Wednesday, February 17, 2016

Product Review--PELVINN Kegel Exercise Weights

Product Review--PELVINN Kegel Exercise Weights:



I purchased this Kegel Exercise Weight set in April of 2015 and have been using them ever since-- so for 10 months now. There are many different shapes and styles of weights on the market. I chose these because the shape looked like it would be comfortable and I liked the fact I could easily increase the difficulty by selecting a heavier weight.  These were my first attempt at a kegel exerciser. I knew my muscles were week, but I didn't want to spend $150+ on some gadget. At $30-40, this felt like a less risky investment. Here is an example of them on Amazon


The weights are a smooth plastic with a string at the end to help remove. There is a free phone app designed to use with them. It is called Kegels4me. I've taken a few screenshots but it is essentially just a timer. It does allow you to record which weight you used and how difficult you found the workout each time, but it is pretty crude.





I started using the weights for 15 minutes every morning and evening. At first I was surprised that I couldn't even hold the lightest weight for the full time. I'd have to push it back in a few times when it started slipping. But it didn't take long before I could hold it, then I'd switch to the next weight up. I always stand while using them-- sitting down would be pointless-- and at first I had to stand still. But once I started getting stronger I found I could walk around without losing hold. That made it easier to get my 15 min because I could do it while I got ready in the morning and then while getting ready for bed at night.

Once I got to the heaviest weight, I experimented with leaving it in longer and also with attaching additional weight to the string to make it heavier.  But found this more trouble than it was worth.  I'm to the point now where I can do a whole aerobics video with it in. I'm quite satisfied with my muscle strength now but continue to use the heaviest weight 15 min a day for maintenance.

It's an incredibly simple thing to use, and I've seen huge changes in my pelvic muscles. I don't understand why Kegel weights are not more popular.  I have struggled with urethral spasms for years and they are finally under control thanks to getting my muscle tone back. I HIGHLY recommend the use of Kegel weights.
Illustration of size relative to a typical tampon
As to these weights in particular, I've generally been satisfied. They insert easily and are comfortable. I don't need lubricant.My only real complaint is the seam in the center. For one thing, it is a little bit rough feeling when you are inserting. But more of a concern, it makes the weights hard to clean.


The rest of the surface can easily be cleaned with soap and water and occasionally some rubbing alcohol, but I find crud accumulates in the crack that takes special care to remove. The only other complaint is that the end where the string attaches is pretty wimpy. I've had several break. That might be due to me dropping them on the floor (which does occasionally happen). But this isn't a big deal because frankly you don't need the string to be able to pull it out.
Weight with broken end

Monday, February 15, 2016

Why I won't be having a mammogram

I'm getting close to that age where mammograms start getting recommended. While learning more about cancer testing, we thought we'd learn more about them. I've always heard that mammograms are terribly uncomfortable. Think about it, the try to squish your breast in a vise. What fun. So are they worth it?

The first thing that scares me about mammograms is the amount of radiation involved.

We all know that x-ray radiation can cause cancer.  No medical professional will deny this. Thus the lead apron at the dentist.  Controls about who is near x-ray machines (even family support).  And so on.   With that in mind think about this:

According to the ANS a mammogram has 4 times the amount of radiation as a chest x-ray 1.  And it's fully concentrated on the breast!  Should I routinely blast my vulnerable breast cells with high levels of x-ray radiation, to prevent cancer? It's like they are thinking "we'll keep on x-raying until we find something"  And if they keep x-raying they'll make something and then yes they will find it.  

Be wary of anyone recommending mammograms that simply state the amount of radiation is "small".  Or other vague or subjective terms.  If they are afraid to quantify the amount of radiation then they aren't being open about the potential harm.

The Second thing that scares me is the false positives.

"Approximately 50% of women screened annually for 10 years in the United States will experience a false positive, of whom 7% to 17% will have biopsies".2 A breast biopsy isn't the worst thing in the world, but it still isn't pleasant. Worse yet is the fear associated with it. You get that dreadful panic for the week or two between the worrisome mammogram and the biopsy when you are literally afraid for your life. I've seen friends go through it. It isn't pretty.

Another aspect, and this one was definitely news to me, it is possible to have small cancerous lumps in the breast which go away on their own untreated! Sometimes, these cancerous cells that must be found through a mammogram, because they are too small to be noticed or symptomatic, are not actually dangerous! Sometimes the body can make the necessary corrections on its own.3 So detecting them "early" with a mammogram leads to unnecessary invasive treatments-- mastectomies, radiation, chemotherapy-- and once again, terror. And those treatments in and of themselves can be life-threatening.

"Of all breast cancers detected by screening mammograms, up to 54% are estimated to be results of overdiagnosis." 2


Am I suggesting that no one should ever be tested?

Of course not. If you detect an abnormality, by all means you should get it checked out. I'm wanting to have people consider is routine testing of healthy people with no symptoms. Rather than giving these blanket recommendations, we should be given factual information about the risks and benefits so we could make educated decisions for our personal situations.

