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August 8, 2020

PT For Your ED: Dr. Angela Treadway Discusses Pelvic Floor Physical Therapy and Erectile Dysfunction

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 

This is Donna Lee, Dr. Mistry stepped away, and as he stepped away, I brought in our super amazing pelvic floor physical therapist, who we talk about, if you’re a regular listener, you talk, you hear us talk about her every single week. So she’s here live and in person. Welcome Dr. Treadway.

Dr. Treadway: 

Hello. Thanks.

Donna Lee: 

Thanks for being here.

Dr. Treadway: 

I’m happy to be here.

Donna Lee: 

You’ve been with dr. Mystery for like the entire time.

Dr. Treadway: 

13 years. We’ve pioneered, we pioneered the partnership between a physical therapist and a urologist within the medical office. As a pioneer, you have to fight a lot of battles, and we definitely have come through them very successfully.

Donna Lee: 

Of course. Since you’ve been here the entire time like him, I’m sure you’ve seen all the craziness come and go and all the amazing patients. One of the reasons why I joined this practice three years ago, it was when I first had a discussion with Dr. Mistry as a surgeon, I thought, “Well, certainly he wants to just go cut everybody open.” He, his first words to me were, “Well, I have this amazing pelvic floor physical therapist, and I send my patients to her first and she can fix them most of the time. And then if they still need surgery after that, then we do surgery.” And I was like, “What?” That’s amazing to me.

Dr. Treadway: 

I know, it was amazing to me, too. Dr. Mistry and I first met at a pharma dinner, when I just happened to get invited because of certain places I was working at at Round Rock Medical Center at the time in a center for continence. And the pharma reps would come in there, I would get invited and I would take notes under the table because I didn’t know anything about the meds, but I learned a ton. He watched this whole thing unfold and he said, “You’re going to work for me.” I thought, “Who are you?”

Donna Lee: 

“And is that your real name?”

Dr. Treadway: 

Is that your real name? Really, or like a stage name.

Donna Lee: 

We joke about that on the radio, becaause somebody called him out for being gimmicky for having a fake last name.

Dr. Treadway: 

That’s so funny.

Donna Lee: 

Isn’t it funny?

Dr. Treadway: 

And it’s such a common Indian name.

Donna Lee: 

That’s funny. So I thought we’d have kind of go back in time. We had you on the show early on when we started the show several months ago, but I want to talk about what you do for our patients because it’s life changing and it’s incredible. And you see so many male patients as well as female, but what are your like top three patient types that you’re treating this week?

Dr. Treadway: 

Oh, this week? Well, the top three patient types I treat would be pelvic pain, incontinence, male and female–male, a lot of it post-prostatectomy; female, it can be postpartum or it can just be over time. But really if I drill it down to what I really do, the pelvic floor is full of muscles that no one really pays attention to. I mean, even in physical therapy school, they just say, well, there’s the pelvic floor and moved on, because you have to take training after physical therapy school specifically to handle the pelvic floor. It just has to do with the intimate nature of everything. So you get extra special time. A lot of it. And then you take a five hour exam, but that’s one important.

Donna Lee: 

It is for the patients.

Dr. Treadway: 

Yeah, it was worth it too. If you think about muscles, they can either be overactive or underactive. They can be too tight or too short and anywhere in between. So essentially I’m looking at symptoms that relate to what the relationship is between the muscles and the muscles of the pelvic floor and the abdomen and the hips and all of that. And so when they come to me with their complaints, I take a big thorough history to figure out which pieces are going on here. Like some people that are having leakage and incontinence, they’re not necessarily a weak. They might be doing too much activity and making their muscles exhausted. So when it comes to and they cough and sneeze, they have nothing left. I have to figure that out. Taking all the data is like the coolest part ever. I feel like, you know, a detective, I kind of am.

Donna Lee: 

Detective Dr. Treadway.

Dr. Treadway: 

Detective Doctor. Yes, that’s a new degree. That is really the crux of how I figure out what to do when people come in with problems. Some of my females might have a pelvic organ prolapse and that prolapse might be causing them to not empty their bladder. Well, sometimes it might be thought that they’re overactive in their muscles, but that’s not true. That’s where something is actually in the way, it’s obstructed. So really it’s muscles and tissue. Is it too tight? Is it too loose? What’s the relationship with your movement? What’s the relationship with your abdomen? The, what a lot of people don’t ever think of, because you know, who knew this, the breathing diaphragm and the pelvic diaphragm are the top and bottom of a pneumatic chamber. The abdominals are the walls. It’s like a soda can. And if anything goes wrong with any piece of that pneumatic chamber, the pressure, you’ll have a problem. You’ll either not let stuff out or everything gets out, you know, and anywhere in between. So that’s another piece of the puzzle. So I can look at lots of different things.

