes to breast cancer they usually have to take out the tissues and they always not always but they usually 90 % of the time always take out and test the adjacent lymph nodes and so when you take out the lymphatic a piece of lymphatic system it makes the whole system work harder. to move the fluid throughout the entire body. And so that's where it usually occurs. And it's kind of unfortunate to say sometimes the cancer doesn't cause lymphedema, sometimes surgery. Because they did what they need to do to, yes. And it's unfortunate that some oncologists or breast surgeons, breast reconstruction surgeon, they're like, you know, I saved your life. Thank you. Appreciate it. You you took the cancer out, but.

Stacey C: Wow.

Dr.Tiana Polite Brown: the surgery caused the lymphedema because now my system is overworked and now it's damaged because of the surgery and then they come and see me. And so that is one of the main things. It's like, oh, I got cancer. So I'm going to automatically get lymphedema. There's 25 % of the population when it comes to breast cancer that actually don't get lymphedema within the first year, year, year one to year five. But depending on the type of surgery that they had, the amount of lymph nodes that were taken out, that is when that in instances of lymphedema increases

Stacey C: Okay. Who does lymphedema affect?

Dr.Tiana Polite Brown: Mm-hmm. Everybody it can affect everybody. It mostly affects ⁓ women, men. I do have some men that are ⁓ that are on my caseload that end up having lymphedema because of prostate cancer or inflammation of the prostate that clogs up that small area that have some of the pelvic lymph nodes in that area. But they are kids that are born with it that's Malroy's disease where they were already born with a malformed lymphatic system. And so, yeah, I honestly say everybody.

Stacey C: Okay, how often is Lymphedema, misdiagnosed or overlooked?

Dr.Tiana Polite Brown: Okay. Very often, takes a literally takes a village and it takes professionals like myself to go out and advocate not just to the oncologists and vascular doctors because those particular professions are ⁓ ⁓ board or aware of lymphedema, but it's really like our primary care and internists that don't quite see it. They see patients as, you just are at hate to say the word, but overweight or fat and You just need to lose what you need to walk more and then you know, you'll you'll you'll you'll put you on this diuretic and then you should reduce You know the size of your limb and that's not the case. They need actual help. So it is chronically chronically overlooked and under diagnosed and seen as obesity seen as They need a bariatric surgery to help reduce some of their the limb volume sometimes that can help but the lymphedema is still there. Sometimes it's seen as, you know, chronic wounds, diabetes. It's like, oh, you're just swollen because, you know, you're eating too much carbs or you're eating the wrong stuff. And I've seen patients that will totally change their entire diet, do total liquid diets, drink their water, all that stuff. And they still wouldn't lose the weight that they needed to lose. So definitely chronically, chronically underdiagnosed and overlooked. unfortunately.

Stacey C: Wow, I can't imagine getting a surgery like bariatric surgery. And that wasn't the cause of what was going on with me.

Dr.Tiana Polite Brown: Bye. Yes, yes. And you can lose some weight. Weight is, ⁓ you know, weight definitely is always a factor, but it's not the all leading cause. And I hate when health professionals just stick to that, lose weight and everything will get better. Not necessarily.

Stacey C: Wow. ⁓ Is it genetic, preventable, or both?

Dr.Tiana Polite Brown: It is, so it is, it can be preventable, but it definitely has a genetic component. There is a, hereditary component, That usually happens, it's usually passed down from the maternal gene. So the matriarchs of family usually have it. ⁓ If your mother had it, then most likely you would have it. If you have a sister, then most likely your sister would have it and then on down the line. And I think that when it comes to preventable, it can to a extent, but honestly, anything could trigger it. I've had a patient that very active. She was born with ⁓ When we found out, ⁓ we went down her history, But she was a hiker. went out and she got bit by a tick on her lower limb and then her limb just swelled up. Never had any issues, never had any other instances of swelling. But that particular parasite or that bite helped just, whatever was going on her system was already overworked while she was just doing her thing, staying active, doing everything she was supposed to do. But that one tick bite triggered her lymphedema and now she has to wear compression for the rest of her life just for doing that. And so it's kind of hard to say when it's preventable. ⁓ I to say more manageable because anything could happen. There was an instance where a patient breast cancer and she stayed in the States. She had her surgery, she didn't have any issues. no residuals of lymphedema. Her husband wanted to go out of the country for the first time, flying for the first time in 20 years. For their 20 year anniversary, she beat cancer, she's doing great. Soon as she got up in the air, the arm that the breast cancer was when she had the surgery ended up swelling up and she ended up having lymphedema after that. And so it's one of those things that's... It can happen at any given time, it does happen, it can be more so manageable. But yes, genetic, there's always a genetic component and preventable. We can do things to try to prevent it, but if it happens, it can be more manageable. Hope that answers your question.

Stacey C: Yes, it did. I'm just amazed that like you said, it can happen at any time. You know, the lady just flying and the one who was hiking, from a tick bite, usually from a tick bite, you think just Lyme's disease, not something, not lymphedema.

