Leap High

A long, long time ago I was a ballerina. Nothing professional, but I loved it and I was decent at it, and every time I would get home from class my Dad would ask me the same question-
"Did you leap high?"

NOT ME doing a Grande jete. This is my
favorite Carolina Ballet Principal ballerina
Margaret Severin-Hansen,
an actual professional doing a proper leap. :) 

Grande jetes (big leaps) were my very favorite. Hurling myself into the air (gracefully of course) was easy for me. I remember doing it with total abandon yet a good bit of control. My ballet teacher even made me the donkey in Carnival of the Animals because the donkey's dance was basically just insane hopping all over the stage. When I got my driver's license my Mom and I secretly ordered a vanity plate for my car that said LEAPHIGH and surprised my dad with it. Now that I have kids I realize it was mostly for all of their friends to be able to keep tabs on me around town, but still, it was special and I had it for years.

At my wedding, my Dad walked me down the aisle. When it was time to officially "give me away" he whispered in my ear, "Leap high." It was exactly the right thing to say.


Years later, that careless sense of leaping has been replaced by complete fear of the unknown, of where I may land if I were to jump, of falling when I hit the ground. Adulthood and motherhood have broken me down and have brought my anxiety to the forefront of a lot of decisions, because safety and security just make more sense when you have three kids.

However, when my Nana died a year and a half ago, my world seemed to fall apart and a lot has changed inside of me since then. I don't think I fully grasped what it would be like not to have her in my life after 34 years. I was very depressed, struggling every day to get it together. Slowly I began to question a lot of things in my life. I thought more about what made me the way I was, what I wanted to improve on, how deeply my sense of self worth was broken and why that was, not having experienced anything that could lead to that. Working through a lot of these issues sort of rocked my world. I started to become angry at myself for being so scared all the time. Scared of failure, scared of what other people think of me. I don't want my girls to live with that fear, but if I am their example, how can they not pick up on it?

So, that brings me to the here and now. After almost a year of soul searching, prayer, agony, fear, tears, hope, and more agony, I am leaping. I am taking a big jump for the first time in a long time into the unknown. I am leaving a job that I have had for 10 years and I am going out on my own. I am leaving a place that gave me my first job out of PT school, with a boss who taught me how to be a good PT and allowed me to pursue my dreams of practicing pelvic health. Leaving the place that let me have three babies and work when I could, always giving me support and never judging me for choosing motherhood as my top priority. A place where I could decorate my room with plants and pictures and even a pretty little needlepoint vulva that my best friend gave me for Christmas. (Sidenote: That's true love right there by the way. Stitching your friend a pretty vulva for her clinic room = love.)

I am walking away from Advanced Physical Therapy Solutions and leaping headfirst into what I am calling Fayetteville Pelvic Health. I don't know exactly what it's going to look like yet. I am not sure how it will evolve. I know that I want to continue to serve men and women of my beloved hometown, but I want to do it in a way that looks a little different from the traditional model. I am working a lot of the details out now. There is still a lot up in the air, lots that makes me anxious, but I'm not letting myself live in fear of the unknown anymore. I may fail. I may fall. I will most definitely have some stumbles, but if I don't try I'll never know what I'm capable of. Everyone at APTS has been incredible, supportive, excited for me. In some ways it makes it harder to step away. These people are the cream of the crop. Literally the best PTs around, hands down. Incredibly smart, outside of the box thinkers who never settle for mediocre and are always learning. It's truly a dream job working with such highly skilled therapists. It certainly made me a better PT every day that I came to work and learned from my colleagues. It's going to be lonely and scary not having them to help me, but I want my kids to watch me leap and watch me stumble and then watch me get back up to accomplish something that is on my heart. I want them to know that sometimes doing the scarier thing is okay and that failure does not define them, or me. Perfectionism has kept me living in my safe zone all my life, and I'm sick of it. I am not perfect and I don't have to be.

So here I go. I'm leaping I hope I still have just enough grace to land on my feet. But I am realizing that even if I fall, I'll be okay. I can get up and keep dancing.

Stay tuned for more information on Fayetteville Pelvic Health - coming soon in May!!

The Marathon and the Urine Shoes

Catchy title isn't it? Sadly it is an accurate description of myself and my shoes following my first marathon a few years ago. I ran my first marathon on January 10, 2016 at Walt Disney World. My twins were two and my son was four. Our parents kept them for us so my husband and I could head down just the two of us. It was a great getaway despite 26.2 miles of heat and humidity. And the urine shoes. Cause I mean, urine shoes aren't the most romantic addition to a weekend without the kids.

Stopping for a photo in front of the castle! 

Training for a marathon with three children aged 4 and under is easy. I truthfully couldn't dedicate the time that I now know is essential. Not only that, but eating well is hit or miss as a mom of young kids and my diet was not the least bit appropriate for marathon training. However, I needed to do something to show myself how far I had come since the days of having twin infants. I needed a goal that didn't involve feeding children or kissing boo boos. I hated running at the time but I also knew it was something I could do easily without spending much money and without having to drive anywhere for a class. Plus, my husband and brother in law had started running marathons and since I am a competitive Type A woman, I couldn't accept being outdone by two boys who had never grown a human in their bodies. No offense men, I'm just sayin. So off I went on my crusade to become a runner.

