Get to the Root Cause of Endometriosis and Chronic Pelvic Pain with Guest Dr. Jessica Drummond

Endometriosis and chronic pelvic pain have plagued many women and left them feeling hopeless. We want to give you that hope through this podcast and video with Dr. Jessica Drummond, a physical therapist and health coach, as we go through the various imbalances that could contribute to endometriosis, whether it be hormone, immune, inflammation, gut, or nervous system dysregulation. In addition, we'll go through practical tips on how to improve your quality of life as you deal with chronic pelvic pain. You won't want to miss this amazing talk!

1:30 - Jessica Drummond's Journey with Fatigue and Stress
6:10 - Endometriosis in a whole body approach
8:00 - How does Endometriosis present
10:10 - 3 prong approach to endometriosis
11:40 - Hormone Imbalance not the only cause of endometriosis
13:00 - Help Immune and Digestive health to improve endometriosis
15:30 - Pain and Pelvic Physical Therapy
18:30 - Exercises good for Pelvic Floor Relaxation
20:25 - How to reduce inflammation for Endometriosis from foods to stress management
26:00 - Keys to stay away from fight or flight, signal your brain of safety.

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Dr. Jessica Drummond's Information:
» Website: https://integrativewomenshealthinstitute.com/
» Facebook: https://www.facebook.com/IntegrativePelvicHealth/
» Instagram: @IntegrativeWomensHealth
» YouTube: https://www.youtube.com/c/JessicaDrummond

Transcript

Dr. Carrie Lam, MD: 0:06

Welcome to the Dr. Lam Show. Today we have Dr. Jessica Drummond, who is a physical therapist and certified health coach, CEO of the Integrative Women's Health Institute and best selling author of two books, outsmart endometriosis, and clinician to coach. She has over 20 years of experience helping women with chronic pelvic pain and endometriosis. She lives in Connecticut but she does a lot of help through Texas. And so her practice is all over the nation. We're so excited to talk to her today about endometriosis getting to the root cause and chronic pelvic pain. So welcome, Jessica.

Jessica Drummond: 0:49

Thank you so much for having me.

Dr. Carrie Lam, MD: 0:52

So tell us about your journey on integrative medicine, how you got here and why you're so passionate about doing what you do.

Jessica Drummond: 0:58

I started my career just about 20 years ago as a physical therapist, and I was an athlete as a kid, so I always thought I would go into orthopedics and I did start there orthopedics, manual therapy. But I pretty quickly began to specialize in women's health and physical therapy, which is essentially specialized orthopedics in pregnancy, shoulder issues related to breast cancer surgery, pelvic pain, urinary incontinence, pelvic floor issues. Over time, I became more specialized in women's health. And my clients that were most challenging were women who struggled with chronic pelvic pain conditions, endometriosis, period pain, interstitial cystitis, bladder pain syndromes, constipation, etc. At the time, the surgeries for endometriosis were not very good, women were having way too many surgeries in a lifetime, and there was not really a lot of good tools, and the doctors were prescribing a lot of opioids. So women were getting addicted, because there were not many pain management options. Physical therapy tools were good, but often it would hit the wall in many cases. I saw a lot of women with implanted stimulators and things that didn't work and often made things worse. So sometimes into that journey, I had a child of my own and during postpartum I did not feel very well and I learned later I was very fatigued. I had a lot of anxiety and it's tricky because it was my first baby and it was assumed that I will be exhausted. But I thought I was perfectly fine a few weeks ago. Now, looking back, what I think happened was that I had a reactivation of epstein barr virus which I had as a kid. Essentially, it was HPA axis dysregulation, and adrenal fatigue. So I was really tired and got every cold, flu and chronic sinus infections and not just tired and feeling sleepy, but deep fatigue. This went on a long time from back in 2003, to about 2006. And, there was no functional medicine but I found an integrative practitioner. She is one of the earliest functional medicine physicians who I had worked with in Texas, and send her all the difficult clients, and now I was the difficult patient. She's still in practice today even though I haven't seen her in a few years. She and her family do Chinese medicine and integrative practice and sort of the earliest versions of functional medicine. Coming back, I had to re evaluate my relationship to work and to stress. I had to change my diet to be much more nutrient dense, sleep a lot more, and stop high intensity exercise. I just stopped exercising entirely for a couple of years. And over time, I got healthier, that was around my early 30s. I was healthier in my late 30s than I had been in my 20s. I went back to school and got a doctorate in Clinical Nutrition. In the last 10-12 years, my practices integrated those early experience with pelvic floor and women's health, physical therapy with bringing in a functional nutrition, lifestyle medicine, health coaching approach, and knowing, that our pain science has evolved so much in that time, chronic pain really is a brain injury, if you will. And so the more systemically we could lower inflammation and improve brain health, that could help us really support the system to heal from the symptoms of endometriosis. While we can't necessarily reverse the disease, having women you know, go through much better higher skilled excision surgery instead of multiple times. And then the system is both prepared for that surgery and recovery. Then women have tools to keep their symptoms controlled through their lifetime.