Dr.Tiana Polite Brown: Mm-hmm. Yes. Yes. Lyme disease. And she didn't get Lyme disease. That's the interesting thing. wasn't like it didn't, it wasn't like a total overload to the system. From what I understand, she did not get any Lyme disease. It was just that bite in that particular time at the particular place. And her system just was like, all right, I'm done. And just overload and cause that, that chronic swelling in her limb.

Stacey C: When should someone push for a second opinion?

Dr.Tiana Polite Brown: As soon as they feel like they're not being heard, lot of my patients end up working with surgeons that say, hey, I saved your life. You're good to go now. Your cancer's gone. And say, yeah, but my arm is heavier. I'm having pain. I'm having a hard time lifting it. Hey, my body's changing. I don't like how one side is bigger than the other. What should I do? And then sometimes they say, Okay, you need to go to a professional that, you know, I've seen this before. Let's get you checked out. And sometimes they say, but you don't have cancer anymore. And so as soon as you feel like your symptoms are affecting any part of your life, you need to go see somebody that may know something that could help. It's unfortunate that it shouldn't have to be one thing other than, one thing overrides the other. Yes, thank you for saving my life. However, this is also affecting my quality of life. So anytime you're not heard, please ask somebody else.

Stacey C: have to advocate for yourself. I'm amazed at these, you know, the information that you're giving Like I just, I'm like, wow, you know, I didn't know about ⁓ it just happen, living everyday life and, and to have a surgeon say to you, I saved your life from cancer. Like you should be grateful that I have a side effect from it.

Dr.Tiana Polite Brown: Yes, yes, this is not the worst thing that I've heard. Believe it, it's like, this is not the worst thing that's ever happened to anybody. It's like, you don't have cancer anymore. I'll see you in six months. And that's it. And it's disheartening.

Stacey C: That's wow. I'm just... Wow. Well, advocating for yourself in the medical field is a whole nother conversation in itself. ⁓

Dr.Tiana Polite Brown: Yes, yes it is. Yes it is. We can talk about it.

Stacey C: Yeah. What made you passionate about working with Lymphedema patients?

Dr.Tiana Polite Brown: So I am a daughter of a breast cancer survivor. My mom, Belinda Polite, she got breast cancer when she was 21 years old. And then she had me when she was 24, 25ish, and then my brother four years later. And so I didn't see, she did a really great job with kind of keeping it to, know, keeping it to herself between her and my dad. And so I got older, I started to notice like different things are changing in my body that, you know, when I hit puberty, was like, my arms never quite, you know, never quite filled out correctly. Like I will work out, I would do things, but they will always stay the same shape. And once I start learning about lymphedema and learning that I can do something to fix it, at least, I say fix it, at least to help out the patient. because I didn't know anything about it. That's when I really, really got passionate about it. And just seeing that it's a very hands-on type of therapy. You do the manual lymph massage, you do the compression, you measure, and the work that you do on the entire body, not just the limb, you can see a difference within one session. Sometimes it takes more sessions. Most times it does take the consistency of that, but the patient can feel a difference after one session. If done correctly, they feel their limb is a lot lighter. They feel like, I can use the bathroom now. Once I use the bathroom, I can get this excess fluid off my system. And so that's what really like drawn me to it, that it was one of the therapies that you can see a delayed or instant gratification of the work that you've done ⁓ the patient. And so seeing that change and seeing them get educated and then be able to manage to get them into for wrapping with compression wraps to getting them to a compression garment. to getting them to, okay, hey, I'm able to move more. Hey, I'm no longer walking with the walker. I'm using a cane now. I'm more mobile because I have less fluid in my leg. So now I can go play with my grandkids. I can go take a little bit longer walks in the beach like I used to, but before it was like I could barely lift my leg just to put my shoe on. And so seeing that change and that gradual difference was a huge thing for me. when increasing patient's quality of life.

Stacey C: does a typical day look for someone ⁓ is managing lymphedema?

Dr.Tiana Polite Brown: So it definitely, definitely varies, but for the most part, ⁓ is getting ⁓ in the morning is a struggle. Their limb ⁓ is ⁓ heavy. So I was talking to, in a sense of lower extraneous lymphedema, they have to get up, they have to clean the limb because if their limb is so that they have folds on their legs, they have to make sure that they clean it, underneath the folds ⁓ keep any type of infection from happening because they're at a higher risk for cellulitis. So you know how if you're in the middle of the night ⁓ you hit your small toe on the edge of the bed and you half asleep, you know, that's just like out, that hurts. I can go lay down, it's fine. But for a person with lymphedema, that can be a trip to the hospital. And that could be at least three to five days of IV antibiotics

Stacey C: Mm-hmm.

