It’s Time to Recognize Lyme (Part II)

By Riva Preil

After several months, the disease progresses to the third stage, late disseminated phase, if untreated.  By this point, the disease has spread throughout the body and to multiple organs which severely impairs one’s ability to function.  The joint pain intensifies and the neurological symptoms and pain (called Bannwarth syndrome) worsen. Permanent paresis may be present in the most severe cases.  Cognitive changes such as short term memory loss and concentration difficulty may be present due to Lyme encephalopathy. Furthermore, personality changes, psychosis, anxiety, panic attacks, and depersonalization (a feeling of detachment from oneself) may occur.

Considering the horrible progression of the disease just described, it is important to be mindful of prevention and treatment tips, especially if you engage in activities that put you at greater risk of exposure to infected ticks.  First of all, the more covered you are, the more protected you are!  Tick bites can’t penetrate through one’s clothing, so be sure to wear clothing which minimizes skin exposure while camping to decrease risk of being bitten.  In addition, it is important to inspect your body after hikes and camping trips, especially because tick bites, which are not necessarily painful, may go unnoticed by a bitten individual.  If you notice a bite, especially if it develops into the bull’s-eye rash described above, speak with your primary care physician and request that you be screened for Lyme disease.  Early detection means faster recovery via antibiotic treatment.  It will prevent the disease from progressing to later, more debilitating stages which often involve lengthy and expensive intravenous antibiotic treatment regiments.  Please refer here for more information and useful tips.  Also, for more information about Lyme disease, please watch Under Our Skin, a documentary (available on Netflix, poster above) from director Andy Abraham Wilson.


It’s Time to Recognize Lyme (Part I)

By Riva Preil

Lyme disease is a bacterial infection (belonging to the Borrelia genus) which is transmitted via infected ticks.  The disease is named after the towns Lyme and New Lyme, Connecticut, where many cases were reported in 1975.  It is considered a vector transmitted disease, a disease that is transferred from one agent (such as an insect or animal) to another organism.  Once the infected tick bites an individual, the borrelia infection can enter the human bloodstream and can spread to many different body systems if untreated.  Generally speaking, there is a one to two week incubation period, which means that the symptoms may not appear until several days post infection.

The three stages of Lyme disease are: early localized infection, early disseminated infection, and late disseminated infection.  During the early localized stage, the bacteria remain at the site of the bite and have not yet spread to the bloodstream.  The classic sign of this stage is a red bull’s eye rash pattern which may be warm but is usually not painful.  This rash is called erythema migrans (EM) or erythema chromium migrans.  It is present in approximately 80% of cases and it usually remains for three to thirty days.  Other signs of the early localized phase mimic those of the flu, including headache, fever, and muscle soreness.

If left untreated, the disease progresses to the early disseminated phase.  At this point, the Borrelia bacteria enter the bloodstream and spread throughout the body.  This may occur within days to weeks after being bitten, and transition from localized to disseminate stage differs from person to person.  The EM rash may develop in body parts other than the original bite site, and the individual often develops joint, muscle and tendon pain.  Furthermore, they may experience heart palpitations and dizziness due to heart rate changes.  In addition, 10-15% of people develop neurological signs (called neuroborreliosis) including facial muscle weakness, similar to Bell’s Palsy.  Some may even develop meningitis, which manifests as severe headaches, neck pain and stiffness, and light sensitivity.  The person may also experience radiculoneuritits, which includes shooting pain and altered sensation due to nerve impairment. (to be continued…)

Health Professionals Gather for National Educational Retreat

Check out the press release from Amy’s venture, the Alliance for Pelvic Pain’s upcoming weekend retreat!


CONTACT: Alexandra Milspaw
April 22, 2013


Bethlehem, PA – On April 27-28, 2013 leading health practitioners from New York, NY and Bethlehem, PA will arrive at Historic Hotel Bethlehem to host the first educational retreat for female chronic pain patients in the country.  Robert J. Echenberg, M.D. & Alexandra T. Milspaw, M.Ed., LPC, Deborah Coady, M.D., Amy Stein, M.P.T., and Nancy Fish, MSW formed the Alliance for Pelvic Pain and organized this weekend’s retreat, “Connecting the Dots of Your Experience,” which will offer educational seminars, interactive workshops, one-on-one attention and treatments by local health care practitioners, and more! Patients from 18 different states as well as Canada, and the United Kingdom will attend.


WHO: Patients, Health Practitioners from Bethlehem, PA & New York, NY
WHAT: Educational Retreat for Female Patients with Chronic Pelvic Pain
WHEN: April 27-28, 2013
WHERE: Hotel Bethlehem, 437 Main Street, Bethlehem, PA 18018

This retreat is created for female chronic pelvic pain patients with complex symptoms involving one or more of the following: Interstitial Cystitis (IC), Irritable Bowel Syndrome (IBS), Pelvic Floor Dysfunction, Vulvodynia, Vestibulitis, Lichen Sclerosis, Pudendal Neuralgia, Endometriosis, and other pelvic, genital, and sexual pain disorders.

Heading the organization of this retreat, Alexandra T. Milspaw, M.Ed., LPC states, “Our mission is to expand knowledge and care to the underserved population of female patients with chronic pelvic pain. We seek to create an atmosphere where patients can feel safe to be their authentic selves. We listen. We care. We believe. This will be a weekend filled with compassion for the self, and forgiveness for others who do not understand the plight of chronic pelvic pain.”

