MTRF by GCNY Marketing

Manhattan www.mtrfny.org Tel. 718.285.0588 Fax. 718.285.9323

Therapeutic RESEARCH

FOUNDATION

Journal

Year 1 . Issue 1

The Center for Excellence in Therapeutic Health

2 3 4 5 6

The Health Resource and Marketing Corner News & Events

Dyspareunia A Painful Despair

The Manhattan Therapeutic Research Foundation (MTRF) proudly anticipates the launching of its first comprehensive therapeutic facility designed to offer wrap around services in sexual and pelvic health. In addition to traditional physical therapy, The Center for Excellence in Therapeutic Health will offer men and women physical, emotional and nutritional treatment for the various disorders that comprise pelvic floor dysfunction and sexual dysfunction such as, but not limited to, interstitial cystitis, organ prolapse, incontinence and vulvodynia.

The Center was conceived with two purposes in mind; to provide a comprehensive one stop shop treatment center for pelvic floor disorders and sexual dysfunction, and to offer affordable and/or free health services, education and outreach to the public at large. In addition, the Center will also act as the springboard for the therapeutic research that MTRF will contribute to the field of pelvic floor disorders. The Center is proud to introduce as part of its team, RPT, Ian Mari Micabalo, formally Director and Founder of Corework Pilates and Rehabilitation Center in Davao, Phillipines, Barbara > Continued on page 6

The Health Care Overhaul

Pelvic Floor Exercises Part 1

Editor: Christine Lawson Corporate Secretary

christinelawson@mtrfny.org

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Presidents Corner Healthcare is universal language to all people in need of service. This present administration is formulating a reform plan to further curb healthcare costs over the long term, while investing in quality improvements consumer, protection and premium assistance. If this plan works, a lot of under privilege healthcare needy will be benefited. As a President/ CEO of Manhattan Therapeutic Research Foundation our main objective is to focus on the value of human lives through discovery, rehabilitation, experiment, enhancement, and education in the field of science, medicine, and therapy. The officers and staff of Manhattan Therapeutic Research Foundation will do our best to give our share of contributions, knowledge, expertise, and discoveries in treatment of sickness, > Continued on page 2

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The Health Resource and Marketing Corner:

A commitment to Quality, Care and a Nurturing Environment

Life as a healthcare professional in a city like New York can be a tough, exhausting and often impersonal experience. For example, it is not unusual or shocking that a physical therapist, may be faced in treating up to sixty patient a day, only be further expected to handle billing and related administrative duties especially if they are a direct provider. Most will have time merely to get home, attend to family, if the case, and prepare for the next day. In contrary to such pressure, health care professionals are sought upon by patients and employers to provide reassurance, treatment and quality care, negating everything that surrounds them. Added to that is the fact that many work weekends, double shifts or highly unusual hours. The administrative team at Manhattan Therapeutic Research Foundation recognizes the stresses that many

in the health field experience. It is a core belief of our foundation that only when our health providers are well cared for, both physically and mentally, will they in turn be able to make a difference in the care and treatment of their patients. We strive for care that goes beyond procedures and office etiquette. Our goal is that our health team provide for patients as if they were their own family. We recognize that quality care starts from the top, from the administration. The following are some basic descriptions about we expect of our health care professionals as well as what we offer to them. • We seek health care professionals with who have hands on experience; those who have worked with actual injury and treatment. • In addition to offering treatment, our health staff should be willing to offer findings based upon their

experience

• Providers should be willing to attend lectures, seminars and engage in continuing education of which MTRF is willing to provide for. • Our pts are well exposed working with patients within the inner city as well as rural areas, with the sensitivity and capability of relating to and treating different populations and cultures. In turn we supplement our staff by: • O f f e r i n g full health benefits • conducting seminars for > Continued on page 8