Dr.Tiana Polite Brown: and fluids because any denting damage to the tissues could open up and cause a wound and because lymphatic system, which is part of our immune system, could overrun overload and it can cause, it immediately can turn into a ⁓ cellulitis or, you know, MRSA infection that can send them to the hospital. And so, being very mindful, they have to always stay covered. They're always thinking about how they, not just how they feel, but how they look. When your body is not proportionate because how heavy the limb is, you don't wear the clothes that you used to wear, that you were able to wear, that you want to wear. You usually, you know, wear larger clothes. ⁓ You know, if ⁓ patient does have access to the garments and the compression wraps, ⁓ have to put that on themselves, learn how to put that on themselves if they're by themselves. They would have to have family members to help them. And so it just takes a lot. A lot of the things that my patients talk about too is just getting out into the world. If they have a large limb, one side is bigger than the other and they do have compression wraps. people look like it looks like a cast or it looks like a big ace bandage. It looks like, you you maybe had a burn or something. And so when they're just going to the marketplace or going to the store, you got people staring at them. You got people. saying, oh, what's wrong? Did somebody, did you fall and break something? Are you okay? And having to explain yourself over and over again. Some of my patients end up having weeping, is, lymphorrhea, which is that the skin is so full of lymph fluid that it can't move. It just comes out of the skin. It looks like the skin is crying. and is literally leaking and pushing out wind fluid, leaking fluid. And so they end up having to keep cleaning themselves. There are some patients that will leave a trail of fluid behind them without them knowing because they might have accidentally hit the side of their leg or their lymphomididymis limb. It's ⁓ lot. ⁓ a certain smell that may come with it because of the lymph fluid.

Stacey C: ⁓ wow.

Dr.Tiana Polite Brown: ⁓ And so it's very isolating. It can be very isolating if they don't feel confident or comfortable in their care, if they're not able to manage it themselves, they just stay home, unfortunately. ⁓ And so it can be very ⁓ isolating. They go to their doctor's office because if you're able to, if she sure as covers it, and if you have the transportation, you usually come see a specialist like me at least two or three times a week for at least six weeks, sometimes eight weeks.

Stacey C: Hmm.

Dr.Tiana Polite Brown: And depending on how severe their lymphedema it could be months. I've seen patients for a couple of years just to help manage their lymph fluid, just to help them. so ⁓ it lots of time, lots of just pressure to get up in the morning and to get past the fact that they don't have a normal life. They have to always about

Stacey C: Bye.

Dr.Tiana Polite Brown: their limb, how their limb affects the way that they move, the way that they do stuff, the way that they look.

Stacey C: Can stress make the symptoms worse?

Dr.Tiana Polite Brown: Can stress make the symptoms Yes, yes. Increase, when you have ⁓ stress, you increase your cortisol levels, which increases your inflammatory markers and your inflammatory levels. when you're inflamed, you are more likely to ⁓ an increased permeability of fluid go through the tissues because now your body is in this always fight or flight mode and is constantly putting those things out there, making you swell more. So yes.

Stacey C: Mm-hmm. do you help your patients cope with a ⁓ chronic

Dr.Tiana Polite Brown: Yes, I talked to them just like, okay, like how you asked me, what does your day look like? What is something that you think you could change with this? is, what can we do to make one aspect of your life better? And sometimes it is just listening to the fact that, I'm hurrying, I'm tired. I don't like the way I look. Let's find a way to do this. There are some, I've had a conversation with patients like, hey, let the genes go. If you are chronically ⁓ and your lower left leg is swollen and you keep trying to put jeans on or sweats on just to ⁓ ⁓ I can do this or this is what I was wearing, I able to just talk with of my female patients, like, start wearing, ⁓ out your pants. Those hammer time pants, I would do this. You start, you know, changing your wardrobe, going and get you something different that you are more comfortable in. Now, if you want to wear that, that's fine. But if it's bothering you, find a way to work around it. I sent I sent her like pictures and videos like flowy dresses to wear that you could, you know, you know, wear during the summertime here, you could wear your compression garments underneath here. still look nice. Do you think so just doing a thinking about the change of clothes or garments, what you can do to help you feel better? Yes, that leg is still there. But how can we how can we literally address it to help it help you, you know, deal with your quality of life, but literally, it's just just listening to them and saying, okay, what are some things that you can do? Sometimes just saying, hey, I have a you have a hard time getting up in the morning. To get here because of the heaviness of the limb and along with their other comorbidities sometimes like okay Schedule your appointments 10 10 10 o'clock and beyond I'll see I got it. I can I can make sure I lock in You know, these are the days that I have like some 10 o'clock so the next couple weeks 10 10 and beyond let's do that if it's hard for you to get up at 8 o'clock in the morning because you have to It takes time for you to get up to clean yourself to wash yourself to get your clothes because that limb is so heavy Let's do this. So being, you know, saying, okay, this is what your schedule needs to look like. Let everybody know that I can be on I-10 by I-10. That's fine. know, know, work, know, build your, build your way, you know, ⁓ build yourself up trying to, cause this is life changing. So you've to change your life according. So just having that conversation with them. ⁓

Stacey C: you sorry, I thought you were finished. I said, I can't believe you told your clients to wear some hair tie pants.