If you know me at all you'll know that one of my biggest soapbox topics is postpartum care in the US. It's totally unacceptable in many cases. I am a Pelvic Health PT, so I know better, but most women get NO instruction on their postpartum bodies. Because I'm a PT I am also the worst kind of patient. I'm non-compliant and totally lazy, unlike most of my patients who actually do their homework. I didn't do much of anything to prepare for running besides, well, running. I had some pain in my buttocks here and there and some incontinence during my training but honestly, I just didn't care.  I think I had struggled so much with stress and postpartum depression over the past few years that peeing on myself didn't seem like a big deal compared to taking care of kids.

On race day at Disney it was muggy and hot and we had been up for hours in order to get the starting line on time. We had walked a long way from the shuttle to the corral and adrenaline had been flooding through me all morning - not really ideal for my body which is typically already full of stress chemicals. By mile 7 I was losing control of my bladder. Whenever I would slow down to walk (which was VERY often) I would leak urine. By mile 9 or 10  I was already uncontrollably peeing on myself. The benefit there is no porta john lines, but still.

I struggled to get through the race. I was SO hot and had 11 blisters on my feet. I was soaking wet from sweat and pee. The high of crossing the finish line was unreal, despite my urine shoes. But the fact is that I should never have been at the point where I was just peeing on myself for miles and miles. It's not the least bit normal or okay.

For my second marathon, the Outer Banks Marathon, I trained smarter and ran solo. I ate better and made time for Yoga. I tried working on my abdominal, hip, and back strength. I PR'ed this race and felt amazing through it. Then came my third.

Outer Banks!

I don't know why I wanted to do another one. I suppose many runners can attest to that need to prove yourself faster. I ran the Wrightsville Beach Marathon this past March because it's close to home and we have a beach house nearby. I stuck to my training schedule, ate well, but even so my body just wasn't feeling it. I had major pain in my buttocks and down my legs every time I ran. My back ached literally all the time. I couldn't walk in the mornings when I first got up so I sort of threw myself forward into the bathroom holding onto the walls until a hot shower helped me stand up straight. I ran the race in pain. Major pain. Annoyingly enough, at first it wasn't even my "normal pain." I had put a tampon in that morning (because nothing is more awesome when you are trying to run 26.2 miles than menstruating at the same time) and within the first two miles I was having rectal pain. Yes, literally pain in my butt. I knew why - I'm a Pelvic Health PT and all - so I knew my pelvic floor muscles were tightening because they didn't like the tampon in there at that moment. Nevertheless, I persisted. At mile 7 I stopped at a toilet and yanked it out, texting Ashley (my PT Best Friend) cuss words and whines about my pelvic floor woes. The good news is that the rectal pain went away when I took out my tampon. The bad news is that my back and leg pain presented itself immediately because now my brain could feel it since my bum was happier. Hurray.

I almost quit this race. My daughter had started vomiting at 3am the night before, our car broke down, and there was a chance my family wasn't going to make it to the finish line. I was over it, but I had a college friend who was biking to various points along the route cheering for me which pulled me through. The pain was excruciating and basically debilitating and I cried a few times toward mile 20 because it was awful, even with me popping Tylenol during the run. I crossed the finish line only 15 minutes behind my PR which was super surprising to me. Even so, I could hardly move for three full days, something that isn't normal even after a marathon, at least not if your body is working well. My brother in law pointed out after the race that I actually ran it injured, and that was the first ever time I had ever thought of it that way. I was injured.

Wrightsville Beach Marathon

I have run maybe a couple of miles a handful of times since that race but there is pain. I am 5 years postpartum from my youngest babies and the lack of care of my body has finally caught up to me. It took some time for my diastasis to cause me problems (for more about my Diastasis read this blog post), for my pelvic floor weakness to cause pain, but now here I am - fairly broken because of some of my postpartum issues even though I am years past my delivery. My Cesarean scar still needs some TLC, my abdominals need retraining, my pelvic floor is still very weak. Had I done something for myself after my twins were born I can almost guarantee I would not have peed for an entire marathon all the way down into my shoes. I can pretty much assume I would be running my fourth marathon soon. Instead I am feeling more dysfunctional with every week that passes. I am on my friend Ashley's schedule at the end of the month to get some PT of my own. I am going to spend some time diligently trying to get my body back into a functional place. It's going to take some time, but I love the idea of running a few more marathons. I want to run a big city one like Chicago or NYC. I want to run one when I turn 40. I want to show my girls that our bodies do incredible things and that hard work pays off.

Me and my father in law at the finish line of the Ft. Bragg 10-Miler last year. 

