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A Surgeon for the Pelvic Floor: Dream or Reality?

Abstract As surgeons, we have evolved from barber surgeons to superspecialists. In the future, the pelvic floor surgeon will be even more specialized and most likely cross-trained so there is true understanding of all aspects of pelvic floor disease. Probably more importantly, there will be a team for the pelvic floor, and pelvic floor problems will be addressed by a true multidisciplinary team with the surgeon as a major stockholder in this process. All aspects of care will evolve to comprehensively consider the entire pelvis along with the entire GI tract and nervous input. This chapter reflects my crystal ball for the future care of our pelvic floor patients. As surgeons, we all started as barber surgeons. Our tools were used to cut hair and then perform surgical procedures. As medical and surgical knowledge was advanced, we broke away from our barber heritage and concentrated on our surgical skills. Initially, surgeons were all generalists operating on the entire body. But the body is complex, and vast quantities of knowledge were deciphered for each specific region or organ system. With time, the combination of knowledge and technical demands were overwhelming for a true general surgeon, and therefore our predecessors began to focus their skills toward specific organ systems or regions. Thus, specialists were born. However, humans are curious and always striving to learn more and improve. Our knowledge and tools have exponentially advanced over the past 50 years, and superspecialists were needed as the problems continued to become more complex. The pelvis is one of those extremely complex regions of the body. It is unique being a box made from the boney pelvis with a floor made of muscle. Piercing that muscular floor are the urinary and bowel systems in men and women (additionally the vagina in women). We have learned that all of these pelvic systems are interrelated. Changes or compromise in one area can lead to a problem in another area. For optimal pelvic health, all regions must work individually and together as a unit. When looking at the treatment of pelvic disorders, we are at a crossroads that is steering us toward further specialization by the current health care specialists that treat this area of the body. The multiple surgical specialists that have a stake in its treatment include general surgeons, colorectal surgeons, gynecologists, urologists, and some other branches. Each of these disciplines many times work in isolation when assessing and treating their compartment of the pelvis. Ironically, this contradicts the pelvis being a unit with each compartment – anterior, middle, and posterior – interrelated. Additionally at many current symposiums and educational meetings, it is promoted as being essential for all healthcare providers treating pelvic disorders to work together and treat the pelvis as one entity. However in practice, this does not seem to be a uniform reality. Therefore, the future of pelvic healthcare requires this area be treated by a multidisciplinary team (just like occurs with rectal cancer) in order to provide optimal care. This will require surgeons treating disorders currently designated as “pelvic floor problems” to think broadly and in concert with all providers that participate in treatment and care for this region of the body. “Pelvic floor surgeons” may become true multidisciplinary surgeons. They could draw from the experience of each compartmentally trained surgeon (colorectal and general from the posterior compartment; obstetrical/gynecologists and urogynecologists from the middle compartment; and urologists and urogynecologists from the anterior compartment). This type of surgeon would be broadly trained and able to treat and operate on all aspects of the pelvis. Another option which may be more likely is that they will lead a genuine integrated multidisciplinary team with a common goal to provide expert care for the entire pelvis. While nobody knows how we will care for these patients in the future, I have taken this opportunity to think of my “wish list” and look into my crystal ball. The following are my thoughts about idealistic future care for our pelvic floor patients.

Herbs, Vitamins & Other Supplements

There are many products on the market that claim to burn fat. Some do it through raising your body
temperature, which ultimately raises the amount of calories you burn, even while at rest. Others boost
your liver function, resulting in greater amounts of fat being metabolized. And yet others raise your
heart rate which burns higher rates of calories.

The problem is knowing which ones are okay and which ones may hurt you. While no single pill is the answer to weight issues, there are some supplements that have been shown to help you in the process.

Natural Supplements to Consider
Three of the best natural weight loss supplements you should consider are:

Guggul – Originally used for medicinal reasons, this plant can help you drop six times more
weight, as that is the result of research when some participants took guggal and others took a
Herbs, Vitamins & Other Supplements

Green tea – Because its caffeine speeds up your body and makes you less hungry, green tea is
great for weight loss. Additionally, it contains phytonutrients which, according to The
American Journal of Clinical Nutrition, can help you get rid of double the weight of non-tea

Dandelion – This natural substance helps promote liver function which increases your body’s
ability to metabolize fat. Additionally, it also helps your body to release excess water.
Of course, there are many other options as well, but they’re not as well researched. According to
WebMD, they are:

Chitosan – A sugar found in the hard layer on the outside of shellfish such as lobster, crab and
shrimp and is said to stop absorption of cholesterol and fat.

Chromium Picolinate – A mineral that boosts insulin activity which ultimately raises your

Conjugated Linoleic Acid (CLA) – Chemical components found in linoleic acid that are
thought to get rid of fat and reduce hunger.