Dr.Tiana Polite Brown: She did. She found some from from good will she showed it I mean because it's like if Make make the adjustment. Well, let's see what we can do. I showed it but my patients love me and I love them, too So I just I just be talking to over just be real talk. be like, hey, ⁓ let's let's go here Let's do this because these are situations, you know

Stacey C: right. Yeah. Yeah. They ⁓ but aren't the barrel, the barrel style jeans now aren't they like more like hammer time pants.

Dr.Tiana Polite Brown: Yes, yes, they don't have to go with the time. Mm Yes, they are the why I would call them I used to call them elephant pants. The really wide leg pants that kind of come out here. I love them. I love them myself, you know. And so just making that adjustments like, ⁓ you know what, I don't have to sit here and struggle to put on jeans that used to fit me before my leg got swollen. But at the same time, you know, being, you know, ⁓

Stacey C: They're like a more, they're a little wider too than the wide legs. Okay. Yes.

Dr.Tiana Polite Brown: being sensitive to that. It's like, you able to do that? Here are some, you know, are you able to make some adjustments? We do just, you know, you have a friend who's a seamstress. Can we, you know, where do we need to go? I'm not to say, oh yeah, go to the mall and get you something like this. We actually go over like that's sometimes part of my sessions. Like, okay, what is it within your budget? What can we do? Where can we go that may have some type clothes like this? One of my favorite things I do is go to a shien, go shien, a haul We actually go over like that's sometimes part of my sessions. Like, okay, what is it within your budget? What can we do? Where can we go that may have some type clothes like this? One of my favorite things I do is go to a shien, go shien, a haul

Stacey C: Right. Right.

Dr.Tiana Polite Brown: Get you some long dresses, get you some of those pants, those colorful, wide leg pants, know, four for $20, man. And just rotate them bad boys and just take it from there.

Stacey C: Yes. Yes, we love shein.

Dr.Tiana Polite Brown: you Shein

Stacey C: ⁓ You talked about and mentioned treatment and management. So where can the listener start at home if they have chronic disease?

Dr.Tiana Polite Brown: Yes. So there are plenty of resources that are online, especially on YouTube, I would honestly want you to go get seen by a certified lymphedema therapist. At least get your first initial ⁓ evaluation or assessment they can get you in the right track. ⁓ Main thing is to do that. But the thing is, a lot of people will have compression, but it's not the right compression. You know, there are some those stocks and stuff that we get, you know, from Walmart for $15. That may not be the thing that you need. If you were to even get some off of Amazon, that's not a terrible thing, but you got to make sure it's fit properly because a of these quickly, you know, compression garments are one size fits all. But having a lymphedema therapist to actually measure you and get the proper garment because you may need the Velcro wraps that wrap around. You may need more of a large calf. Your leg may not fit the norm shape, so you may need something custom. So there, ⁓ I really urge your listeners to go find a certified lymphedema therapist that's able to do a full assessment and give you all the information that you need. But As far as at home management, we all talk about drinking your water, great, but moving is very important. Even if you're sitting down and you're doing leg seated exercises, marching in place, pumping your ankles for your lower extremity. For here doing diaphragmatic breathing is helpful for the upper and the lower extremity. So we have to say diaphragmatic breathing, belly breathing to help with the internal pump along with your diaphragm. And with the thoracic duct that goes right here in the middle, very helpful. Even just doing little arm circles, going up, doing here just to get that muscle pump moving. Because the lymphatic system doesn't really move on its own, it actually moves with the movement of your body. So that's why when our patients get ⁓ sedentary, of the swelling of the limb, and they just kind of sit because everything is so heavy and they're so tired all the time, it gets worse. because nothing is helping move that lymph fluid. So that's what I would honestly say. Please get checked out by a certified lymphedema therapist first before you decide to do ED treatment.

Stacey C: Okay. And I would have never thought, like you just mentioned, measured for the compression, that that would be important.

Dr.Tiana Polite Brown: Yes, yes, getting the right stuff because I mean.

Stacey C: No, go ahead. No, go ahead. I want you to finish.

Dr.Tiana Polite Brown: I mean, you wouldn't want to go to like, you know, bra measurement. You would want you to kind of eye it, but you will want somebody to say, okay, no, you're actually this size. No, you have the bandwidth here. You probably need this cup size because you don't want to come out. Worst thing is coming out the store and you bought something that's a tight bra. Ain't nobody got time for that. But answer your question. Right.

Stacey C: Mm-hmm. You That is so true. You do not want to type raw. How important is consistency with compression?

Dr.Tiana Polite Brown: Very important, you should be compressed every day. It is ⁓ long term and lifelong commitment to wear the right compression and to be compressed every day. Especially when you're traveling, I would say if you can't do it every day, if you're on the road for more than 30 minutes sitting down in the car, wear compression. If you are flying, riding a train, know, ⁓ bicycle, whatever, wear compression. it's every single day. So that's why wearing the ⁓ the right size compression is very important because if you wear it every day it needs to be comfortable because the first thing that when it comes to compliance If they don't wear their compression first thing I think is it comfortable is it cutting off circulation? Is it itchy? Is it not the right material? Does it keep sliding off once it becomes inconvenient? Compliance goes down. So that's why it's very important to ⁓ to wear compression. So compression consistency is ⁓ very important.