There are alternative Screenings.

And there are also alternatives to mammograms, although you rarely hear about them. Ultrasound is also effective at testing for breast cancer-- without the discomfort or the intense radiation.

So why are mammograms pushed so heavily?

It is a big industry and in a lot of ways it is all about the money.  If the number of  mammograms was eliminated or reduced people would lose their jobs. Hospitals would not be able to recoup the money they spent on their expensive machines.4


More articles on Mammograms:

"experts now advise against mammograms"
http://articles.mercola.com/sites/articles/archive/2012/03/03/experts-say-avoid-mammograms.aspx

"Evidence also suggests that risk of breast cancer caused by exposure to mammography radiation may be greatly underestimated"
http://www.breastcancerfund.org/clear-science/radiation-chemicals-and-breast-cancer/ionizing-radiation.html?referrer=https://www.google.com/

"The shocking truth about cancer tests"
http://drjockers.com/new-research-reveals-how-dangerous-mammograms-are/

References:
1. ANS radiation dose chart: http://www.ans.org/pi/resources/dosechart/
2. http://www.cancer.gov/types/breast/hp/breast-screening-pdq#section/all
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320224/
4. http://www.whyisamericanhealthcaresoexpensive.blogspot.com/2012/11/mammogram-screening-reconsidering.html

Friday, December 4, 2015

Dr. Kegel Cliffnotes

While Dr. Kegel's paper is very informative, it is also exhausting reading. Here's my layman's attempt at summarizing it:


A Nonsurgical Method of Increasing the Tone of Sphincters and their Supporting Structures

ARNOLD H. KEGEL, M.D., F.A.C.S.
Assistant Professor of Gynecology
University of Southern California School of Medicine

1948
 
Background
Through experience as a surgeon and research with cadavers, Dr. Kegel had noted that the pelvic muscles of women were often weak and thin from disuse. He theorized that just as we exercise other body parts to tone and improve the strength of weak muscles, surely there must be a way to repair these muscles that way as well-- instead of resorting to surgery, which was not effective long-term anyway.

He focused his attention on the pubococcygeus, nicknamed PG. He describes it as the most versatile muscle in the human body. It helps support all the pelvic organs, helps the muscles that control the openings, and is essential for maintaining the tone of the other pelvic muscles. The PG gives off countless fibers which interlock and insert themselves into the muscles of the urethra, middle third of the vagina and rectum.


When a patient's organs were in the right positions, the PG and its components would be found to be well developed. When the muscles were weak and thin, symptoms like uterine prolapse (uterus falling down), incontinence and sexual disfunction would occur. The next step is to test whether a patient can voluntarily contract various muscle groups. First he would have them retract and draw in the perineum (the diamond-shaped area corresponding to the outlet of the pelvis, containing the anus and vulva.) Next, the index finger is inserted to the middle third of the vagina (as above) and the patient is asked to squeeze it. A normal patient can immediately respond with a firm grip felt over a wide area. Others will state that they didn't know it was possible to contract those muscles. These patients will have the most weakened muscles.



Dr. Kegel would quantify this response using a device he developed called a Perineometer. It was inserted in the vagina and could measure the pressure exerted by contractions of the vaginal muscles. In a well developed vagina, a slight rise in pressure is detected when the device is inserted, without any patient effort. In weakened patients, this initial pressure is much lower. The pressure change caused by intentional contractions were then measured. Strong, immediate increases in pressure indicated a strong, well-developed PG. A weakened PG resulted in small or even imperceptible increases in pressure with attempted contraction.



Therapy
He points out that it is super important while doing these movements to make sure the patient is actually contracting the PG muscles and not just the muscles around the outer edges of the openings. He points out that women with poor PG function have compensated all their lives by depending on these external, surface muscles. So the goal is to focus more inward and upward, so that the inserted finger feels the contractions as these movements are made.
 
Most patients can learn pretty quickly to find these muscles, but some may require weeks of this practice. There is no point in further therapy until this can be done.

Diagnosis
A firm vaginal canal indicates that the fibers of the PG are well developed. Loss of tone and and prolapse of the vaginal walls indicates that the PG fibers are weak and thin. You can test the vaginal muscles by inserting an index finger into the vagina, up to about the second joint, so that you are feeling the middle third of the vagina. In a normal vagina, the canal is tight and the tissue resists from all directions. The walls naturally close around the finger. The walls feel firm and deeply attached to the surrounding tissue. On the other hand, if the middle of the vagina is roomy in all directions, regardless of whether the opening is wide or tight, and the walls offer little resistance to touch and feel thin and loose, this indicates that the PG fibers have weakened from lack of use. 

