Know & Do Better Melanie Carminati

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.

In the world of wellness and rehabilitation, Pilates stands out as a transformative and holistic approach to physical well-being. In this enlightening podcast episode, we had the privilege of hosting a roundtable discussion with our team at Inspira Physical Therapy & Pilates in Brooklyn, who are experts in the field. Dr. Melanie Carminati, PT, DPT, GTS, NCPT, founder of Inspira Physical Therapy & Pilates, leads the conversation with her team, each with a unique journey into the world of Pilates. They share insights into the essence of Pilates, its evolution, and its profound impact on the mind and body. Let's dive into the world of Pilates and discover the magic it holds.

Nicqueva Haughton was featured on our Endometriosis Fundraiser expert panel discussion speaking on stage during the live event as a patient advocate about her experience with endometriosis. She has many words of wisdom and encouragement to give individuals who have endometriosis and are either at the beginning of getting help or have been going through it for some time. This blog post was written based on the Know & Do Better podcast episode, The Patient Perspective: Nicqueva Haughton's Journey & Triumph with Endometriosis. 

Living with endometriosis can be a challenging and often misunderstood experience. In this blog post, we will explore the personal journey of Nicqueva Haughton, who battled endometriosis from an early age, endured excruciating pain, and eventually underwent a hysterectomy. Despite the hardships faced, there is hope, resilience, and a message of empowerment for others navigating this condition.

Nicqueva Haughton experienced endometriosis symptoms soon after her first period at age 12. The pain gradually worsened over the years, causing her to miss school and endure debilitating cramps that were far beyond what was considered normal.

Due to her young age, Nicqueva did not see an OBGYN until she was 18 years old, prompted by her mother's concern. The doctor discovered grapefruit-sized masses during an ultrasound, leading to a surgical procedure that resulted in the removal of her left ovary. The diagnosis of endometriosis was given, accompanied by the devastating news that she might never bear children.

At the time of diagnosis, endometriosis specialists were scarce, and Nicqueva’s doctor did the best with the limited information available. Despite the surgery providing temporary relief, the pain eventually returned, leaving her to explore various procedures and treatments. 

Contrary to the doctor's initial prognosis, Nicqueva defied expectations and became a mother of three. Unexpectedly conceiving her first child at a young age, followed by subsequent pregnancies, brought immense joy and gratitude to Nicqueva.

Years later, after enduring chronic pain and its impact on her personal and professional life, Nicqueva decided to pursue a hysterectomy. She described the struggle of being heard and understood by medical professionals, advocating for her health and well-being. The surgery revealed that endometriosis had spread to her bowels and bladder, underscoring the severity of the condition.

Nicqueva shares her initial apprehension about her identity and femininity after the hysterectomy. However, she emphasizes the significant improvement in her quality of life, highlighting her newfound ability to participate in activities without constant pain and worry.

Living with endometriosis is a challenging journey, marked by pain, uncertainty, and often delayed diagnosis. This blog post aims to shed light on one person's experience, highlighting the importance of self-advocacy and the significance of finding the proper medical support. Through Nicqueva Haughton’s story, she hopes to instill encouragement for others facing endometriosis, emphasizing that there are paths to motherhood and fulfilling life despite the challenges posed by this condition.

Internet Resources for Endometriosis

Nancy’s Nook

EndoFound

Internet Resources for Mental Health

CDC.gov

Mental Health First Aid 

Are you struggling to conceive and considering fertility treatments? We delve into the world of fertility treatments on the Know & Do Better Podcast with Dr. Edward J. Nejat, the practice director of Generation Next Fertility in New York City. Dr. Job is an esteemed fertility specialist and reproductive endocrinologist, known for his patient-centric approach and expertise in various fertility treatments. In this blog post, we will explore the basics of fertility treatments and the role of different practitioners in the process. When a patient visits Generation Next Fertility, the initial step is to establish their goals and aspirations regarding family planning. Dr. Nejat emphasizes the importance of understanding the patient's desired number of children and long-term family planning goals. This information plays a crucial role in customizing the treatment approach to ensure the best possible outcomes. Dr. Nejat recognizes the vulnerability and emotional challenges that patients face when seeking fertility treatments. At Generation Next Fertility, the focus is on creating a supportive and compassionate environment. The initial consultation serves as an opportunity to establish rapport, actively listen to the patient's concerns, and provide guidance throughout the fertility journey. The clinic aims to be more than just a healthcare provider but also a partner for patients on their path to parenthood. Fertility treatments involve a multidisciplinary approach, requiring the expertise of various professionals. At Generation Next Fertility, a team of approximately 75 staff members, including clinical assistants, laboratory technicians, stenographers, and finance specialists, work together to provide comprehensive care. Each team member plays a vital role in ensuring patients receive the highest quality care and support.