Stacey C: there any new or emerging treatments people should know about?

Dr.Tiana Polite Brown: So I will say when it comes to lymphedema, it is all about the management, but there are some, it's called the venogram and it's a ⁓ decompression. So basically if you do have let's say of your lower extremity, right? You can go to a vein specialist and they go through and do a stent in your iliac. vein which goes along the ⁓ line, your pelvic area, and helps dilate and open that up to help drain everything better because the lymphatic system likes to run along the lines with the venous system. And so if there is a over a 50 % blockage then they would actually put a stent in there, open it up, and then allow drainage. Now I've seen this happen where a patient lost over 10 inches around her leg with lymphedema after this treatment in two weeks. However, because she has a history, it's all depending on your comorbidities, because they may have a history of chronic kidney disease or diabetes, it can easily come back up and swell back up. So that's why it's very hard to do any like new to kind of like completely drain it because lymph fluid is always going to find a way to get back into tissues and recollect. Now it all depends on everybody, there are certain people that don't qualify for it. If you're at stage two kidney disease, you do not qualify for that particular exam or procedure because the dye would be too much on your kidneys.

Stacey C: Mm-hmm.

Dr.Tiana Polite Brown: And so knowing your patient's history is very important because can do that. ⁓ yeah, you can go in, do they get that drain? But then it's like, ⁓ wait, you got stage three kidney disease. You can't do that. And so, yeah, they have some different things that they like, the bulking. There are some surgeons that are doing like water assisted kind of like liposuction around the area.

Stacey C: Okay, wow.

Dr.Tiana Polite Brown: but they have be very mindful because you want to find the right person to do that, to really be mindful of the lymphatic system versus just going in there because it could cause more damage if they're not careful or qualified to do so. red light therapy is helpful ⁓ to with the inflammation. It's ⁓ not be-all cure. It's definitely help in conjunction with manual lymph drainage, compression, skin care. and exercise, but it can be a help. But again, if you have a history of any type of cancer or radiation to the area, then you do not qualify for that because red light therapy or even blue light therapy can actually re-burn the skin. If you have those radioactive deposits still in the tissues that can be activated by any type of ⁓ radiation, and that can even come from the sun as well. So that's why it's important for you to talk to a lymphedema therapist so they can tell you what can be helpful, what cannot be helpful, things like

Stacey C: Okay, well thank you for that. No, thank you for that information. I'm learning things as well. To get into our next topic of discussion today, the pelvic floor dysfunction. ⁓ Can you explain what is it and who it affects?

Dr.Tiana Polite Brown: Sorry. So when it comes to pelvic floor, pelvic floor again can affect dysfunction, can affect anyone, male or female. And it's many things. ⁓ It's of hard to kind of pinpoint it. But pelvic floor dysfunction can come from, you know, again, hereditary birth, how you are people that have scoliosis have a... a more higher instances of pelvic floor dysfunction because spine is off kilter and then their pelvic ⁓ is off kilter, then that means the muscles, there are 16 muscles down there, that means that they can be taught on one side ⁓ and on the other side. So kind of knowing that ⁓ there are that have any type of connective tissue issues. I'm starting to get more patients that have EDS, is elders, Dannos syndrome. And it the connective tissue around your body more lax. So these patients usually have more instances of prolapse because the ligaments and the pelvic organs are not as tight intact to where they're supposed to be. And so they're easily able to drop. through the vaginal canal. Patients that have really tight pelvic muscles, patients that had surgery, patients had babies, whether it ⁓ be or C-section, it can affect any and everybody, to be honest. I've ⁓ had some patients as well that had issues their bladder and using the bathroom and having bowel movements. ⁓ because of histories of ⁓ Crohn's disease, developmental issues, things like that. So it can affect everybody. Long story. ⁓

Stacey C: I thought it just was mostly women. So I learned something as well. ⁓ How common is pelvic floor dysfunction really?

Dr.Tiana Polite Brown: Mm-hmm. Extremely common. Um, one of the things that I say is like it's something that's normal It's normalized, but it's not it should not be normal. Um a lot of my women that have um issues with you know sneezing or when uh pee when they sneeze jump laugh Especially after having a baby. It's like oh that just happened. That's just what happens with women You know, we just have a no that's not normal, bro. We can fix that And so you'll be surprised just saying like how people have just accepted the fact that, ⁓ guess sex is supposed to hurt all the time or sometimes, or I'm always gonna have issues on my period, or I'm always gonna have issues with, you know, for men, ejaculation or holding my bowels, or I'm just gonna have issues with peeing myself after having kids that just come to the territory. No, there are things that you can do to help fix that. non-surgical things and then some people do need that extra intervention, that extra surgical intervention to help that to increase their quality of life.