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Presidents Corner

illnesses, and disorders. Furthermore, MTRF’s other purpose to provide services and healthcare is supporting government reform to enhance and development human lives. Healthcare is a universal language and each and every one of us have obligation to help and serve the needy and under privilege. This October 2009. I am proud to announce that we will open our new research and therapy facility, “CENTER FOR EXCELLENCE IN THERAPEUTIC HEALTH”. It will be managed and operated by Registered Physical Therapists, Doctors and Medical professionals. This facility will cater to people regardless of age, sex, race, nationality, religion, status and color. We will open this Center for public who needs to be treated and people who needs treatment. I honor God for giving me strength, wisdom and knowledge. We hope that everybody will support our cause. We will accept criticism, corrections, advice, and suggestions to improve ourselves. However, we will reject negative criticism that is not beneficial to our cause.

Jonathan Suarez c President/ CEO b

News

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Events

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Welcome to the Family

MTRF is excited to report that Marty Fernando is currently being petitioned and awaiting approval for the HIB visa. We look forward to have such an aspiring pt on board. Welcome Marty! Welcome also Ian Mari to the MTRF family. A highly accomplished PT provider in the field of pelvic floor issues namely, post partum distress, Ian has directed his own very successful facility in the Philippines focusing on the practice of Pilates. We are pleased to have Ian as the Director of pelvic floor disorders at the new Center for Excellence in Therapeutic Health. Congratulations to Jonathan Suarez on his first anniversary as President/CEO of MTRF. Jonathan successfully led the company from scratch to the current launching of The Center for Excellence in Therapeutic Health. MTRF welcomes Chloe Saavedra, daughter of pt Cielo Saavedra to the family. Chloe was born at Elmhurst hospital on August 26th 2009 weighing in at 6lbs 5 ounces. Congratulations Cielo and Chloe.

News The availability of the H1N1 vaccination is on schedule or ahead of schedule. There are two types of the vaccine available, the flu shot, an inactivated vaccine containing fragments of killed influenza virus, and a nasal spray, which is made using a weakened live flu virus. Vaccine makers began shipping H1N1 nasal spray to 21 states and the cities of New York, Chicago, Illinois, Los Angeles. The first round of these deliveries will be the nasal spray, which contains live virus and is recommended for people ages 2 to 49 with no existing health conditions. The spray is not recommended for pregnant women, children younger than 2 or people with health problems. The virus has been called ’striking’ on pregnant women. From the time the disease was discovered in April until the end of August, the pandemic has killed 28 pregnant women in the United States. Another 100 have required hospitalization in intensive care units. Public health officials are certain that flu activity in the U.S. is more prevalent this year than in previous years, with ‘substantial flu illness in virtually all states’.

Events

On the 4th of July, MTRF held its first welcoming and fundraising

concert. The Indie Day Music Festival led also in part by Ted Reyes of the Filipino Express, was held at the very trendy Crash Mansion in NYC. Notable performers were Alfa, Jason Castillo and, Bleud. Many from the Filipino American community enjoyed this energizing event. Sponsors included United Staffing Registry and Poptimes Magazine. On July 11th and 18th MTRF held the first seminar in pelvic floor disorders for our physical therapy staff. The seminars were presented by DPT Gopi Jhaveri of Metro SportsMed. The seminars were highly informative and extremely well prepared and presented by Ms. Jhaveri. The pt staff gained most valuable information which they will diligently be applying to our future practice of pelvic floor disorders. For those pts interested in certification programs for PFD, MTRF is willing to sponsor courses and accommodate for the time needed.

Future Events

In December, MTRF will be holding a blessing event for our new therapeutic facility, Center for Excellence in Therapeutic Health. Please stay informed for finalized detail regarding this joyous event. Contact Isabel Christian at 718285-0588 for further details.