If PT were the standard of care following childbirth (which let's be honest, is MUCH HARDER on our bodies than running a marathon), I would be in a better place. I am so excited when new moms take it upon themselves to come in for PT in the early postpartum time frame. They are so much ahead of the game. They understand how to move well, how to work out safely, how to keep themselves healthy. They prevent this gradual breaking down of the body that I am dealing with at the moment. I knew better, but I didn't take the time. It's easier not to. I'm paying for it now, but I'll be okay. I am going to take it slow and figure some things out. I am going to take some time to allow my body to move well again. My body is very different than it was before I had children, and I am totally okay with that. However, I need to learn to use this new and beautiful body well. I am excited to see what Ashley helps me find that needs work and to see if I can get things working better. It's definitely nice having a best friend who also does what I do and can get me back to running. I can't wait to hit the pavement again for something more than a short painful jaunt around the block. Ladies, mothers: we don't have to live this way. We can change how postpartum care is delivered in our country if we would just talk about this. Share this with your girlfriends, your daughters. Tell them there is help and hope and something so much cheaper than having to buy new shoes every time you run. Don't go squishing around in urine shoes like me. Find a PT and give your body the gift of moving well.

Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Why You Should Be Discussing Your Vagina Tears With All Your Friends Right Now.

I'm stepping up onto my soapbox because, y'all, I'm so sick of this crap. I only work a couple of days a week but nearly every week I see a woman who is postpartum and is shocked that her pain or her leaking isn't normal. IT'S NOT NORMAL. I'm not mad at you guys, I'm just mad at the state of our postpartum care. I will say that I read through the new guidelines put out by the American College of Obstetricians and Gynecologists and they sound great, in theory. But I'll also say that just last week I had a patient come in to see me in the morning before heading to her OB's office for her last follow up after childbirth. She sent me a message that afternoon saying that her OB told her that her pain and leaking were normal because "oh, of course, you just had a baby." Then sent her on her way.

Eye roll, mad face, eye roll, heavy sigh, irritated growl. If you know me you know exactly what those faces look like. I have no poker face and I don't hide my emotions well.

When I gave birth to my son, my first baby, I tore. Down below is a graphic illustration of perineal tearing with childbirth. I'm putting this in your face because we need to be aware of this and open to discussion with our loved ones. Or strangers. I have more discussions than you'd think with strangers about this thanks to the power of social media and it makes me so happy. I love meeting a stranger and immediately discussing their vagina. It means that we are breaking down some walls, at least here in Fayetteville.

Day 2 after our son was born, feeling rougher than I looked.

So anyway, at the time my son was born I was only dabbling in pelvic health physical therapy and I had only taken one of the three main courses, so I was very green. I was also exceptionally exhausted. I didn't know enough at the time to ask my physician about the degree of my tear. I remember her saying a few times that I was going to be sore because it was a "pretty good tear." In addition to being exhausted I am almost positive I had postpartum depression the entire year after his birth, so again, I didn't think twice about any of it. The tear had to be cauterized three times over the next few months before it fully healed but I was too tired to care. My MD asked me how sex was and I never told her that there was no way in hell either of us were remotely alert enough to even begin the process of that. She just assumed and I let her, I was probably embarrassed to tell her we hadn't done that since the baby but I can't remember. I knew nothing back then y'all. Not about pelvic health, or motherhood.


Years later I went back to work and devoted by time at work to pelvic health patients. Around that time that my friend gave birth to her son. I was accidentally present for his birth, something we hadn't discussed, but she was induced with pitocin and honestly I thought it would take forever, so I went to the hospital to sit for a couple of hours and no joke it was suddenly 8am and he was on his way any second. So I hid in this little closet with the sink in it in the delivery room because I was pretty sure I wasn't supposed to be there for the birth. Oops. I stayed long enough to snap some photos and ask her doc how badly she had torn.

Me (as a Pelvic Health PT): "Did she tear?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health PT): "How bad was it?"
Doctor: "Yes."
Me: (as a knowledgeable pelvic health Doctor of Physical Therapy): .....

Eye roll, mad face, eye roll, heavy sigh, irritated growl to myself. Look, when your friend has a baby and is enjoying the moment, you don't make a scene. I kept my mouth shut and just sat there updating her family with photos, then drove her husband's truck into a concrete post in the parking deck on my way to get her other car with the baby's car seat in it. Once again, oops. In my defense, that parking deck is a bear and also his truck is like a flipping tank. Also they knew I am not a great driver when they gave me the keys so...

Image from the University of Sydney: http://sydney.edu.au/medicine/nepean/research/obstetrics/pelvic-floor-assessment/English/sydney%20pelvic%20floor%20body/After%20Birth/Anal%20Sphincter%20Muscle/Anal%20Sphincter%20Muscle%20html.html

Anyway, at her follow up appointments with the physician he didn't once mention her tear, her recovery, her emotional status, her continence, her pain, sex, NOTHING. I wasn't surprised because this physician had made me cry ugly tears during a difficulty period in my nursing of my TWIN BABIES. Which, umm, may sound totally easy to a man who doesn't lactate or birth babies, but nursing two babies is the opposite of easy thankyouverymuch. Anyway, thankfully a couple of years later she was ready for us to work on her incontinence issues because that's what friends are for after all. She's good now, but if she didn't have me going into my tiny fits of rage and explaining what is normal, what's right, what's good care, what's going to happen after birth, she'd have been like the majority of women out there who have NO idea what is normal.