Education
The first step in therapy is to help the patient find and learn to activate the muscles. He found that 1/3 of patients could not contract their PG voluntarily on the first visit. He would use a process of pushing with a finger at different internal locations to prompt the patient to contract the correct muscles. He'd basically find a connected muscle that they could contract and then work from there towards the PG. This teaches the patient to find and feel these disused muscles. For continued practice, the patient is directed to squeeze the inserted finger, draw up and in the perineum, draw up the rectum as though checking a bowel movement and contract as though interrupting the flow of urine. 
 

Resistive Exercise
Dr. Kegel felt that patients were unlikely on their own to be able do continue to use the correct muscles without help and supervision. He also felt that without measurable results, they were likely to become discouraged and stop exercising. So he recommended his Perineometer for contraction practice at home. It provided resistance to the muscles that needed strengthening and provided measurable results. Patients were advices to use the device for 20 minutes, 3 times a day. They were also encouraged to do additional contractions without the device throughout the day. He found that 50% of patients would slip back into their old habit of using the external muscles, so he recommended weekly appointments for the first month to firmly establish proper technique. He found that most complaints of fatigue and aching muscles were due to improper technique. 

Results
Patients who dutifully did their exercises experienced the following changes: stronger and more sustained contractions, thicker muscles throughout the pelvic area, improved positioning of the pelvic organs, firmer and longer vaginal walls, and reduced uterus prolapse. Patients with urinary incontinence showed dramatic results. 212 patients with severe urinary stress incontinence were treated and 84% were able to establish good urinary control through the therapy. 

The widest application is for women with genital relaxation after childbirth since 30% of women complain of this condition. Previously, women had to just suffer through symptoms until after menopause when surgical intervention would be recommended. Dr. Kegel found that progress was a slower with these cases, probably because since their symptoms were less debilitating they are less motivated and more haphazard in their exercise. But patients who were diligent felt improvement after 2-4 weeks of exercise but exercises needed to be continued longer to build lasting, structural changes. 

Preventative use
Pelvic resistance exercise during pregnancy builds thicker, stronger muscles, resulting in easier postpardum repair and less postpardum relaxation.

Exercise is also recommended after any pelvic surgery to help return muscles to working condition.
 
Conclusion
I noticed this statement in his conclusion, "On the basis of therapeutic results achieved, it seems possible that other ill-defined complaints referable to the genital tract in women might profitably be studied from the standpoint of muscular dysfunction." 

 REFERENCES:
 Anson, Barry J. Atlas of Human Anotomy. Philadelphia: W.B. Saunders Company, 1950
 Bushnell, Lowell F.: Physiologic Prevention of Postpartal Relaxation of Genital Muscles. West. J. Surg., Obst & Gynec. 98: 66-67, February, 1950
 Counsellor, Virgil S.: Methods and Technics for Surgical Correction of Stress Incontinence, J.A.M.A.46: 27-30, May 3, 1951.
 Curtis, Arthur HJ., Anson, Barry J., and McVay, Chester B.: The Anatomy of the Pelvic and Urogenital Diaphragms in Relation to Urethrocele and Cystocele. Surg., Gynec. & Obst. 68: 161-166, February, 1939
 Jones, Edward Gomer: The Role of Active Exercise in Pelvic Muscle Physiology. West. J. Surg., Obst. & Gynec. 58: 1-10, January, 1990
 Kegel, Arnold H.: The Nonsurgical Treatment of Genital Relaxation, West, Med & Surg. 31: 213-216, May, 1948
 Kegel, Arnold H.: Progressive Resistance Exercise to the Functional Restoration of the Perineal Muscles. Am. J. Obst. & Gynec. 56: 238-248, August, 1948.
 Kegel, Arnold H.: The Physiologic Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence. West, J. Surg., Obst. & Gynec. 57: 527-535, November, 1949
 Kegel, Arnold H.: Active Exercise of the Pubococcygeus Muscle. Meigs, J.V., and Sturgis, S .H., editors: Progress in Gynecology, vol. II, New York: Grune & Stratton, 1930, pp. 778-792
 Kegel, Arnold H.: Physiologic Therapy for Urinary Stress Incontinence. To be published in J.A.M.A.
 Kegel, Arnold H., and Powell, Tracy O.: The Physiologic Treatment of Urinary Stress Incontinence. J. Urol 63: 808-813, May, 1990
 Read, Charles D.: The Treatment of Stress Incontinence of Urine. Meigs. J.V., and Sturgis, S.H., editors: Progress in Gynecology, vol II, New York: Grune & Stratton, 1950, 690-697
 Collins, Conrad G.: Chicago Med., Soc. Bull. 241-246, October 13, 1931
 Source: Arnold H. Kegel, MD, FACS. Stress Incontinence and Genital Relaxation. CIBA Clinical Symposia, Feb-Mar 1952, Vol. 4, No. 2, pages 35-52.
Am. J. Obst. & Gynec. Aug 1948. “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles.” Dr. Arnold H. Kegel, MD FACS





Sources for the orginal content:

GyneFlex
Do the Kegel