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Dyspareunia

A Painful Despair

Dyspareunia, or sexual pain, until recently, has been a rather painful despair for many women. Although dyspareunia is not a new diagnosis, identifying the source of this pain is complex. Classically viewed as the result of either a medical or psychological cause, the more contemporary view acknowledges that psychosexual , relational, physiological and contextual factors all may have a role in sexual pain. Traditionally, women were sent from one gynecologist to another with little luck in finding an answer not to mention a treatment for their pain. Until recently, most women have experienced prolonged physical and psychological distress as a result. The Diagnostic and Statistical Manual of Mental Disorders, 4thed, text rev (DSM-IV-TR) published by the American Psychiatric Association, defines dyspareunia as pain that interferes with intercourse. This is an oddity because most disorders are defined by their symptoms rather than the activities they interfere with. However, new terminology is currently being developed to differentiate between different types of sexual pain. Specifically, two types of categories have been defined; namely provoked or unprovoked pain. Provoked pain may be found in mechanical stimuli such as penetration or other exterior sources such as trauma, sexual abuse, sports, childbirth or dermatological reasons. Unprovoked pain also known as chronic pain, is that pain which occurs without stimulation. This type of pain usually resides in the mind and manifests in a circular mental/phys-

ical syndrome. For example, a patient may have experienced trauma or pain in her history, such as sexual abuse, which produces fear of future pain. In the presence of fear, the muscles in the pelvic floor often contract and tense up which, alternately, will result in pain whether or not there is a physical reason. In this case. the pain develops a life of its own and becomes a chronic syndrome. Other factors adding to the sexual pain equation are urogenital atrophy usually as the result of post menopausal reduced estrogen levels and referred pain resulting from an alternate source of pain. Typically, sexual pain has been most commonly reported amongst distressed women in their 20â&#x20AC;&#x2122;s and 30â&#x20AC;&#x2122;s who are establishing their sexual lives and pre and post menopausal women as a result of hormonal shifts such as a reduction in estrogen. A third category reporting sexual pain is postpartum women, who have described their sexual pain as burning, cutting or radiating. These women have reported sexual and nonsexual triggers of their pain. However, as research has widened, it is more apparent that sexual pain has no boundaries in terms of age or history. Many patients today have become frustrated by the inability of health care practitioners who fail to provide an explanation for their sexual pain or who are simply dismissive. However, the fault is not entirely that of the practitioners. Research is still too inconclusive to provide solid and accurate answers for sexual pain. In most cases it seems that psychological and physical aspects resulting in sexual pain are intertwined

as opposed to one or the other. Comprehensive treatment for chronic sexual pain A positive development amidst the complexity of diagnosing sexual pain is that the treatment spectrum has increased proportionally. Experience is beginning to show that pain during intercourse can and should be assessed and treated as any other pain syndrome. Patients should receive an accurate and thorough assessment analyzing all aspects of the pain; location, quality, intensity, and duration. Activities that provoke pain or in which pain interferes should also be assessed. When treatment focuses on the immediate pain itself, a comprehensive treatment plan including a gynecologist, a mental health professional with training in sexuality, a physical therapist and often a dermatologist is the ultimate approach. Often the pathology of the pain cannot be identified. A dermatological evaluation can identify skin problems that may or may not be the source of the pain. Pelvic floor physical therapists deal primarily with incontinence, but work with the same pelvic muscles that are involved in sexual pain. Many have had success evaluating and treating sexual pain by working on the muscles that are the source of pain. Finally, as pain is ultimately in the brain, psychology is a major tool for addressing it. The involvement of a mental health professional is a key component of the comprehensive evaluation and treatment of the patient experiencing sexual pain.