9 years at APTS where I have been able to develop
a Pelvic Health practice over the past 4 years. 

Now thankfully, many women do have doulas or PTs or friends or midwives/physicians who understand that we need to do better in our country when it comes to the postpartum period. Many of them get great care. I do realize that, but I also see first hand that most women aren't getting that. And it's just not okay. In France, Pelvic Health PT is the STANDARD OF CARE. As in, you have a baby, you go to your pelvic PT for a few visits (or more depending), but you always go. It's like the norm there. In the US, most women don't have a clue about what we are, what we do, or how to get to us and frankly don't end up begging for a referral until years later when they have suffered for years. That's unacceptable. It makes me super mad and frustrated. My patients who have come in to see me soon after birth tell me all the time that they are the only ones out of their girlfriends who don't have issues. Guess why. Because we teach them how to re-learn the right way to use their body, their muscles, their pelvic floor right away before things get worse. We start using the correct abdominal muscles, get the pelvic floor working well, take care of scar tissue early so it doesn't become a problem, we nip the painful intercourse in the bud right away before things progress to marital distress. It's the right thing to do after birth. Birth isn't easy and no matter vaginal birth or Cesarean birth, it's hard on the body. It creates changes in the body that aren't necessarily bad, but warrant a couple of visits with someone who knows what your body needs and deserves after birth.

In my last Facebook video I begged people to spread the word. I'll say it again. Please, please, pretty please talk about this with your friends, family, colleagues, strangers you meet at the next wedding you go to. It's too important to keep it all taboo. There is someone in your world who is suffering right now from leaking so much they can't work out and they feel depressed over what their body has become. Someone whose marriage is suffering because she can't have sex with her partner because it hurts too much. Someone who can't play outside with her kids because her back or pelvis hurts too much. You could change someone's life by talking about what's normal and what's not normal. I'm not being dramatic. This is what I do, I see it all the time. It can be life changing. Please help me make this stuff okay to talk about it at book club. Or at girl's night. Or even your next dinner party. I don't care when you discuss it, but discuss it. We all have pelvic floors. We all have some issues going on down there at one time or another. So let's help each other. Tell your people that LEAKING IS NEVER NORMAL, SEX SHOULD NEVER HURT, and there is help for it. Here's my latest video if you haven't seen it on Facebook yet. 

End rant. Happy face, clapping hands, little dance. Thanks y'all.

Here are the updated guidelines for postpartum care:
https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

What's with the plant? Are you moving in?

Over the past year, I have arrived at my clinic hauling arm loads of home decor, books, and artificial houseplants into the back room. At first, the joke around the clinic was that I was "moving in" and my little back room in the clinic quickly became known as "Lacy's apartment." I tried to transform the perfectly lovely little PT treatment room into my own space, almost obsessively. I am the first to admit that I crave my space to feel peaceful, put together, even a little fancy by some standards because that's just how I am. However, that was never my goal in my clinic room. I just didn't want it to feel, well, "clinical."

Back circa 2009 when my name went up on the sign of the clinic! The start of my eventually becoming a Pelvic Health PT!

When you go to a medical practice complaining of a problem "down low" as I like to put it, you already feel insanely on edge. A lot of the time you have been to numerous medical offices and had to wear the dreaded paper gown while sitting naked in a cold room with shiny instruments closing in on you. I have been fortunate - I've had only one provider who has ever made me feel small and "less than" in one of these rooms, and thankfully it was unrelated to my pelvic pain issues because that would have been worse, but even with the kind physicians making you feel comfortable, you never feel comfortable, amiright? So I want my practice to be one of the places where you do feel comfortable. Or at least as comfortable as you can be when you are dealing with an issue down low.

For starters, when you come into my room, I don't want to it to remind you of all the other experiences you've had in your journey. I don't love thinking back on the room where I was told about my pelvic pain diagnosis, even though it was a pretty defining moment in my life (in a good way). It just takes me back to the other places where they kept telling me there was nothing wrong, all the poking and prodding, all the self doubt and fear. That's not what physical therapy is about.

In the back room of our beautiful clinic is my little oasis. Admittedly the paint color is a little too bright for me though it's a great color, but otherwise, it's a little place of peace for me. I have some of my favorite books there -  some about pelvic health, some about sex, even a couple of parenting books that I've accumulated. I have some succulents, some gold accents, and some art on the walls. I even begged for a purple chair so people didn't feel like they were sitting in the traditional medical office chairs. It's not perfect, but it's a reflection of me. And that's my goal. I want my patients to sit down and know ME. If they don't know me, they can't trust me. I am typically an open book when it comes to my body, my experiences in my own health journey or my pregnancy experiences. I want people who are sitting in front of me to know that there's nothing they could ask me or share with me that would make me judge them or shock me. In that room, we talk about everything from sex to menstruation, from erections to pregnancies, from motherhood or fatherhood to marriage. Pelvic health is not an island unto itself isolated from the rest of the PT world, but it's definitely a little different from "normal" outpatient orthopedics in that it's a vehicle for some pretty deep and in depth conversations that years ago I couldn't imaging having with people who were basically strangers at the time.