Glucomannan – A derivative of the konjac plant that allegedly prohibits fat absorption

Please understand that just taking these herbs and not changing your food intake or exercise level isn’t going to help. They act as a supplement to healthy behaviors.

And, even products found in nature can be harmful. So, if you’re considering taking anything in an
attempt to assist your weight loss, make sure you talk to your doctor first.

Fitness Focus Tips

Benefits of Physical Activity: It can take some extra effort to stay active during cold winter months, but the benefits far outweigh the costs.

 The benefits of regular physical activity include:

  • Release of endorphins, which help our body combat stress and tension. 
  •  Increase of red and white blood cell production, contributing to a healthier immune system. 
  •  Weight management. 
  • Improved sleep. 
  •  Increased lean body mass. 
  •  Improved bone density which helps prevent osteoporosis. 
  •  Reduces feelings of seasonal depression and anxiety. 
The 2008 Physical Activity Guidelines for Americans recommends adults get at least 150 minutes of moderate-intensity physical activity per week. This includes the winter weeks. Get motivated by working out with friends or family, or find a "workout buddy," that will hold you accountable to daily workouts. Schedule your workouts on your calendar, and view each workout as a meeting with your boss or an important client. You wouldn't cancel that meeting, so don't cancel these. Enroll in an activity class at the local YMCA, rec center or yoga studio, where you pay up front, this will incentivize you to go to the scheduled classes. Try a new indoor class such as yoga, Pilates or Zumba, or try out a new indoor sport like tennis, racquetball, squash or swimming. If the weather is too frigid to leave home, find home workout DVDs at your local library, or find one online that can be downloaded or streamed directly to your computer. Often when we want to work out the least is when we need it the most. Remember, getting started is the hardest part, and you'll thank yourself once you’re done.

Fitness Focus Tips
Fitness Focus Tips

Fitness Focus: Stretch 
Stretching offers us a multitude of physical benefits, and it is an easy task to fit into your day. Do these two stretches seated. 1. Ankle Rotation: Sit with a tall spine, feet flat on the floor, calves at a 90 degree angle to thighs. Place your right ankle on your left knee. Rotate the ankle ten times clockwise and then ten times counterclockwise. Switch sides. Repeat. Helps to loosen your hips and increase blood flow through your legs. 2. Chair Cat/Cow: Move to the front of your chair, tall spine, feet flat on the ground. Place your hands on your knees, fingers pointed forward. Inhale, and with an exhale round your spine, drop your head down. On the next inhale, arch your back and lift your head. Flow through this movement a number of times   

Fitness Focus: Stand Up!
 There’s no argument that we’ve become a culture of sitters. We spend countless hours behind our steering wheels, we slump over keyboards and computer screens all day, and we unwind by plopping in front of our televisions. Much of this sitting is unavoidable. What you can do is simply stand more, when possible. Take 5 minute walking breaks every hour, or one minute standing breaks every half hour. If space is cramped, march in place. Challenge yourself to stand up every time you talk on the phone, or read all in-coming emails standing. Even simply adjusting your posture can help counteract the circulation and muscle deficits caused by constant sitting.  

Fitness Focus:Take the Stairs
 Perhaps the simplest yet still drastically underused exercise tool is hiding in your office stairwell. Stair-climbing has become the poster child for workplace wellness, and for good reason. Opting for climbing over riding can increase muscle power, strengthen your heart, lower cholesterol, relieve workday stress and dissipate midday energy depletion. Chances are, you work in a building with at least a few flights of stairs. Start skipping the elevator and utilize the stairwell for trips in and out of your office. First floor dwellers should start to take “stair breaks.” Set your watch for 5 or 10 minutes and do laps up and down the stairs. Need a challenge to get you started? Pledge to go elevator and escalator free for a week. Once you get started, you’ll never look back!  

Fitness Focus: Arm Exercises 
Maintain your muscular strength through the holidays by adding in these two arm exercises to your daily schedule: 
1. Bicep curls: Use a full water bottle, or substitute a stapler or paperweight. Sit tall, core muscles flexed, feet on the ground. Hold water bottle in your right hand, rotate the palm of your hand forward, and let your arm hang straight down. Tuck your elbow into your side and curl the water bottle up towards your shoulder. Repeat 15 times both sides. The slower the better on this movement. 
2. Arm Lifts: Sit in the same position as for bicep curl. Hold water bottle in right hand, arm hanging straight down, elbow into side, this time face your palm towards your side body. Inhale and on an exhale raise your right arm up, straight out to the side until it is parallel with your shoulder. Inhale, release back down. Repeat 15 times each side.  