Donna Lee: 

That’s interesting. Gravity kind of sucks sometimes.

Dr. Treadway: 

Gravity is a factor.

Donna Lee: 

So in a lot of the male patients, I know when I started, it was all new to me because I came from a family practice background and we didn’t have these really specialized, cool things that we worked with. But knowing what you do every day, I mean, I see your patients coming and going, what do you think is the number one male type issue that would be treated with pelvic floor physical therapy, aside from cancer?

Dr. Treadway: 

Aside from I don’t treat cancer, I treat the outcome of the surgery. But I would say probably looking at erectile dysfunction.

Donna Lee: 

Oh, well, that’s a big one for our listeners.

Dr. Treadway: 

That’s a big one, right?

Donna Lee: 

We get a lot of questions.

Dr. Treadway: 

So, you know, there’s a musculoskeletal component, because anything that moves there’s a muscle moving it.

Donna Lee: 

What ED symptoms would, like Dr. Mistry, or Dr. Yang, or Dr. Ong, or Dr. Jacomides, what do they see and then they decide, “Oh, you need to go see Dr. Treadway for pelvic floor physical therapy,” with regards to erectile dysfunction?

Dr. Treadway: 

I don’t know that they do that. I think Dr. Mistry sends me everyone, and I’m not sure anyone else thinks about that. But there’s usually a component, there’s usually a component of tension. So if you think about it, of course, it depends on the age of the person, it depends on their cardiovascular health because erectile dysfunction is like the first symptom of cardiovascular problems of, you know, the arterials in the penis are the smallest, they’re like one cell thick. So if there’s going to be blockage, you’re going to see it there first. You know, before, before they’re even in a cardiologist’s office. So, and I know that those, you know, the docs know this, so they’re trying to manage it medically because they have to. The musculoskeletal component is not necessarily well, I mean, it has been researched, but, you know, I saw the one study that got yanked out of pub med. Don’t know why, I could speculate, but I don’t want to get in trouble. However, so the tissues, the erectile tissues have to be able to engorge. So there’s your blood part, but if the musculus, the musculature in the area is too tense, it might not be open to being able to engage, or if it is open to engorge and the musculature there is too loose and not really under the control of the patient, it might drain before they want it to. So there’s that, there’s that aspect. The other thing is I have to ask the patient, you know, are you not able to achieve, or are you losing it? And, you know, depending on what they tell me sometimes losing, it means you gotta keep your head in the game, because if you go from rest and digest to fight or flight, so if your autonomic nervous system regulates to a fight or flight direction, well all the blood’s going to go to your thighs because, you know, so you can run away from the tiger. So, you know, these, all these little teeny pieces they add up and it takes the history, I’m telling you, you gotta take the history and figure out what piece of the puzzle is just missing. Or how many, you know, if you have too many pieces, you can take a few steps away. So that’s how, how I handle the erectile situation.

Donna Lee: 

So when a patient comes into a new patient, or maybe our patient or another doctor’s patient, when they come in to you, that’s a good hour intake, if not longer?

Dr. Treadway: 

I spend a great deal of time on the intake. The first intervention is probably 15 minutes or less in terms of taking, I take data, I give them an idea how to start some exercises and I try to get them in right away for that followup, because that’ll be all intervention. But yeah, the intake is pretty, pretty heavy.

Donna Lee: 

Gotcha. And what about when somebody is coming to you for, for erectile dysfunction issues and you’re taking their intake and then they become a patient, generally how many visits do they have with you?

Dr. Treadway: 

That’s a good question. So the musculoskeletal changes, like in any human, it’s a four to six week physiological timeline.

Donna Lee: 

That’s alway the magic number: four to six weeks.

Dr. Treadway: 

It is, it’s amazing. It’s cause that’s how our systems change stuff. So, I advise the patient that it’s going to take the first three weeks to get the neuromuscular thing down, like, you know, 21 days to a new habit. And then after that, they can expect the musculoskeletal to come along.

Donna Lee: 

Awesome. So sometimes several visits, but I’ve seen your patients leave here or leave our clinic smiling and happy. And you’re just so incredible. And we appreciate you being part of this. I’d like to have you back on another time and talk about supplements because you were the most well-versed human I know when it comes to wellness and supplements and all ties into physical therapy, doesn’t it?

Dr. Treadway: 

Of course.

Donna Lee: 

And crystals, I’m going to talk about full moons and crystals with you. That’s what I wanted to do.

Dr. Treadway: 

I better go do some research.

Donna Lee: 

Because that’s my jam.

Speaker 1: 

The Armor Men’s Health Hour is brought to you by NAU Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.

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