Dr. Carrie Lam, MD: 6:11

Yeah, I love that you're talking about endometriosis, which we tend to ignore as just a hormonal issue or a pelvic pain, and something structural is going on. But no, like you're saying it's a whole body issue including hormone balancing, adrenal, stress levels, gut, and immune system, are all imbalanced when you are dealing with endometriosis. So that's nice to hear you have that personal experience, and that's how you're helping people now. Also you bring up adrenal fatigue, because that's mainly what we deal with our patients. So yes, we definitely see women also go through endometriosis. Nowadays it is better to try to prevent as much surgeries, right? Because that's not the fix, it is more of a band aid, that they think that it's going to help but they end up coming out of surgery and don't feel better. Right? So, tell us a little more about endometriosis, the type of patients that you see and how you can get them through their chronic pelvic pain.

Jessica Drummond: 7:29

Endometriosis is very common, one in 10 people with uteruses have endometriosis. So that's 176 million people in the world. There are many organizations that work in endometriosis, who are beginning to educate school nurses, pediatricians going to colleges, because that's when endometriosis is generally presented. It's something you have at birth, so it's a partially genetic disease. And then how it expresses normally begins to present in pre puberty. Most of the time it's missed at that point, because it looks like digestive issues or bloating or weight gain, or fatigue, then later, it might be presented as this could be endometriosis when there's period and pain involved. However, with adolescence, the pain isn't usually cyclical, because of course, the cycle itself is not established. So the pain can be more random. It can be chronic constant, it can be intermittent, but not necessarily in alignment with the cycle. But endometriosis is the number one reason that girls miss middle school or high school, because they have such severe pain. They can't, you know, show up for their tests and their softball practice and all the things that they're trying to do. So endometriosis takes young women girls and young women kind of off their career path. 74% of women with endometriosis say that they've kind of had to take a life detour, because they couldn't keep showing up the level that they wanted to. Many of my patients have pushed through that and have big careers but there's a point where they just can't sustain the energy they need to show up at that very high level of pain. So now not everyone with endometriosis has constant high pain. In some women, it's actually silent and they don't even know they have endometriosis until they're struggling with fertility. So those are the most common times that women become aware. In traditional gynecology offices, it's very common still, for women to just be put on hormonal birth control, to quiet it down. But that's not really what we want to do. We have to think of endometriosis like a three pronged disease one, it has a genetic underpinning. So we want to increase the index of suspicion if there's family members with endometriosis, or infertility or bad periods. The hard part is that this is one of those things, it's not really well talked about. And it can actually make it worse in some ways in terms of diagnostic delay, because, all the women in our family have this horrible period, so welcome to the club. Not really, it's not normal, just common in your family. So just because other women have dealt with in your family, you still should seek treatment. Next, it's an inflammatory condition, and there's an autoimmune component. So the lesions themselves, so endometriosis, literally, there are these growths that are non cancerous, but they are certainly life altering. They're made of tissue that similar to but not exactly the same as the lining inside the uterus, which is why it's called endometriosis originating from endometrium. But it's not exactly the same tissue histologically. These lesions, which can be hormonally driven, many of them produce their own hormones. We used to think it was an issue of estrogen dominance. But in 2018, we learned that these lesions can have upregulation of estrogen and progesterone receptors, both or neither. So we want to optimize, hormone balance so that women are generally healthy through their endometriosis. But manipulating the hormones doesn't always do anything, which is why 30% of women might be helped by being on birth control, because you're essentially suppressing estrogen. So you'll kind of quiet the symptoms for a while, but it doesn't cure the endometriosis. In fact, it kind of puts a bandaid on it that can prolong fertility issues. In rare cases, hormonal suppression as the overall strategy is a reasonable thing to consider. But treatment with hormonal suppression, even if it's just birth control, does not address the root cause. We want healthy hormone levels but that won't always cure endometriosis, because different kind of lesions can be all in the same woman. We won't know what those lesions without surgery and histology. The things we want to focus on is immune health and digestive health because the digestive and immune systems are so intimately linked, and even beneath that the nervous system, especially the autonomic nervous system. So lowering inflammation, and optimizing immune health is really what we do to propel women prepare their bodies for skilled excision surgery, if they decide to go that route, and if it's appropriate for them. There are more and more very skilled surgeons who, while they might be trained as gynecologists, but this is their life's work. It's as important as choosing your cancer surgeon because you want to choose someone who specialized. You can have an elective surgery and take 3-6 months prior to get your body healthy, lower your inflammation, balance your hormones, optimize your immune health, digestive health, get plenty of nutrients, so you have a lot of resilience for the surgery. And then recovery from surgery will be easier and you can have a plan for that to how to recover the inflammation and get rest. So that's our approach, because sometimes surgery is necessary but we don't want to just do that in a vacuum when someone's been struggling for years.