Fitness Focus: More Stretches 
Stretching throughout the workday can help combat neck strain, muscle stiffness and headaches, along with numerous other workplace ailments. Try neck stretches. Sit upright without letting your back touch your chair. Align your head directly over your spine. Inhale, and on the exhale, drop your right ear toward your right shoulder. Relax your right shoulder away from your ear. Move ear to shoulder, not shoulder to ear. Hold the pose for ten long breathes, feeling the stretch on the left side of your neck. Slowly lift your head and then switch sides. Repeat often. 

Fitness Focus: Low Back Stretches 
To release locked back muscles practice chair twists. Sit towards the front of your chair, thighs together, knees pointed forward, and feet flat on the ground. Inhale, stretch both arms up, exhale, lower and grab the left back of your chair, or the left arm rest, with your left hand. Rest your right hand on your outer left thigh or on the desk in front of you, as you twist to the left. Hold for five to ten breaths. Inhale raise arms up and back to center, then exhale switch sides and twist to the right. Make sure to relax shoulders away from ears, breathe into your rib cage and engage your lower abdomen muscles. 

Fitness Focus: 20 Minute Ideas 
Just because there isn't time to make it to the gym for an hour workout doesn't mean you can't fit in 20 minutes of home cardio or muscle training. If you have access to a home computer there are a number of free home workout videos you can use. Try this one for lower body: 5 Minute Lower Body, and this one for upper body: 10 Minute Upper Body. Additionally jumping jacks, running in place, push-ups, holding plank position, hopping in place, stationary squats, lunges and marching in place are all home activities that can help you stay on track this holiday season. Remember, workouts don't need to be long to be beneficial. Every little bit helps 

Fitness Focus: Chair Squats 
Being active at work doesn’t have to mean leaving your desk. Try this chair squat exercise. Sit on the edge of your chair with your feet planted firmly on the floor shoulder width apart. Raise your arms up in front of you parallel with the floor. Exhale; push yourself up to a standing position. Inhale, start sitting again, gently touch the seat with your bottom, but do not fully sit down. Exhale stand back up. Repeat 10 times, or for one minute. Helpful Hint: Relax your shoulders, and try not to clench your jaw. Use your leg muscles not your face muscles. Calorie Alert: Set an alarm to repeat this throughout the day. To burn off enough calories for one of your favorite cookies repeat 5 times  

Fitness Focus: Midday Yoga 
When your brain feels like it's bursting from overflowing emails, endless meetings, spreadsheets and to-do lists, a few midday yoga movements might be the cure. Calm Eyes: Sit comfortably, spine tall, shoulders relax down your back. Rub the palms of your hands together quickly to create heat. Close your eyes, press heels of hands into eyelids, rest fingers against forehead. Stay here for 3 long deep breathes. Four-Count Breathing: In your seated position, inhale through your nose on a slow count of 4, at the top of your inhale, hold your breath for four counts, and then exhale through your nose for 4 counts. Repeat ten times. Standing Forward Bend: Stand up tall with shoulder aligned with your hips. Bend knees slightly, and fold your torso gently forward. Let your head hang heavy, taking all effort out of your neck. Grab for opposite elbows and gently sway side to side. Stay here for ten long, deep breaths, and then inhale slowly and roll up. Exhale, you’re ready to head back to work.  

Why Water is Fundamental to Weight Loss-How To Lose 10 Pounds In A Week

When it comes to weight loss, drinking water helps to melt the fat!

The Advantages of Water
Your life would cease to exist if your water supply was cut off, so your body gets defensive when it
doesn’t get the amount it needs. We covered that briefly when we talked about bloating, which is when your body retains water if it feels dehydrated.

That’s why it’s important to consume more water if you feel like you’re retaining it. Once your body
gets the amount it needs, it will be comfortable enough to let the excess go. The result is a lower weight and smaller waist.

How do you know if you’re bloated? When you make a fist, does your skin get tight? Can you clearly
see where your rings are worn? If you answered yes, then you probably need to drink more water.

Water also helps the vitamins and minerals that you consume get to the cells via your blood stream. So, if you’re not drinking enough, they don’t move as easily throughout your body, thereby causing you to not be as healthy as you can be.
Why Water is Fundamental to Weight Loss-How To Lose 10 Pounds In A Week
How To Lose 10 Pounds In A Week

Lastly, water is necessary for all your vital organs to work as intended. For example, your kidneys need water to flush out the toxins. If they don’t get enough water to do so, they rely on the liver for help. Since the liver is so busy filling in for the kidneys, it can’t do its main job, which is metabolize fat.

You see, when your body runs efficiently and effectively, you will burn fat at a higher rate. Put simply, drink water and drop pounds!

What’s an Appropriate Water Intake?
The best thing you can do for your body is drink at least eight 8 ounce glasses of water, or one ounce
for every two pounds you weigh. So, for example, if you weigh 150 pounds, you would want 75 ounces of water a day. And, if you sweat a lot or have a health condition like diabetes, you’ll likely need even more.

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