Stacey C: What is the difference between a weak pelvic floor and a tight pelvic floor?

Dr.Tiana Polite Brown: They can be separate and then they can be together at the same time. So you can have a weak and tight pelvic floor. The weakness comes from the inability of the pelvic floor muscles to be able to relax and then contract when it's supposed to. Whenever you have a weak pelvic floor, is considered it's not activating the way it's supposed to. It's not ⁓ reacting at time where you need it to. Then a tight pelvic floor is just mean it's just staying closed like this when you think of the couple is like to open like a you like the Miami you and So whenever it contracts it contracts like this to close up the orifices and then whenever relaxes open backs up So whenever you have a tight public floor and it stays tight, you can still have leakage Even though you have a tight public floor because the muscles are just staying tight and they're not being able to move so anything can come through, may take a little bit longer and it may sit in that canal for a little bit longer because of the tightness of the pelvic floor, but it would get its way through because you're not able to relax it and contract it the way it's supposed to be. So you can have weak and or tight pelvic floor, if that makes sense. So they can come together or they come separately.

Stacey C: Mm-hmm. Why do so many women normalize pain, and or it's just a part of aging?

Dr.Tiana Polite Brown: because the health care professionals that we go to tell us that it's normal. And that's unacceptable. They tell us, ⁓ well, that just happens when you have a kid, or, ⁓ that just happens at the time. ⁓ well, you know, just here's some moisturizer, here's some estrogen cream, you'll be fine without explaining what's going on. And it's also a very intimate space as well. The one thing I love about social media is that It allows us to talk about things that we thought only affected us. And it's like, ⁓ my God, that's crazy. We have the same experience. And so, think it's great that people are saying, Hey, this is what's happening, but this, this is not, you know, this is not acceptable. Something can be done about it, but, unfortunately it's their shame. There's still shame around, not having a functional pelvic floor or functional pelvic organ.

Stacey C: you

Dr.Tiana Polite Brown: And it's just like, okay, well, I guess this is just my life now. I guess I'm just gonna wear pads for the rest of my life. I guess I'm not gonna be able to enjoy sexual interaction. It just comes to territory. I'm glad I had fun back in my 20s, but I guess my 40s and 50s and 60s, I'm just gonna have to just live with this. And that's not the case.

Stacey C: Well, that leads me to my next question. what would you tell someone who feels embarrassed to seek help?

Dr.Tiana Polite Brown: I them ⁓ first thing, because I've been asked this multiple times, like, am I the only one that you've seen this? Has anybody else dealt with this? Like, yes, you are not the only one. And I've worked with people like you. And there is light at the end of the tunnel. Talking to somebody that you feel comfortable with. As a pelvic health therapist, and I feel like me as a clinician, there is no TMI. But I had to make sure that I was comfortable with what ever somebody had to tell me you know, when it came to that particular ⁓ realm of therapy, of conversation, that I make them feel comfortable immediately. I try to at least make them feel comfortable immediately. So finding a therapist that you feel comfortable with is definitely one of the first steps. And you feel uncomfortable with that too. Sometimes writing it down be very helpful. I've read notes from patients, like if you don't want to say it out loud, here's a pen and paper, write it down. And then I can respond to you either voice ⁓ I can write it down as well. I've done that as well because there, you know, some people just feel very uncomfortable, recognize and realize that this is a, it is, is everybody has one. Everybody has a pelvic floor, but not everybody knows what to do with it when it's not functioning correctly. You know?

Stacey C: Mm-hmm.

Dr.Tiana Polite Brown: Or even if it is functioning, some people just don't know what to do with it. And so it is a, finding that space, whatever you feel comfortable telling. And so there are times where, you know, ⁓ patients feel comfortable telling me a lot of stuff, you know, how they feel, you know, the initial eval. And sometimes it takes a couple of sessions. It's like, Hey, I meant to ask you about this, but now I feel comfortable telling you about this. This is my experience. This is what happened and take it from there.

Stacey C: Right. are some of the symptoms and causes of pelvic floor dysfunction?

Dr.Tiana Polite Brown: Too many things. Let's see. Like I talked to you about, for the women, childbirth, unfortunately, there are certain cancers, ⁓ uterine, cervical, even PCOS, endometriosis, and ⁓ as well discomfort ⁓ dysfunction in the pelvic floor. For my men, prostate cancer, usually see that's usually the the main culprit is enlarged prostate or prostate cancer. Either they had radiation or chemotherapy or had the prostate completely removed and they end up having leakage. There's some people that have gallbladder issues that I was able to figure out, I like, hey, you have gallbladder, you have a hernia. A hernia is an opening here that messes with your inter-abdominal pressure, which causes more pressure at your pelvic floor, pelvic, not pelvic floor muscles, but pelvic organs that could cause leakage and pain as well. And it's ⁓ so different things. I've had a few patients that have found out, like, hey, your gallbladder might be diseased. That's why you're having issues with fecal incontinence getting them to the right place and getting them to a gastroenterologist. Like, yep, you're right. Get the gallbladder taken out. Boom. Symptoms have gotten better. So it's so many different things, even with you eating how you eat and some people have it just too much air because they're always chewing gum and they end up having trapped gas here in the area, the diaphragm, it end up having too much pressure. It's so many different things. You having ⁓ a knee injury could cause leakage. Having a hip replacement can cause leakage because one side is ⁓ short or tall or shorter than the other because of the hip or knee replacement, it causes dysfunction here in the pelvic, not just in the pelvic joint, but in the pelvic bone. And that causes leakage and causes shifted of the pelvic organs, which causes leakage. So there are some patients that where ⁓ would just give them a shoe insert in one of their legs that are shorter than the other because of a surgery or because of how they were born. ⁓ that leakage has stopped.

