Know & Do Better Melanie Carminati

Host: Dr. Melanie Carminati, PT, DPT, GTS, NCPT
Guest: Dr. Juan Salgado, MD

Dr. Salgado from San Juan, Puerto Rico, is a distinguished endometriosis specialist renowned for his expertise in obstetrics and gynecology, particularly in minimally invasive surgery. Today, he generously shares his journey and insights into the revolutionary treatment of endometriosis.

Dr. Salgado's Journey: From Tradition to Innovation

Dr. Salgado embarked on his medical career as an OB-GYN over three decades ago. However, it wasn't until 2009 that a pivotal moment reshaped his approach to endometriosis treatment. Faced with a patient's harrowing experience due to untreated endometriosis, Dr. Salgado recognized the pressing need for change. Determined to evolve, he embraced laparoscopic techniques under the mentorship of pioneering figures.

With unwavering dedication, Dr. Salgado mastered advanced laparoscopic procedures, including bowel resections and bladder excisions. His commitment to excellence has revolutionized endometriosis treatment, emphasizing the crucial role of accurate diagnosis through techniques like endometriosis mapping via sonogram.

The Power of Endometriosis Mapping via Sonogram

Endometriosis mapping via sonogram offers unparalleled accuracy in diagnosing deep endometriosis compared to traditional methods like MRI. Dr. Salgado underscores the importance of training and expertise in interpreting sonogram results accurately. He advocates for the widespread adoption of this technique to optimize surgical planning and ensure comprehensive lesion removal.

Advocacy and Collaboration: Spreading Awareness and Expertise

Dr. Salgado's vision extends beyond clinical practice. He strives to disseminate endometriosis mapping globally, collaborating with organizations like Endometriosis Puerto Rico and Endo Communities worldwide. Through advocacy efforts, he aims to increase awareness and access to advanced treatments for endometriosis.

Empowering Patients: Education and Support

In conclusion, Dr. Juan Salgado Morales epitomizes innovation and compassion in endometriosis treatment. His journey illustrates the transformative power of dedication and expertise in improving patient outcomes. As we navigate the complexities of endometriosis, Dr. Salgado's insights serve as a beacon of hope for patients and practitioners alike.

We extend our heartfelt gratitude to Dr. Salgado for his invaluable contributions and unwavering commitment to enhancing the lives of those affected by endometriosis. His passion and expertise inspire us all to strive for excellence in healthcare.

Embarking on better pelvic health is crucial for overall well-being. Today, with Dr. Melanie Carminati, a distinguished Doctor of Physical Therapy and founder of Inspira Physical Therapy, we explore endometriosis's impact on pelvic floor anatomy, receiving expert advice on treatments and exercises.

Understanding Endometriosis and Its Effects:
Dr. Carminati highlights the intricate relationship between endometriosis and pelvic health, revealing that 93.3% of women with endometriosis experience pain. Additionally, 75% exhibit increased tone in their levator ani muscles, emphasizing the prevalence of hypertonic pelvic floor issues among this group.

Research Findings and Pelvic Floor Physical Therapy:
Systematic reviews confirm that pelvic floor physical therapy reduces pain and improves overall quality of life for individuals with endometriosis. This underscores the transformative impact of targeted physical therapy interventions on managing pelvic pain.

Demystifying the Pelvic Floor:
Dr. Carminati explains the pelvic floor's anatomy as a three-layered muscle group and its significance in understanding muscle tension, dysfunctions, and treatments.

Objective Assessments and Holistic Considerations:
She begins with objective assessments, revealing the prevalence of hypertonic pelvic floor muscles and emphasizing the need for tailored interventions. She also considers diaphragm breathing dysfunctions and fascial restrictions for a comprehensive evaluation.

Connecting Through Subjective Experiences:
Dr. Carminati acknowledges subjective experiences such as dyspareunia, urinary issues, and pain, fostering empathy and encouraging individuals to seek personalized solutions.

The Pelvic Floor's Role in the Deep Functional Core:
She discusses the pelvic floor's connection to the deep functional core, emphasizing its interplay with the diaphragm and its disruption in dysfunctional pelvic health.