The

Health Care

OVERHAUL

No doubt the debate is on and heated regarding Obama’s campaign to overhaul the current health care system. This is a highly complex and multilayered subject that involves not only the practice of health care itself, but also economics, politics and as well as moral and philosophical values. Major news covering resources such as the Times itself admits to the difficulty in thoroughly informing the public on hard to explain concepts such as ‘how spending $829 billion over ten years and adding 29 million people to health insurance rolls could save the government money in the long run’. Major analysts report that the phase to anticipate is when the many proposals in Congress are narrowed down to a single bill, although unclear when that may be. Nevertheless, in an attempt to help readers understand the basic ideas of Obama’s plan and what has been referred to as ‘the most consequential social policy debate since the creation of Medicare’, listed below is the general outline of the original propositions for the reformed health care system under President Obama. (Please also refer to the New York Times online blog, ‘Prescriptions’ together with a daily paper printed version to make better sense of the debate and to gain background information when needed.) Choices for all Americans The Obama Plan proposes to: • create a new insurance marketplace, the ‘Exchange’ that by 2013 will give Americans without access to affordable insurance and small businesses one-stop shopping for insurance where they can easily compare options based on price, benefits and quality. • provide new tax credits on a sliding scale to individuals and families that will limit how much of their income can be spent on premiums. • provide small businesses tax credits to offset costs of providing coverage for their workers and eligibility to enter the Exchange so that they have lower costs and more choices for covering their employees. • offer a voluntary public health insurance option to those who cannot find affordable coverage. Obama believes this option will promote competition, hold insurance companies accountable and assure affordable choices. • will make coverage available imme-

diately for those have fallen through the cracks due to pre-existing conditions, without a mark up in price. This ‘high risk’ policy will temporarily protect individuals and families against financial ruin until the Exchange becomes available in 2013, offering a wider array of choices. Overall increased stability and security The Obama Plan proposes to: • end discrimination against people with pre-existing conditions. It will be against the law for insurance companies to deny coverage for health reasons or risks. • limit premium discrimination based on gender or age • prevent insurance companies from rescinding coverage that has already been purchased when people are sick and need it the most, except in cases of fraud. • cap out-of-pocket expenses and will prohibit insurance companies from imposing annual or lifetime caps on benefits.

• eliminate extra charges for preventative care such as mammograms, flu shots and diabetes. • will extend new protections for Medicare beneficiaries. These protections will extend the life of the Medicare Trust Fund to pay for care for future generations. • eliminate ‘donut-hole’ gap in coverage for prescription drugs by providing a 50% discount on brand name prescription drugs for seniors who fall into it. By 2019, the President’s plan will completely close the ‘hole’. The average out-of-pocket spending for such beneficiaries who lack another source of insurance is $4, 080. Deficit Reducing Plan The Obama Plan proposes to: • implement reform to further curb health care costs over the long term, through health system savings and new revenue, including a fee on insurance companies that sell very expensive plans, while investing in quality improvements consumer protection, prevention and premium assistance. > Continued on page 6

The

Health Care

OVERHAUL

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Additional cuts will be added if savings are not realized. • implement plans that will emphasize quality over quantity in the ‘delivery system ‘of health care. Examples include incentives for hospital to prevent avoidable readmissions, new ‘ bundled payments in Medicare and support for new models of coordinated approach to care and outcomes such as medical homes .

• to add a new and independent ‘Commission’ to ensure that our tax dollars go directly to caring for seniors. The Commission made up of doctors and medical experts will make recommendations to Congress on how to promote greater efficiency and higher quality in Medicare. The Commission will not be authorized to propose or implement Medicare changes that restrict care or affect benefits, eligibility or beneficiary access to care.

The Center for Excellence in Therapeutic Health Bartlik, M.D. of Weil Cornell Medical Center. Former doctor of orthopedic medicine, Dr. Cecialia Jucaban, of the Phillipines, and Ms. Marievic Villanueva, RPT provider and senior physical therapist of the Center. Each of these team members are unique in what they offer to the Center as well as top of the notch in quality care, knowledge and experience. Ian Micabalo, will utilize his specialized skills and experience in Pilates, Rebab medicine, post partum distress and, most recently, pelvic floor disorder. With extensive credentials and certifications as well as a plethora of hands on experience, Ian will lead the program of pre/post natal and pelvic floor disorders. Dr. Barbara Bartlik joins the team of The Center with a wealth of expertise to offer in the field of sexual and mental health. A board certified psychiatrist with twenty –five years experience treating patients suffering from depression, anxiety, sexual dysfunction and the range of psychiatric disorders, Dr. Bartlik’s services will be instrumental in complementing the treatment of PFD as well as non PFD related issues. Cecial Jucaban will offer to the Center her experience in orthopedic medicine,

• order immediate medical malpractice reform projects that could help doctors focus on putting their patients first vs. practicing defensive medicine. • will require large businesses (more than 50 workers) to offer their employees coverage or pay a fee to help cover the cost of making coverage affordable in the exchange.

