FAQ for Pelvic rehabilitation

1. What to expect at your 1^st appointment: you will 1^st fill out a questionnaire specific to your condition such as incontinence, pregnancy pain, tail bone pain, constipation etc. Please fill it out with as much detail to help your therapist. You will also sign a consent to treat form.
2. You will change into a gown and the initial evaluation will include a spinal/ pelvic alignment analysis ( alignment/ posture is everything!!!), visual inspection of your perineum, palpation of your abdominal area and muscles in your hips which attach to the groin. You may need an internal vaginal exam or rectal exam. DON’T WORRY its not like at the doctors when they use a speculum. I just gently feel the muscles internally with a gloved finger. I will instruct you to cough, bare down, move a leg so I can feel what the muscles are doing at the attachment internally. If the muscle is spasmed with relax and lengthen it, if the muscle is weak then we strengthen it.
3. I may use the surface electromyogram SEMG machine: I place small electrodes near your anus/ vagina to see the electrical output made by the muscle when you perform a contraction. Or I may use the real time ultrasound to see a picture of your bladder, uterus, rectum and pelvic floor muscles so I can see what they are doing when you perform a contraction. This will help the patients to see and feel themselves do a correct pelvic contraction so they can replicate it at home when doing their home ex program.
4. You will get home exercises and you must do them!!!!!!!! I can only help patient that help themselves.
5. We have to set goals that are functional and measurable. Insurances will not reimburse for therapy just for pain. We must set goals such as the following: “ to decrease pain in the tailbone area from 8/10 to 3/10 so patient can tolerate her 30 minute drive to work” , “ patients goal is to increase pelvic floor muscle strength from 3/5 to 5/5 to eliminate urinary leakage in public and eliminate need for incontinence pads” or “ to decrease adhesions in the lower abdominal cavity to increase circulation/ decrease inflammation in order to normalize stool consistency from a Bristol grade of 6 to a 4 and eliminate need for stool softeners”. To attain these goals it may take 4 weeks or for some it may take 6 months. As long as we show progress we can continue therapy. (some insurance limitations apply) If progress plateaus I must discharge the patient and refer them back to their physician.
6. Therapy sessions can be from 45 mins to 60 mins depending on patients tolerance. Therapy will change from session to session based on progress or flare-ups. Patients are usually seen 1-2x a week for 6 to 8 weeks then reassess.
7. Emphasis of physical therapy is to teach the patient how to be independent with their self management of symptoms.

 

 FAQ for lymphedema

1. At your initial evaluation day please wear something loose so I can easily push the garment up and out of the way. Only patients with lymphedema of the breast and groin have to undress and change into a gown.
2. Patients with lymphedema of the legs must bring shoes that are a size bigger so they will accommodate the wraps on the feet.
3. Your limbs will be measured so we can keep tract of the swelling. We can manage lymphedema swelling but you will have some good days and some bad days depending on what you ate, what you drank, hot how and how humid it is. Therapy will decrease the girth/ swelling in the limb as much as possible. Therapy will decrease the stiffness and harness of the skin. I will teach you how to manage the swelling so you will have more good days than bad.
4. Goal of therapy is to teach the patient to manage and contain the swelling, so they can walk better, be more independent at home. Also to decrease risk of infections and wounds.
5. You will start with compression wraps in therapy and will progress to a compression garment such as a compression stocking, sleeve, glove for maintenance once discharged from therapy.
6. The patient and therapist will determine together what compression garment will work best for them. The therapist will tell you where to order your garment and what size when the time is right.
7. Your schedule for lymphedema therapy will depend on the severity of your condition and your ability to come to therapy.
8. Patients are usually seen daily for 60 mins for a 1-2 weeks. Treatment will consist of manual lymphatic drainage, scar tissue release, therapeutic/ decongestive exercises, compression wrapping and home ex. Once the limb is as small as we can get it, you will be measured for a compression garment. Therapy may decrease to 2x a week for 1-2 weeks to make sure the compression garment is containing your swelling.
9. Medicare and AARP do not cover compression garments. Private PPO insurance might cover them but to get authorization for them takes weeks. For private insurances will order from SUNMED ( 1800-714-7434)a third party company that will fight with your insurance to get coverage.

Butterfields pharmacy, Oxy pro, Perkins do not accept insurance. You will have to pay cash and try to get reimbursed by your insurance yourself. I will get the prescription from your doctor for you.

During the initial evaluation if the patient agrees to the plan of care, upon returning to therapy the next visit all lymphedema patients must deposit $100.00 cash with the therapist to be used for compression garments once the patient is ready. The therapist will hold the $100.00 to be used at any DME store the patient wishes to purchase their stocking, or to be used for copay if going through SUNMED ( if insurance is going to pay).

This policy is to ensure the patient will purchase compression garments and be compliant with therapy. There is no point in doing lymphedema therapy if the patient will not wear compression garments once discharged.

10. Patients must purchase their 1^st garment to prevent swelling from returning while waiting to see if an insurance will cover it.
11. Lymphedema patients will need to come back to therapy once a year for a tune up and to see if the compression garments are working.