Practical Insights into Pelvic Floor Physical Therapy:
Dr. Carminati outlines what to expect during therapy, covering communication, sexual function, and physical assessments to tailor treatment plans effectively.

Layered Approach to Therapy:
She employs a layered approach, combining external observations, palpation, and internal assessments to create tailored treatment plans.

Manual Therapy and Osteopathic Techniques:
Various manual therapy techniques, including Winback radio frequency therapy, aim to relax hypertonic pelvic floor muscles and restore pelvic health.

Osteopathic Techniques for CNS Regulation:
Osteopathic techniques like craniosacral therapy aim to regulate the central nervous system, crucial for pain management.

Pelvic Floor PT Treatments and Exercise Considerations:
Neuromuscular reeducation and exercise, such as diaphragm breathing and Pilates-based core reeducation, are integral components of therapy.

Building a Collaborative Support Team:
Dr. Carminati advocates for a multidisciplinary team approach to pelvic health, fostering collaboration between healthcare providers and specialists.

Validation and Encouragement:
She validates individuals' experiences and encourages them to seek supportive healthcare, emphasizing the importance of trust and collaboration in rehabilitation.

Host: Dr. Melanie Carminati, PT, DPT, GTS, NCPT
Guest: Dr. Jeffrey Charles Schildhorn 521 Park Ave. Suite 1, New York, NY 10065 Phone: (212) 980-1375 Email: info@jcsnyc.com

On the Know and Do Better Podcast, we bring you expert insights to empower your health decisions. In today's deep dive, we explore critical considerations before surgery, guided by the expertise of Dr. Jeffrey Schildhorn, an esteemed orthopedic surgeon. Uncover the nuances of joint replacements, insights on managing hypermobility and trauma surgeries, and valuable tips for a successful preoperative journey.

Meet Dr. Jeffrey Schildhorn
Dr. Schildhorn, a distinguished Duke University graduate, brings a unique blend of academic excellence and hands-on experience to orthopedic surgery. His specialization in minimally invasive procedures reflects a commitment to reducing post-surgery downtime and enhancing patient outcomes.

Conservative Orthopedic Approach
Dr. Schildhorn advocates for a conservative approach in orthopedic medicine, emphasizing alternatives to immediate surgery. This approach prioritizes careful planning, physical therapy, and minimally invasive procedures, aligning to restore normal function without unnecessary intervention.

Deciding on Joint Replacements
Discover the criteria Dr. Schildhorn uses when considering joint replacements. From advanced arthritis to symptomatic pain hindering daily activities, Dr. Schildhorn sheds light on the factors that guide his recommendations. Gain insights into the nuanced decision-making process, ensuring patients receive the most suitable care.

Hypermobility and EDS Considerations
For those dealing with hypermobility and Ehlers-Danlos Syndrome (EDS), Dr. Schildhorn’s approach favors physical therapy over surgical intervention. Dive into the reasons behind this preference, emphasizing the crucial role of muscle stabilization in achieving optimal outcomes.

Trauma Surgeries vs. Joint Replacements
Dr. Schildhorn provides clarity on distinguishing trauma surgeries from joint replacements. Understand the immediate decisions involved in trauma surgeries, often guided by distinct fracture patterns visible in X-rays. This expert insight showcases the precision required in different surgical scenarios.

Setting Patients Up for Success
Unlock valuable tips for preoperative success, ranging from the importance of preoperative physical therapy to addressing metabolic issues and maintaining a healthy lifestyle. Dr. Schildhorn emphasizes the role of preoperative weight loss in enhancing overall outcomes, providing actionable steps for patients to take charge of their health journey.

Decision-Making and Finding the Right Surgeon
Explore the intricate decision-making process for surgery, emphasizing the crucial patient-surgeon relationship. Dr. Schildhorn stresses patients' active role in postoperative care, attending appointments, and following instructions for a smoother recovery.