Stacey C: wow. ⁓ mouth was open when you were explaining it because I was like a replacement in your hip? ⁓ Wow.

Dr.Tiana Polite Brown: Yeah. I know. Yes, yes, yes,

Stacey C: should someone see a pelvic floor specialist?

Dr.Tiana Polite Brown: would say as soon as those symptoms happen and as soon as those symptoms are affecting your daily life. I've done things too, even if you are pregnant, I've done kind of like a prophylactic type ⁓ of therapies where had a ⁓ pregnant patients that that didn't really have too much leakage and have too much back pain. But we went over labor positions. We went over actually stretching the perineum because they wanted to have ⁓ natural births. So help preventing them from having tears, perineal tears is very important. So anytime you feel like something in your life could affect your pelvic floor and is affecting your pelvic floor, get a pelvic floor therapist consultation. ⁓

Stacey C: Okay. What are some treatments and how long does therapy typically take?

Dr.Tiana Polite Brown: So of course, like every body, all depends in occupational therapy, it depends. it depends on what they're able to do and how symptoms present. I've seen patients that just needed help with having a conversation with changing their diet, saying, hey, are you doing a lot of keto? Okay, cool, we need to add some fiber into that. You need to increase your water intake. make sure you're doing a diaphragmatic breathing when you're doing your squats. And I've seen them maybe one or two times and their symptoms have gotten better. I've had patients that unfortunately are chronic public pain patients with endometriosis, adenomyosis, had ⁓ injections in their pelvic floor because of the tightness. And I've seen them for over six months to try to relieve some of their symptoms. But pelvic floor dysfunction looks like pain during sex, leakage of bowel urine, Pelvic floor heaviness, feel like you prolapse, you feel like you wipe yourself and you feel like a ball of tissue coming out of your vaginal canal or rectum. Sometimes even hip pain, lower back pain that can be connected to the pelvic floor. It's a whole myriad of things. There are a few people that have issues with constipation and diarrhea as well that I also work with them about. So it's a mixture of different exercises, different stretches, education, diet changes. Sometimes I use a TENS unit, which is electro stimulation to the visceral areas or to the areas of the sacral nerves, which is like in your lower back area, to help with that brain bladder connection. I've done a multitude of things with some patients. I've them and I looked at them. did their initial evaluation, ⁓ got medical records and saw what they had and see what was happening. It's like, you need to go to surgery as soon as possible. So it definitely all depends. But sometimes it just needed that. They just needed that second set of eyes because they probably already been to urology or to gastro. or their women's health professional or their family medicine professional, they just need somebody else to say, hey, this is bad, might need to go in and do this. And I have a great relationship with the current ⁓ ⁓ that I work with. And it's like what I say is meaningful and they move forward ⁓ ⁓ my assessment. Because like, hey, Tiana, I'm seeing this, but I want you to assess them and see what we need to do and take it from there. So once you build that relationship with other specialists and professionals, it makes it a lot easier for you to go and advocate for your patient. ⁓

Stacey C: Wow, well that's great for your patients, especially ones who may be seeing those type of specialists that you have that close connection to them.

Dr.Tiana Polite Brown: Mm-hmm.

Stacey C: Is it ever too late to improve symptoms?

Dr.Tiana Polite Brown: No, I love working with my older patients that are, they had their kid at 21 and they're 71 and that 50 year old kid is still giving them pelvic problems. And I love telling them, like, I got you. I know you 50 years postpartum. What?

Stacey C: Heheheheh!

Dr.Tiana Polite Brown: You can get this thing. Yes. ⁓ yeah. I absolutely love it. Yes. There is no age. I think the only time it is too late when you don't ask to be honest. ⁓ I've seen patients young, ⁓ and seen their, seen their symptoms get, get much, much better because nobody ever told them like I, like, like you said before, it's just been taught. Well, I guess you just leak after you, you have a kid and I guess you can't get on trampolines after you have a kid and no more roller coasters because my insides are flipped upside down after I had a child. And so there are so many things, but it's never too late to get pelvic floor therapy. I patients from, the youngest I've seen was 70, ⁓ the youngest was seven and the oldest was E9. So everybody can benefit.

Stacey C: Wow. How are lymphatic health and pelvic health connected, if at all?