Dr. Carrie Lam, MD: 15:01

Like you said, they can always come back if you're not really getting to the root cause. And you're talking about the three problems. So let's just reiterate that. So was it the immune, the inflammation that you're talking about?

Jessica Drummond: 15:15

Inflammation, autoimmunity, and genetics, which you can't really alter, but you can alter inflammation and immune health through the digestive, immune and nervous systems. So those are the systems that we're focused on. And sometimes the pain drivers aren't even directly related to the endometriosis lesions. It's also very important to have a pelvic physical therapist on board. I'm not really hands on in the clinic much anymore.

Dr. Carrie Lam, MD: 15:54

I'm gonna ask how do you do your telehealth when being a physical therapist because you think, you need to go see someone for physical therapy?

Jessica Drummond: 16:03

Generally, so although there's a lot you can do, once you understand your own pelvic floor, this is your pelvic floor. So here sitting bones, and here's your vaginal opening and rectal opening, there are lots of muscles here. So this is the analogy I like to use. So imagine like you're walking down the street one day and a branch falls on you and you get a cut on your shoulder. That's fine, but imagine that doesn't heal for like, a year or two years or six years, right? You're gonna kind of tense up your shoulder and your neck and your you might start having chronic headaches and maybe arm pain and shoulder issues. It's not because there were musculoskeletal problems. It's because your body was protecting the injury. So if you have endometriosis lesions on your bowel, around your reproductive organs, you might have in the muscles and nervous system and joints of the pelvic floor and hips and back and legs, some protective tension, that can cause a lot of pain. It can cause sexual dysfunction, urinary issues, chronic pain, and period pain. So, pelvic physical therapists should also be a part of that team. And while I don't do a lot of that some you can do some of this with telehealth. But ideally, work with someone locally.

Dr. Carrie Lam, MD: 17:35

Would you recommend a woman's health PT?

Jessica Drummond: 17:39

You would search for a women's health physical therapist, pelvicrehab.com, pelvicguru.com, or the American Physical Therapy Association has a Academy of pelvic health. So that's what you're looking for. Talk to them because some pelvic health physical therapists are specialized in incontinence or some specialize more in osteoporosis. You want someone who works with a lot of chronic pain.

Dr. Carrie Lam, MD: 18:11

Yeah, so not only the immune in the gut, but also structurally right? Like you said, you need someone to loosen those muscles that have been tensed for a long time. I know it's a very person dependent but are there just in general good exercises for these chronic pelvic pain that women or people who have endometriosis can try at home?

Jessica Drummond: 18:38

You can certainly start with diaphragmatic breathing, pelvic floor relaxation, and avoid hardcore Kegels. You want to just relax the muscles of the pelvic floor. You can use wands and dilators and tools that help to gently stretch the muscles of the pelvic floor. You know, things like butterfly stretch, you can put a block between your heels if you're sitting up with like your feet together and stretch your heels apart. It can stretch those sitting muscles and bones apart slightly, in a gentle squatting position. One of our students at the integrative Women's Health Institute, Brianne Grogan, talks about prolapse. She has great videos on YouTube under Fem fusion fitness for this down training which is opposite of strengthening those muscles. We want to teach them to relax, stretch, and the abdomen, back, and the hips can also be involved. So we want to strengthen your hips and legs so that you're not overusing the pelvic floor, when you're lifting your kids off the floor.

Dr. Carrie Lam, MD: 20:03

Great, great tips for the gentle stretches are more like relaxation, not very intense, because a lot of times these women have already been through a lot of intensity exercises or surgeries. And so they might have a lot of scarring too. And then so I love that you talk about decreasing inflammation, and do you have any general tips specifically for women with endometriosis?

Jessica Drummond: 20:35

Yeah, so there's no endometriosis diet, but for each of our clients, we personally optimize their anti inflammatory diet, depending on their genetics, and their situation, if they have bladder involvement, constipation, the first thing we really have to do is make sure we're optimizing digestive function. Good hydration,fiber, good gut motility, which can be helped with physical therapy, but also with supplements like ginger and artichoke, and, with digestive support, like chewing, making sure that you're eating in a calm way. Many women are eating so stressed that they actually aren't digesting well, because you can't be in, fight or flight and rest and digest at the same time. Our biggest challenge is helping women create the space for relaxation and healing and eating some more slowly, less inflammatory foods, lots of vegetable, because fruits may cause yeast issues. Cooked vegetables, easy to digest broths, high quality proteins, good healthy fats, nuts, seeds, avocados, olive oil is fantastic. And a lot of times for our clients, it's about adding nutrients, because when it hurts to eat, it can be more and more restrictive. But to me, if you have pain or digestive symptoms, that's a sign of a nervous system issue, not a food sensitivity. So we have to be mindful. Now, certainly there are people who have food allergens. And avoid processed grains and sugar and have a nutrient dense diet. But we want to think about if we're having symptoms related to either the pelvic pain of endometriosis or digestive symptoms. Think back to the nervous system. How much time during the day? Are you in that recovery mode versus that stress mode?