As we conclude this comprehensive exploration, thank Dr. Jeffrey Schildhorn for generously sharing his expertise. If you are considering surgery or grappling with questions, contact Dr. Schildhorn for personalized guidance. Stay tuned for more insightful discussions in our next post, and take proactive steps toward a healthier, empowered future!

Host: Dr. Melanie Carminati, PT, DPT, GTS, NCPT
Guest: Dr. Marc Goldstein, MD, DSc (hon), FACS

In a recent interview on the Know and Do Better podcast, Dr. Marc Goldstein, a distinguished expert in Reproductive Medicine and Urology, shared valuable insights into the often-overlooked topic of paternal age and its significant role in fertility. This comprehensive guide delves deeper into the lesser-known concerns of older fatherhood and the crucial aspects of male fertility.
Paternal Age and Lesser-Known Concerns

While the public is generally aware of the impact of maternal age on birth defects, Dr. Goldstein emphasizes that paternal age, significantly beyond 45, plays a pivotal role. Studies reveal a doubling in the incidence of Down syndrome major birth defects, a threefold increase in schizophrenia, and a fivefold rise in autism. Despite being published in reputable journals, these findings are not as widely recognized as their maternal counterparts.
Awareness Gap in Paternal Age Concerns
Dr. Goldstein attributes the lack of awareness to a significant gap in understanding male fertility issues. Unlike women, who establish lifelong relationships with gynecologists, men often lack the same awareness and proactive healthcare habits. Conditions like testicular cancer, more prevalent than breast cancer, often go unnoticed until later stages, contributing to the overall gap in knowledge.
Freezing Sperm and Egg
The option of freezing sperm, Dr. Goldstein suggests, is a viable consideration for men. With a successful history spanning over a century, frozen sperm can maintain viability for decades. Like egg freezing, the age at which sperm is frozen influences its success rate. Younger men freezing sperm generally experience higher success when utilizing it later in life.
Male Fertility Evaluation
Beyond age, critical considerations for male fertility evaluation include a semen analysis, thorough examination, and medical history. At-home semen analysis tests provide a screening option, while medical history, including prior surgeries and conditions like undescended testicles, plays a crucial role. Blood tests, such as FSH and testosterone level assessments, offer insights into sperm production and overall reproductive health.
Impact of Medical History
Conditions like bilateral hernia operations or undescended testicles significantly impact fertility. The history of testicular cancer and its treatment, including radiotherapy or chemotherapy, can also have lasting effects on male fertility.
Vasectomy Reversal and Changing Perspectives
Vasectomy, a common contraception choice, can be reversed. Dr. Goldstein highlights changing perspectives on family planning, where couples who pursued reversal due to a change of heart or the loss of a child often experience remarkably high success rates.
Advocacy for Fertility Preservation
In the context of cancer treatment, fertility preservation efforts are essential. Dr. Goldstein stresses the need for increased awareness among oncologists about discussing fertility preservation options, particularly sperm banking, with male patients facing cancer treatments.
Conclusion
Understanding the intricate relationship between paternal age and fertility, considering medical history, and advocating for increased awareness are crucial steps toward comprehensive reproductive health. Dr. Goldstein's insights shed light on acknowledging male and female factors in fertility discussions. For personalized medical advice, it's essential to consult with healthcare providers.

Host: Dr. Melanie Carminati, PT, DPT, GTS, NCPT
BrooklynPhysicalTherapy.com

Guest: Dr. Michael A. Werner, M.D., FACS
MazeHealth.com

Disclaimer: The medical information in this podcast is for informational purposes only, not individualized medical advice. For personalized care, consult your healthcare provider.

About Dr. Michael A. Werner
Dr. Michael A. Werner, Founder and Medical Director at Maze Health, is a board-certified urologist who received specialized Fellowship training in male infertility, surgery, and male sexual dysfunction at Boston University Medical Center. His private practice in Midtown Manhattan and Westchester, New York, is limited to two areas of specialization: male infertility and male and female sexual dysfunction. He's a frequent lecturer and author in medical journals and books on these topics.