Dr.Tiana Polite Brown: Yes. you have, sorry, bring it back. You have lymph nodes are deep and superficial. Inguino is more of the superficial and then the pelvic lymph nodes that are in the gonads. Gonads are your sex organs, your uterus, and even in your colon area. then gonad area in the male is around there, the prostate. and within their scrotum as well. And so when you have any type of injury to that area, whether it radiation, surgery, sometimes I've had a, I think I may had a patient back in the day that had a motorcycle injury, end up having like a crush fracture in their pelvic area and they end up having swelling like here, a tire of fluid that would just sit and settle because the bone fragments just severed the ⁓ lymph vessels and tore up the lymph nodes that they had to take out. And so now that lymph fluid doesn't have any place to go if it's not being redirected. And so there definitely is some correlation. It's mostly, most times ⁓ it has to have some type of effect in the area. So my PCOS girlies, my endoadenomyosis that are ⁓ inflamed in that area that cause pressure. on the inguinal lymph nodes and in the deeper pelvic nodes because their pelvic organ, their bladder, their uterus is denser because of the scar tissue of the and adenomyosis and is causing pressure in that area that can cause ⁓ pelvic congestion causing a of swelling that they just can't get rid of. So, yeah.

Stacey C: What does body literacy mean to you?

Dr.Tiana Polite Brown: By literacy literally means like learning, understanding your own body, knowing what's there and what's not. In my clinic, I have ⁓ a ⁓ picture the pelvic floor musculature on my door. ⁓ And you will surprised, young old people that's kids, people that ⁓ maybe didn't have kids, just been living long time. didn't know where the urethra was, didn't know that the urethra and the clitoris were maybe in close contact, but they're not the same thing. And so understanding your body and understanding, okay, what is supposed to be functioning? What does normal look like? And what does dysfunction look like? It's very important. just breaking it down to, bringing it down to the simple, bringing it out to the ABCs. This is where this is. this is where that is, this is this is supposed to be, this is what's supposed to happen, this is what you're supposed to feel when this happens, but this is not happening because of X, Y, Z, breaking it down to a person's understanding so they can be more educated and be more comfortable in the body that they're in, that they can make changes, that things can happen, that things can get better. So that's the body you literally need to meet, just really educating yourself at whatever the patients or the clients ability of understanding.

Stacey C: What is something that you wish OBGYNs talked about more?

Dr.Tiana Polite Brown: I wish they would talk about pelvic pain more and validating people's experiences that is not always cookie cutter and just really listen to ⁓ what the are, what the women are saying and what they're going through. I think that like for me, I went through multiple doctors and multiple ⁓ pelvic ultrasounds to get to where I am now with my own diagnosis of endometriosis. And now I also found I have adenomyosis as well because I listen to my patient. Cause like they're talking like, girl, man, you've got the same symptoms. me, but in this referral and, and, and, and do that. So I think that I really wish that OB-GYNs will be able to just Continue, I know they're doing a great job and especially with the influx of people that were that they're getting I know it can be a lot but really hone in time and take the time to listen and educate their patient and listen to their feelings and validate them. Don't make them seem like if they're not something that's urgent and emergent that it's not important. Just because you're not hemorrhaging, just because you're not pregnant and the baby is coming out the canal doesn't mean that is less important.

Stacey C: Right.

Dr.Tiana Polite Brown: Yeah.

Stacey C: Well, as we wrap up today's conversation, I hope one thing feels clear. Your body is not broken, it's communicating. Whether it's swelling, you've been ignoring, leakage you've been embarrassed about, or pain you thought was just part of getting older, you deserve answers. You deserve support. And you deserve to feel strong and informed in your own body. I hope that you enjoyed episode three of season three. And I would like to thank our guest, Dr. Tiana Polite Brown for coming to the show. I learned a lot. And I just want to say that when this episode comes out, know you talked about that the topics we talked about do affect men, but when this comes out, it will be the beginning of women's So I just feel that this is very informative for women, but can you please share with the listeners where they can find you?

Dr.Tiana Polite Brown: Mm-hmm. Yeah! Yes, just to, for my professional website, because I'm a military wife and I kind of go in and everywhere. I'm currently right now at this time in Dover, Delaware. And I am currently at ⁓ Bay Health, ⁓ Sussex in Milford. But if you need to know where I'm at and what I'm doing, please follow my professional page, Dynamic Therapy Services. My ⁓ professional webpage is www. DynamicOTServices.com. That is where all my credentials are. That's where I do most of my updates. ⁓ then also follow me on Facebook and Instagram as well ⁓ dynamicOTServices. And either those handles.

Stacey C: Okay, and I'll definitely have that information in the notes for the show. If this episode helped you, share it with another woman or man who needs to hear it. I am your host, Stacey C. Please do not forget to subscribe, share, like, and comment, and make time to see u grow, girl.

Dr.Tiana Polite Brown: Mm-hmm. Mm-hmm. Thank you so much. Grateful to be a part of show. You have a beautiful rest of your day.

Stacey C: Thank you.