Dr. Nejat explains that fertility treatment options vary depending on individual patient needs. The initial evaluation typically involves a vaginal ultrasound and blood tests to assess hormone levels, infectious diseases, and genetic factors. Additional tests, such as hysterosalpingograms (HSG) to check fallopian tube patency, may be recommended if necessary.
One common treatment approach is intrauterine insemination (IUI) involves monitoring the female partner's natural cycle and inducing ovulation through medication. This is followed by the introduction of concentrated sperm into the uterus, either from the male partner or a donor. For patients requiring more advanced intervention, in vitro fertilization (IVF) is often recommended. IVF involves stimulating the ovaries with medications to produce multiple eggs, retrieving the eggs, fertilizing them in the laboratory, and transferring the resulting embryos back into the uterus.
Dr. Nejat emphasizes the importance of tailoring treatment plans to meet individual patient needs. For patients with diminished ovarian reserve or previous unsuccessful IVF cycles, Generation Next Fertility specializes in mild stimulation protocols. These protocols involve lower medication doses to retrieve a similar number of higher-quality eggs, improving the chances of success.

Fertility treatments can provide hope and a path to parenthood for individuals and couples struggling with infertility. With Dr. Edward J. Nejat and the dedicated team at Generation Next Fertility, patients receive personalized care, guidance, and support throughout their fertility journey through understanding patient goals, fostering strong patient-doctor relationships, and utilizing a collaborative approach.

Daphne Javitch is a Health Educator and Founder of Doing Well, who overcame lifelong symptoms of stage four endometriosis through diet and lifestyle. Her approach to health is founded in nutrition but emphasizes holistic well-being, including sleep, stress management, exercise, AIS connection and purpose, and routine building.

Daphne's endometriosis symptoms started when she was 13 years old, and they became more debilitating as she grew older. At the age of 34, she was diagnosed with endometriosis and was advised to go on birth control immediately. Instead, she chose to address her condition holistically with the help of a health coach. Daphne was consistent and rigorous in her approach, and some of her symptoms went into remission within six months. She went from taking 12 Advil a day on the worst day of her period to just one Advil for her entire cycle. This awakened an innate feeling within her and propelled her life and profession in a new direction. 

Daphne believes that consistency, repetition, and creating a routine play a vital role in improving health. She understands that people have a lot of information, but they are missing the how. Being consistent with small adjustments has a cumulative effect and is more impactful than extreme measures that lead to extreme failure.

“Living a healthy life is not just about exercising, it's about finding ways to support your body, especially if you're dealing with chronic pain, chronic conditions, injury, or disabilities. While we have the potential to heal ourselves internally, we also live in a very unnatural modern world that exposes us to toxic burdens. Even if we do everything perfectly, we can still experience health challenges.” – Daphne

When asked what someone could do to lead a more uplifting, energized life with a healthful routine, her response was simple: start drinking a liter of water before noon. This not only ensures hydration but also helps people keep track of how much water they're drinking, which can be difficult to gauge without measurement. Drinking water in the morning is also supportive of intermittent fasting practices and helps give the body an internal rinse after a night's sleep.

As for words of encouragement, Daphne advises people to focus on the return, especially when things don't go as planned. Life is full of unexpected interruptions, but it's important to find joy, excitement, and spontaneity, which can be healing in their own right.

In summary, Daphne's journey with endometriosis taught her the importance of a holistic approach to health, emphasizing nutrition, sleep, stress management, exercise, AIS connection, purpose, and routine building. Her story is a testament to the power of consistency and the innate healing power that we all possess. Follow her along on her journey.

At Inspira Physical Therapy in Brooklyn, NY, we use different holistic osteopathic techniques like Craniosacral Therapy and visceral manipulation. Learn more and book an appointment today.