Of course, by the time patients are done with therapy they are no longer strangers. Often we have not only had intimate discussions but also intimate treatment sessions that involve internal work (like vaginal or rectal). Not always, but sometimes. However, I almost never start with these intimate treatments, because sometimes these are a trigger for anxiety or fear. And I get it. Because I've been there. Unless I can read that someone is eager to get moving in that direction, I typically take a few visits to work on lots of other things that are much less intimate. Internal work should NEVER be forced. It should ALWAYS be 100% okay with my patient. Period. (It's not my body that I'm working on, it's YOUR body, so YOU get the control.) There is always plenty else to do outside of that work, so we take our time. We build a relationship first, I earn their trust, and together we get to the bottom (ha, pun intended) of their issue. Always together.

Always together in the "pretty" room. Not that pelvic health is always pretty, nor is the journey through pelvic pain or incontinence, but things don't have to feel cold and sterile. It can feel softer, kinder, more relaxed, more comfortable. Treatment can be slow, it can encompass everything from the actual physical problem to the emotional implications that come with it. We talk about the guilt, the shame, the heaviness that some of these issues can bring. We talk and we make changes and we treat the person as a whole, not just pointing fingers at various organs or places and expecting things to miraculously heal by this time next week. There's no body shaming or blaming here. There's no guilt over taking two steps back or needed to shed some tears on day. That's not pelvic health. That's not good PT in itself no matter what you are doing there.

Corinne, Lacy, and Colleen renovating my kitchen soon after moving home and starting my career. These girls were my mentors first year out and came to visit me when I got home from UNC after my vagina surgery. They still mock my "waddle" that I was instructed to do when I got out of bed to use the bathroom.

We don't look so pretty here but we are genuinely enjoying each other's company. The road is sometimes full of dust and oil-based paint (that may or may not have made Colleen sick that day) but in the end, it's worth the time and effort.
Also - I took them for Exxon yogurt after this so they did get something out of it. :) 

Look, I've been in that purple chair before. I have been the patient with the tears feeling ashamed that I can't have sex with my spouse because there's something "wrong" with me. I get it. I've been the new mom, the not so new mom, the one with the crazy tear in the vagina after a vaginal birth and the one with the healing C-section scar nursing twin infants. I have been the student on the treatment table half naked while two other students who know nothing about what they are doing poke around in my vagina or rectum as they learn the new techniques to treat actual patients. I've been the one in yoga scared to do three legged dog because I don't trust my pelvic floor to keep everything in and the one at the end of the marathon with urine soaked running pants because my pelvic floor was dysfunctional. There's nothing we do in my little room that I haven't experienced on myself before. I say this not to make people uncomfortable, but to assure you that on some level, I get it. No matter what you are going through, I do get it, even if it's just a little portion of what you are going through. Every story is different. Every journey is different. Every person is different. But my goal is to make sure everyone walks out of the room feeling like they are not alone. That on some level, there's someone who gets it. Feeling confident that there are other people out there dealing with whatever it is they are dealing with, even if they may not have found them yet. Because y'all, I can assure you that whatever embarrassing physical issue you have "down low" is also being experienced by someone else right now. Probably someone you know, maybe even someone you know well. Because as I've said before NO ONE TALKS ABOUT IT.

Duke graduation, getting hooded. I was deep in my pelvic pain journey here but had the courage at the time (not realizing then that it DID take some courage) to take the Women's Health elective and start learning about how to help other women. 

But I talk about it, WE talk about it. We talk about it together with honesty, open mindedness, kindness, and grace. In the pretty room. Because when you talk about these things it should feel safe and unlike a hospital or procedure room. It's clean, it's professional, but it's different, because my hope is that you finish physical therapy and feel empowered, educated, emboldened, and that you know a place for healing that you can come back to should you need it again - this time without fear. Maybe even with a little eagerness, because Pelvic Health is just SO AWESOME y'all. I promise.


Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

On Grief and the Pelvis

Grief. While it's not something new to me having been on this earth from 35 years, at the moment I feel like I am heavily influenced by it. To be honest, I have been luckier than many people in that I haven't lost too many loved ones or been through nearly as much as many have at this point in life. Right now though, at this moment in my life grief has dragged me down in a very real way. Years ago when we lost my grandfather I was terribly sad, but a part of my brain put the grief tightly in another space and locked it away. My attention was focused on trying to make sure my Nana was okay and then, within two months of Granddaddy passing, I was pregnant with our first child. It was the gift that we all needed and I threw all of myself into growing a human, then becoming a mother. A couple of years later our other first "baby," our little spaniel mix Charlotte passed. I had literally just given birth to our twins. They were two weeks old. I didn't have the emotional capacity to grieve her at that time. I loved that doggie, but at the time my grief was filed away somewhere deep because I couldn't face it. I was so tired, overwhelmed, beaten down by delivering the babies via C-section, nursing twins, and keeping up with a 2 year old. It was too much to handle so my brain kept it somewhere far from my consciousness.