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most essential to the monitoring and assessment of patients before, during and after treatment. Finally, Ms. Villanueva, will supervise the entire medical staff with her comprehensive knowledge as a provider and manager. A special addition which Ms. Villanueva offers is her experience with the high culture diversity of patients in NYC. The Center, which plans to open in December, 2009 will be located in Manhattan in the flatiron district. The Center will be managed and operated by MTRF. The 2500 square ft facility will house MTRF administration, a reception area, roughly 6 individual pt rooms, an equipment center room and the treatment office of Dr. Bartlik. The Center is also proud to be able to offer our services in the following languages: English, Tagalog , Spanish and Yiddish “MTRF is extremely proud to be able to develop a new medical facility and perform our services especially under the current market conditions. We are committed to high quality health care and research and are strategizing for long term growth and output in the healthcare industry,” states Jonathan Suarez, President/CEO of MTRF.

Daniel Roshan:

Daniel Roshan MD, FOCOG, FACS is a board certified Obstetrician/Gynecologist with subspecialty certification in Maternal-Fetal Medicine. He is an active member of the American College of Ob-Gyn and American College of Surgeons. He trained at Johns Hopkins hospital and is a member of Johns Hopkins Medical and Surgical Society. ROSH Maternal-Fetal Medicine specializes in fetal diagnostic procedures (eg. chorionic villous sampling, amniocentesis, and fetal cord blood sampling), prenatal ultrasound, including 3D & 4D ultrasound, and gynecologic sonography ROSH Maternal Fetal Medicine 213 Madison Avenue, Suite 1A New York, NY 10016 212. 725.0123

Pelvic Floor Exercises

Breathing exercises

By Ian Mari V Micabalo, PT , PTRP, CPI

PART 1

he pelvic floor is a very important structure of the human body that not just holds our reproductive and urinary organs but also serve to support our posture through its attachments and relationship to the core muscles of the body. In this article we will first discover the external bony prominences that will provide us with bony landmarks. The bony pelvis is comprised of three bones on each side- the ilium, ischium and the pubis and they are connected in front by what we call as the symphysis pubis. For pupose of description, lets start by feeling a bony prominence in the front of pelvis just above the hip joint. This is called the ASIS. If you place your thumb on B sides and try to make a triangle with the index and middle finger pointing down towards the pubis, we can palpate a bony prominence to the front. That is our symphisis pubis.

Neutral spine exercises On a firm, flat surface , Lie on your back comfortably while your knees are bent and the feet is flat on the floor. neutral spine is the position where your ASIS is in perpendicular line with your pubic bone. To find this, place the thumb of both hands on the bony prominence in front of your pelvis and your index and middle finger of both hands on the pubic bone ( symphysis). Begin by slowly rocking your pelvis back and forth until you find a spot that will make these two points in perpendicular line. Resist not to squeeze your buttocks while you are doing this. Remember, it is a gentle and small motion. Rocking pelvis forward & Backward

Posteriorly, lets palpate the two dimples at our low backs. We call this as the PSIS or the posterior superior iliac spine. From this point, try sliding two fingers towards the end of your spine until your almost at the buttocks . This bony landmark is called the coccyx or the tailbone. Initially, we will just try to learn these landmarks for purposes of referring to our exercises. Palpating the ASIS with the thumb and the pubic bone with the index and middle fingers

Strengthening Exercises Before commencing an exercise program, always consult with your doctor first. The movement that I would like to recommend to you are small and subtle movements that might be a bit tricky to do in the beginning, but with practice and a little motivation, these motions can be very helpful in improving strength and flexibility on your pelvic area.