Dr. Carrie Lam, MD: 22:53

So nervous system, what do you normally do for that? Is it breathing? Stress Reduction, meditation?

Jessica Drummond: 23:02

All of that, breathwork, mindfulness practices, it's about the space and commitment for most people walks in nature. If you think about animals, the other day one of my clients was talking about how her Labrador hangs out with her in the office, then relax in the sun 90% of the day, and occasionally go for a sprint and chase after a rabbit. We are animals and should be functioning more like Labradors. But we're chasing after rabbits like 95% of the day, and relaxing 1% of the day. So flipping that is a huge task. You know, most women can't just flip that. But we can start to think that way. What would it look like? If right now, first of all, I just create space for mindfulness 10 minutes, every two hours, or 20 minutes a day. Let's start with something that that's manageable, depending on what someone's doing. Then, more than that, how can I bring this sense of calm into everything I'm doing? How can I enjoy every bite of food more? How can I, just do things a little bit more slowly and relaxed and with pleasure. There's a lot of resistance to that. Because, we're taught from a very young age that you have to be achieving, and you've got to do this right, faster, and many things at the same time. My oldest daughter is preparing for college, she's a junior in high school and she's on all these college sites. So many children are under pressure to get scholarships and get into the best college, join clubs. My 10 year old decided to play the bass, which is a huge instrument. So we get this email, she's going into sixth grade, for her to join Middle School band or choir, and orchestra. There a lot of pressure. So we have to unwind some of that programming, because truly, that is the most important thing. I've been working with women with chronic illness, chronic pain for 20 plus years. And I really understand now that we it's very hard to heal when you're living in a chronic state of perfectionism fight or flight. So we have to create that space. Then the food part gets easier. Now nutrition is really valuable, because nutrition supplies polyphenols and anti inflammatory nutrients and proteins to help balance the brain neurotransmitters. But we can't even enjoy it and absorb it. If we're living in that upregulation.

Dr. Carrie Lam, MD: 26:48

That's so true. You digest your food, but you also digest your thoughts. It's all part of the digestive process. And so it's very important to have all parts be equal and be worked upon, because not everybody will have perfect all three prongs of the tool, like you talked about, you know, so

Jessica Drummond: 27:08

It will never be perfect, because we can't

Dr. Carrie Lam, MD: 27:08

Yes, definitely and laze around like control all of it. Even if we really wanted it to be perfect, like anything in life, you can just get the carbs on the way home. So instead of thinking about doing it right, just leaning into all of those things, on how to calm nervous system, spending time with nature, more nutrients, adding more healing, what we call in pain,science, signals of safety. So the more the brain feels safe, when you're breathing slower, enjoying your life, eating, tastes delicious, positive thinking practices, surrounding yourself with positive people, turning off the more negative stressors that are unnecessary. There are stressors, like you don't have to constantly listen to the news instead you can turn it off that Labrador. Give ourselves the time and not feel guilty about it. Often, we are under pressure because of society or self-made, that we have to be successful by this time and age etc. I love the idea that you said about giving yourself the space and forgive yourself, if you can't be perfect, because no one is. And this helps not only with pelvic pain, but adrenal fatigue hormone balancing your gut, your immune system, your whole nervous system. So thank you so much for talking to us and I learned a lot. I hope all our listeners have really learned about, and endometriosis, the pathways of how you can help it reducing inflammation, getting to the root cause helping your whole system, and not just focusing on Band Aid treatments. So if people wanted to get a hold of you, what would be the best way to find you?

Jessica Drummond: 29:37

My website is integrativewomenshealthinstitute.com and you can visit us on Instagram@integrativewomenshealth. And I'm happy to give anyone listening to this podcast a free copy of my book outsmart endometriosis. Just go to outsmartendo.com

Dr. Carrie Lam, MD: 29:57

Okay, that's really great. And you also do consultations, right? More teleconsultations for people who might be listening and they're still dealing with their pelvic pain and they don't know what to do, they can just reach out to you. So thank you so much, Dr. Jessica Drummond for being on our Dr. Lam show today. And I invite everyone to like, subscribe and hit the notification bell so that you can listen to these weekly podcasts. Have a good day. Thank you.

Unknown: 30:34

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