In my little room in the corner of the clinic, I hear about and see so much grief. So much devastation and heartache. So much resilience and inspiration too, but a lot of sadness and sometimes trauma. Grief over the loss of a loved one, the loss of a baby, the loss of innocence. Grief over the inability to get pregnant or over a birth going very differently from the original birth plan. Grief over a hysterectomy or not being able to be intimate with a partner because of pain. So often, this grief has brought them here to see me. Because grief becomes pain. Like, literally, it can become pain in your body. It's almost, in a non scientific way of looking at it, like your heart can't take it all so it becomes physical pain because it has to go somewhere. Not for everyone of course, but very much for some.

I am a Pelvic Health PT. I deal with pain in places that people don't want to talk about, don't want to hear about, don't want to think about. I ask the questions that sometimes people don't want to answer because inside they know it'll bring more pain to talk about it. But honestly, to heal the pelvis, sometimes you have to heal the grief too. Not me I mean, because it takes a village, and most of the time they have many other people fighting for their healing as well - therapists, psychologists, psychiatrists, counselors, priests. But it is part of my job to explain to people how these feelings - these traumas and struggles, fears and emotional distress - contribute to their pain. It's a long story all about brain chemistry and chemicals circulating all through your body and leading to dysfunction, pain, then more dysfunction, then even more pain. Pain science is for real, and it's incredibly interesting. Typically we talk about stress and how this leads to pain, but often it's the grief that causes the stress. Because grief is no joke, and when your brain perceives that, it very often begins a vicious cycle that leads to pain. Sometimes just for a short term, but sometimes for years. Then, the pain makes you even more tired, more discouraged, more desperate and often depressed.

I tend to see people at their worst. They've often spent years in pain being passed from one practitioner to another and then as a last resort, they end up in this corner room with all the windows and sunlight flooding in, sitting there gripping the purple chair in either fear or desperation or just annoyance at yet another appointment to sit through. But my job is to try and bring hope, and we start by talking. We progress through ups and downs, setbacks and triumphs, laughter and tears. And so often, when we get to the bottom of the inevitable question of "why" it comes back to grief. What are you grieving? What happened, who is lost, what is lost, what is buried deep inside of you that brought you here? It's heavy stuff sometimes.

When my Nana died I was there, in the hallway, just then texting my husband an update and waiting for an NG tube to be placed, and then in the next moment the door flew open and the blue light flashed over the door and she was gone. This loss was the one that I couldn't tuck away, that wouldn't just shut itself in some little place in my brain again. This year I have grieved the enormous loss of one of the most special people in my whole world as well as the losses of my Granddaddy, my sweet little Charlotte dog, the growing up of my children, times lost with loved ones who couldn't be present for one reason or another, and friends who have moved on. Sometimes the weight of all of it makes me feel like I can hardly walk forward. And sometimes it's literally painful. My neck is full of trigger points and my back is aching more than usual. For others, it's pelvic pain. Painful intercourse, pain with sitting or with exercise.  It's a physical manifestation of deep pain that doesn't seem to know where else to go.

Lacy and Nana before a high school Christmas dance, c. 2000

Treating pelvic pain is a lot different than what I expected. Not because it's harder than other PT or because the pain is worse, but because many times people have no idea how the pain came about. It's not a sports injury or a slip on the ice. It's often a mystery. But so often, when we get deeper, there is something inside, in the past, that needed a place to go. In a way, experiencing this grief for nearly a year has been good for me, it's helped me to empathize in a different way with my patients, to understand the hurt in a way that I didn't before thanks to my brain's protective mechanisms. I had buried that away, but now it's always right here. So I get to relate to their pain in a way that I couldn't before. Yes, I too have had pelvic pain and yes, it was hard living with that for those years, but now I understand on a deeper level. Now I see not just how pain can cause grief, but how grief can cause pain.

*For more information on pain science, chronic pain, and more check the link in the blog above.

Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions
910-423-5350
lacy.kells@aptsnc.com

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Yoga and Pelvic Health - A Guest Post by Ashley Chandler PT, DPT

Today I am excited to feature a guest post by Dr. Ashley Chandler PT, DPT on Yoga and Pelvic Health PT. Ashley works at Advanced Physical Therapy Solutions with me and has begun to work in the pelvic health field more and more over the past few years. I am very thankful to have her help in writing about why yoga is an important part of pelvic health PT as well as jumping on the pelvic bandwagon with me! 

Pelvic floor dysfunction and yoga. They have such a great relationship with each other, the more I learn about both the more I think this.

Let's rewind.

I first met Lacy Kells at Duke University in 2006 when we both started our journey towards our doctorate in physical therapy. We became immediate friends and helped pull each other through the rigorous process that is PT school.

Lacy Kells, Ashley Chandler, and our dear friends from Duke
enjoying our reunion weekend in Charleston in 2017. 