Once you have found your neutral spine, we can then proceed to add some breathing exercises. Proper breathing is very important because we want to oxygenate and nourish our bodies to a cellular level, remove toxins away and generously energize our bodies. Start by inhaling deeply through the nose while maintaining neutral spine. Feel your lungs expanding through the ribcage as if your ribcage is stretching on the surface where your lying at. This way, you are encouraging the lower and deeper lobes of your lungs to expand and be filled with air. Exhale through your mouth like blowing through a straw. Do this exercise for 4-5 x.

Place the palm of the hands on the sides of the lower ribs, with the fingers pointing towards the center of the body and the thumbs pointing upwards perpendicular to the ribs. Inhale, and start to feel the air fill the lower and lateral sides of the lungs. This will open the spaces between the ribs.

Pelvic bowl exercises After finding your neutral spine, I would like to introduce subtle movements of the pelvis while engaging deep muscles of the pelvic floor and core . Imagine your navel ( belly button ) as the 12 o clock sign on a face of a clock and your pubis as 6 o clock on the face of the same clock. Start by moving your pelvis on an inhale into 6 o clock position , exhale and bring your pelvis is to the 12 o o clock position. Feel the lower part of your low back move as you initially do this exercise. After doing about 3-5 repetitions, try to not move the spine this time and just focus on the rocking movement of the pelvis.This time, the movement becomes very small and controlled.

Another way of looking at this exercise is to imagine your pelvis as a bowl, which anatomically is a bowl that carries all important reproductive and urinary organs in the body. Start by inhaling and thinking of moving the bowl and trying > Continued on page 8

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The Health Resource and Marketing Corner:

A commitment to Quality, Care and a Nurturing Environment < Continued from page 2

them to excel, perform highly and enjoy their job.

• providing extra-curricular activities during holidays to enjoy the quality of life with family and colleagues. • For those who are non-US citizens, we are able to help and guide you to obtain legal docu-

Pelvic Floor Exercises

ments, provide solid advice regarding immigration and contracts as well as in house tutoring to improve and sophisticate your language skills.

• Sensitivity to your personal needs ie; family, financial and extended leave of absence Manhattan Therapeutic Research Foundation offers a different

of your buttocks. Now as you lie down, try to curl your tailbone, and only your tailbone up towards the ceiling. Imagine as if somebody placed two oranges on your sit bones and asked you to press one orange at a time. Inhale and press the R sit bone exhale and return to starting position. Do the same thing on the L side Do this about 5-10 times as the first three or four repetitions might just be practice. Remember to always feel the motion and do not be stressed with getting these small motions immediately.

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to spill its contents forward, and then getting all of its contents and moving it backwards. The feeling of this motion is a strong contraction of the lower part of the abdomnals into shortening and lengthening and vice versa. Sacral exercises

experience in health care. Whether you are a health provider or patient, you will feel the quality care and security that each necessitate. Beyond the standard practice of health, we become a part of your life here in New York. We are both a touchstone and home to all who engage with us. Your health and/ or practice become an ongoing dialogue with us; a continuation in discovery and growth. Please come and visit our foundation. Whatever your purpose is, we are sure you will walk away with a sense that something positive is truly happening.

move your head or exerting a downward pressure as you inhale. Practice breathing deep and allow the ribcage to move laterally and into the back rather than putting pressure on your lower abdomen.

In supine position, start by imagining a zipper going from the pubis in font to the tailbone. Inhale, and image you are opening the zipper all the way down to the tailbone. Exhale, and start closing the zipper all the way back up to the front of the pubis. Remember that establishing control of the pelvis muscles makes relaxing the pelvis easier. Be careful not to

I’ve learned this exercises as I was doing my Pilates training and I recommend this exercise if you suffer from back pain and sacral discomfort. In order to start with this exercise,lets begin by knowing our ischial prominences. These are the bones that we sit on. So I want you to feel your sit bones by touching the lower part

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