Exploring Men's Health After 70
In this episode, we'll discuss a crucial aspect of men's health after age 70, focusing on sexual health. Our previous podcast episode, "Sex After 70," primarily centered around female sexual health concerns with Dr. Dena Harrison, a gynecologist. However, we received numerous comments asking about men's sexual health and what can be done for men over 70 to maintain a fulfilling sex life. Dr. Werner, could you please share your clinical experience with male patients aged 70 and above? What are some common complaints they come in with in terms of sexual intimacy and sexual function?

Dr. Werner explains that as people live longer, sexual issues in older men become more prevalent. The two primary age-related concerns he encounters are erectile dysfunction and difficulties with ejaculation. The discussion delves into the treatment options for these issues, such as penile implants, penile injections, oral medications, and more.

Pelvic Pain and its Connection with Erectile Dysfunction
The conversation shifts to discussing chronic pelvic pain syndrome in men, which is often not well understood. Dr. Werner elaborates on the different symptoms and their varied manifestations. Dr. Carminati, as a pelvic floor therapist, adds to the discussion by emphasizing the importance of pelvic floor physical therapy and how it can assist in managing pelvic pain and other related issues.

Incorporating Radiofrequency Therapy (Winback Tecar):
Dr. Carminati shares her experiences with radiofrequency therapy, specifically the Winback Tecar system, which she finds beneficial for treating various pelvic conditions. The therapy is described as a warming sensation, and it explains how it helps facilitate deep tissue work for male pelvic pain patients.

Premature Ejaculation and Its Treatment
Dr. Werner addresses premature ejaculation, emphasizing that it's not always a psychological issue but can be physical and, in some cases, lifelong. He discusses treatment options, including the use of selective serotonin reuptake inhibitors (SSRIs) to delay ejaculation and topical numbing agents.

Addressing Low Libido
The conversation then touches on low libido in older men, often related to declining testosterone levels. Dr. Werner highlights the importance of hormone replacement therapy and discusses how it can significantly improve libido in men.

The Impact of Prostate Cancer Treatments on Sexual Function
When it comes to patients who have undergone prostate cancer treatments, Dr. Werner explains the common effects on sexual function and discusses potential treatments. He highlights the importance of early intervention to address post-treatment erection issues and emphasizes the effectiveness of penile injections in these cases.

Hosted by Dr. Melanie Carminati: Chronic pain is a complex condition affecting many globally, often treated with a focus on physical aspects, neglecting psychological factors. Dr. Barbiere, a clinical psychologist with 30+ years of experience, advocates for a holistic approach to chronic pain management. She combines Western and Eastern medical modalities, including acupuncture and herbal medicine, in her practice.

Dr. Barbiere's career spans various roles in NYC hospitals, including NYU Lutheran Labor and Delivery and Ortho-Neuro Rehabilitation departments. Currently, she is affiliated with Manhattan Pain Medicine, offering expertise in pain psychology.

Her dedication extends to her involvement with the New York State Psychological Association and as an adjunct clinical supervisor for Yeshiva University Ferkauf Graduate School of Psychology.

In this blog post, Dr. Barbiere discusses the psychological perspective on pain, emphasizing its impact on emotional and psychological well-being. She highlights the role of the brain in chronic pain and the need to address psychological aspects.

Dr. Barbiere employs a dual approach to chronic pain management: the top-down and bottom-up approaches. The top-down approach targets thoughts and behaviors using techniques like cognitive-behavioral therapy (CBT) to modify distorted thoughts related to pain. The bottom-up approach focuses on the body and nervous system, using techniques such as somatic body awareness, mindfulness, meditation, and muscle relaxation to signal safety to the brain.

Emotion regulation techniques like mindfulness and meditation are crucial for addressing the emotional aspects of pain while pacing and breaking activities into manageable parts helps prevent pain exacerbation.

Dr. Barbiere's insights offer a comprehensive strategy for managing chronic pain by considering both the mind and body. Her expertise underscores the importance of addressing the psychological aspects of pain, providing hope and support for those seeking effective pain management and improved well-being.