  As we were winding down the academic portion of our schooling, we had to choose what elective we wanted to take. Lacy, without hesitation, knew that she would take the women's health elective. I wanted NOTHING to do with vaginas and decided to take the prosthetics and orthotics elective, about as far away from women's health as I could get. I felt no need to know what the pelvic floor was or did, thank-you-very-much.

Fast forward to 2015. Pregnant with my first baby and still mostly uninterested in working with pelvic floor patients. I gave birth in January 2016 with a lovely tear of my perineum. I had sensations of something "extra" in my vagina in the first few weeks following delivery, leading to a panicked text message in which Lacy told me to let myself heal and we'll figure it out when and if we need to. Luckily I have a pelvic health PT as my best friend, because my 6 week check with my delivering MD included a cursory look and a leading question of "everything is going well, right?" Yup, super fantastic (dripping with sarcasm). I'm still weak as can be but thank goodness the prolapse sensations had resolved for the most part.

This lit a fire under my butt to be able to offer other women better care than what I had received. It is ridiculous that my physician didn't complete a more careful examination. It wouldn't have taken long to ask me about leaking or tell me things to watch for and what to do about them (like go visit your friendly, local pelvic health PT for example). So I took matters into my own hands and decided to attend Hermann and Wallace's Level 1 course. Here we go, a weekend filled with giving and receiving internal exams. I don't think many professionals get this level of intimate encounters in their continuing education.

Around this time, Lacy came back into the clinic for more patient care and began seeing almost all pelvic health patients. I became her "assistant" or maybe apprentice is a better way to put it.

I have a background in chronic pain and happen to be a yoga instructor and had found a great relationship between the two, and I soon found that the same can be said of pelvic health and yoga.

To waaaaay oversimplify, the patients Lacy sent to me seemed to be either people who needed to relax the pelvic floor (usually those who are more pain driving and have pain with intercourse, pain with sitting, sometimes accompanied by leaking) and those who needed strengthening because of incontinence. Again, I way oversimplifying the many things that can be going on with a woman but it helped me make sense of things as I eased myself into the specialty.

I did a lot of research, began following a ton of people more experienced than me on social medial and began to find the connection between breathing and the pelvic floor. There is this beautiful dance that happens between the anterior abdominal wall, diaphragm and the pelvic floor. It happens with every breath we take and with pelvic patients I almost always found this to be altered. Luckily, I have been teaching yoga for years and yoga is very much about the breath.

Most fitness or functional cues I use have a yoga twist to them and I already started almost all my treatment sessions or plans of care by watching my patient or client breathe, so I was already very comfortable with this. Combining this with new knowledge of how the pelvic floor and the breathe work together and you get a naturally amazing relationship between pelvic floor dysfunction and yoga. Everything in yoga is tied to the breath and all movement in yoga uses your own body weight as resistance; both things we need to master for our body to work at its greatest potential. There is a component of relaxation, utilization of the parasympathetic nervous system (our relax and digest side) in every class taught which is paramount to happy pelvic floors. Yoga also builds strength, stability, and power. I have always used it in my PT practice, but now that I am becoming more and more involved in pelvic health, I am finding it even more essential. Yoga and pelvic PT definitely go hand in hand, in my totally biased opinion!

Ashley on her wedding day in 2008 in the midst of PT school with our three best friends from Duke, back
when she was totally sure she would NEVER treat vaginas.
#neversaynever 

Ashley Chandler is a certified lymphedema therapist in Fayetteville, NC who leads the oncology rehabilitation program at Advanced Physical Therapy Solutions.  She is also manual therapy certified and uses hands on care every day as she makes movement better for her patients. She has practiced yoga since 2002 and has been a yoga teacher for nearly 9 years and uses this daily in her clinical practice.  In her free time she enjoys the outdoors, traveling with her family, and baking the most delicious treats you've ever tasted. 

You can follow her on instagram @ashleychandleryoga, facebook at Ashley Chandler PT, DPT, CLT. Best of all she has a youtube channel with lots of short yoga flows that you know are safe since she's a Doctor of Physical Therapy AND a yoga instructor. 



Dr. Lacy Kells PT, DPT
The Physio Down Low @ Advanced Physical Therapy Solutions

Follow me on Facebook at Lacy Kells PT, DPT
and Instagram @lacykellspt

Book Club, Sand Dollars, and What They Have To Do With Pelvic Pain

My book club recently read a book called Present Over Perfect. The gist of it is about allowing yourself to be present in whatever season of life you are in rather than constantly striving for perfection in all things. I have actually finished the entire book but did appreciate the overall point. It has definitely helped me pause to enjoy more moments with my kids instead of obsessing over the cleanliness of my house and overflowing laundry hampers. I definitely need those reminders on a regular basis thanks to my type A personality and my anxiety (see my blog post on what anxiety does to your body here).

Present Over Perfect 
by Shauna Niequist with a glass
of wine and some chocolate

When I treat patients with pain, be it pelvic or pain elsewhere, they often have perfection in their heads. I get it, I have been there. If you need proof that I actually do get it, check out my blogs about my own pelvic pain journey HERE and HERE. It's easy to assume that your body is supposed to be perfect to work correctly. When you experience years of painful intercourse, it often takes an eternity to get it diagnosed. Over time, you start to fear that you'll never be fixed and that your body is getting worse and worse. I mean, let's be real, oftentimes it IS getting worse. When one area hurts your entire body can start to move differently. With chronic pain you get actual changes in your brain chemistry that makes you hurt even worse. It's a pretty awful cycle. Pelvic pain gets into your head and makes you question everything from your health to your marriage to your fertility. There is a big component of shame and embarrassment to pelvic pain with a desperate need to hide it. It's a different beast than when you hurt your ankle running. Again, I know this, I run marathons and I've had pelvic pain, and trust me when I say that for most people, pelvic pain is something entirely worse.

My husband and my imperfect self
 on a family road trip, almost
9 years since my pelvic pain
was healed! 

But here is what I tell people: Your body does not have to be perfect to work well. Let's repeat that one more time. You don't have to be perfect to work well, to be whole. In fact, our bodies were not meant to be perfect. If you look closely at your face in the mirror you'll notice asymmetries, little things that aren't quite perfect from one side of your face to the other. Guess what, that is NORMAL. It's what makes us beautiful and unique. Your body isn't made to be perfect symmetrical. Still, we get people in the clinic all the time who have been told that their "hips are off" or that "one shoulder is lower" and that that is what is causing their problems. Here's the thing though - that's how your body was made. It's meant to be a bit like that in most cases. Look at any elite athlete and watch them move. They are always going to have a side with more arm swing when they run, a dominant arm for shooting free throws, a leg that lets them do a few more pirouettes because they can balance better on it. It's normal. The problem is that in their heads "being off" means that they aren't working correctly. Look, sometimes that may be true. Sometimes the little things that are "off" are causing some problems, but most of us that's just how the body is made. You are not meant to be perfect.

Even so, when people come in to see me, they are terrified of their own bodies because they think their body has failed them in some way. They feel broken. I have felt that, it's so true. You end up feeling like even if the pain gets better your body still won't do what it is supposed to do and that you're doomed to a sexless marriage. Or if you think that maybe one day you'll get to have sex you but won't be able to run or exercise because your body is a failure. Or maybe you'll be able to exercise but definitely never ride a bike or sit through your kids' ballgame on the hard bleachers. There are lots of "buts" involved. (No pun intended there.) These thoughts and feelings are completely legitimate, pelvic pain is so scary because no one talks about it. However, there is so much hope.  Before you had pain your body functioned just fine. What needs to happen is not getting everything magically perfect, but instead re-teaching your body how it worked before. How to function well in all its imperfection. And you WILL function well again. It takes a lot of attention, specific training, tweaking of how you move, but it'll get better. It also helps once the ideal of perfection is officially out of your head. Because guess what, your body is going to work well without perfection.

With my friend Tracey after finishing my third marathon with
a ton of imperfections, my weak abs for one because of my
pregnancies.

Imperfect but whole and beautiful. 

On the beach this weekend I found some sand dollars. For me, sand dollars have a special meaning. Last summer I was in a very dark place and I was desperate for a sign of comfort. I had lost someone beloved to me and I was devastated. My blog isn't about religion, but I'll share that I believe in God and while running down the beach alone I started praying for a sign. I asked specifically a sand dollar because I had never in 35 years found one on the beach, ever. I knew it was wrong to pray for that but I did, like I said I was desperate. As I reached the end of the beach a perfectly formed sand dollar was lying in my direct path. For me, I knew it was my reminder that my loved one was okay. I know some people wouldn't agree, but it's my blog so I get the last word. Kidding. But technically I do. Anyway, this past weekend, 7 months after I found that first ever sand dollar I was running again on the same beach and found five sand dollars. It's that time of year for them to wash up I guess. But I chose to think of it as a sign of peace. However, this time, they weren't perfect. Not one of them was. But they were all whole. Let's read this once more - they were imperfect but whole. (Another but y'all.) Like me, like you. Like those of us suffering from pain. We will never be perfect, but our bodies are whole and our bodies will work well. Perfection is not attainable. Our hips aren't going to be perfectly symmetrical, our pelvic floor muscles aren't going to work the exact same on both sides. There may always be certain positions during intercourse that aren't the best for our bodies. But there will be others that are. There are ways to use our bodies that allow them to work well. Without being perfect.


My job is so amazing. I get to teach people how to be present in their imperfect bodies and accomplish the goals that are important to them. I get to take life lessons that I have learned from books, pain, and loss and use them for good. My past has had times of difficult, but those times get to be beautiful now because I have learned from them. All of these lessons translate into healing pelvic pain. Healing pelvic pain is complicated, it's challenging, it's lots of imperfection. BUT, it's not impossible. Every person deserves to learn how amazing their body is and learn to use it without pain. To see how beautiful it is in all its imperfection. To learn to be present over perfect.

Dr. Lacy Kells PT, DPT

The Physio Down Low

lacykells@gmail.com
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