Dr. Echenberg remarks, “My passion for integrated care in women’s health continues with the creation of this multidisciplinary regional approach to the clinical care, education, and research associated with pain in women. We hope that our retreat will contribute to ‘connecting the dots’ for individuals and the community at large.”

Those interested in receiving information about the next scheduled retreat please contact Alexandra at Visit


Love in Health

By Riva Preil

April marks Sexually Transmitted Infection (STI) Awareness Month. STI, a broader term for what has previously been referred to as sexually transmitted disease (STD) or venereal disease (VD), refers to a class of infections that can be spread from one individual to another via vaginal intercourse, oral sex, and anal sex.  In addition, the infections can be spread through non-sexual practices that involve transmission of bodily fluids from one person to another (ex. blood transfusion, sharing of injection needles, sharing of tattoo needles, needle-stick injuries, and childbirth or breastfeeding. Individuals may have received the infection without demonstrating symptoms of disease (hence the recent increased usage of the term “infection” in place of the previously used term “disease”), and in fact, sometimes the infection manifests as pelvic inflammatory disease (PID) and/or pelvic pain. A pelvic floor physical therapist can help treat the symptoms of PID and the associated pain.

There are many different causes of infection.  Several of these include viral infection (ex. ex. viral hepatitis/Hepatitis B virus, herpes simplex, human immunodeficiency virus/HIV, and human papillomavirus/HPV), bacterial infection (ex. chlamydia, gonorrhea, and syphilis), fungal infection (ex. candidiasis, or yeast infection), and protozoal infection (ex. trichomoniasis).

The statistics about STIs are alarming- in 1996, the World Health Organization estimated that approximately 1 million individuals became infected on a daily basis.  In general, of those who become infected, approximately 30% are younger than twenty years old.  STIs are found in teenage girls aged 14-19 on a 2 to 1 ratio compared to teenage boys of similar age, and approximately 25% of female teenagers in the United States have an STD according to the CDC.  Furthermore, AIDS is the biggest cause of mortality in Sub-Saharan Africa, and approximately two billion people worldwide have been infected with Hepatitis B.  Considering these frightening statistics, prevention is of the utmost importance.  This includes vaccination for Hepatitis A and B as well as for some forms of HPV.  In addition, proper condom usage is key.  This involves maintaining proper 1.5 cm (3/4 inch) space at the tip to provide room for ejaculate.  It is also important to use latex, polyisoprene, or polyurethane materials (to protect against HIV) and to avoid using oil as a lubricant due to the fact that it can create holes in the condom thereby rendering it ineffective.

Connective tissue disorders and pelvic floor muscle dysfunction: Is there a connection? Part II

By Stephanie Stamas, SPT

Sjogren’s Syndrome (SS) is an autoimmune CTD where the body attacks the moisture producing (exocrine) glands of the body leading to the hallmark signs of dry eyes and/or dry mouth. This is the second most common rheumatic disease and primarily affects women (9:1 ratio). Another common complaint in this population is vaginal dryness, causing dyspareunia is up to 65% of women with SS (5). A study by Mulherin et. al., examined women with chronic dyspareunia, Raynaud’s Phenomenon, chronic joint pain and dry eyes and/or mouth and found that 63% of these women had either a definite or probable diagnosis of SS (6). In all but one of the women, vaginal dryness presented before ocular or oral symptoms.

Connective tissue disorders are difficult to identify and can take years until a correct diagnosis is made. It is therefore important that individuals with a suspected connective tissue disorder are evaluated and treated by a multidisciplinary team with an experienced rheumatologist as the primary care provider. Early diagnosis is especially important with individuals with SS because they have a 20 times increased risk of developing lymphoma than the general population (7). If you suspect that you are dealing with a systemic issue please inform your physical therapist at Beyond Basics Physical Therapy so that you can receive a more focused, comprehensive and effective plan of care.


5. Shiboski SC, Shiboski CH, Criswell LA, et. al. American College of Rheumatology Classification Criteria for Sjogren’s Syndrome: A Data-Driven Expert Consensus Approach in the Sjogren’s International Collaborative Clinical Alliance Cohort. Arthritis Care Res. 2012; 64(4): 475-487

6. Mulherin DM, Sheeran TP, Kumararatne DS, et al.  Sjogren’s syndrome in women presenting with chronic dyspareunia. Brit J Obstet Gynecol. 1997; 104:1019-1023.

7. Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern Med 2005; 165:2337–44.

Pilates: Scapular Mobility

By Denise Vidal

In the last blog, we demonstrated how core strength can be supported through the shoulder girdle’s connection to the ribcage. We did this by exploring motions called protraction and retraction, that is the shoulder blades’ moving toward and away from each other along the ribcage. In this blog, we are going to explore upward and downward rotation of the shoulder blades, while continuing to practice our protraction and retraction. To do this exercise, you need a dowel of some kind that is wider than shoulder width. You can do this exercise sitting or standing; however, whatever position you choose be sure to align your head on top of your ribcage and pelvis.

To begin, hold the ends of the dowel in each hand and rest it on your thighs. Take a deep breath. As you inhale, feel your ribcage expand into your shoulder blades. As you exhale, engage your abdominals, feeling the front and back of your abdomen hugging towards each other.

On your next inhale, maintain your abdominal tone as you raise the stick to shoulder height. The shoulder blades will begin to widen on your back, just as they did in last week’s blog (picture 1). As you exhale, continue to lift the dowel to the height of your forehead. The shoulder blades will widen more as they upwardly rotate around the
ribcage (picture 2). I like to imagine the tips of my shoulder blades following the path of my little finger. At this point, your shoulder blades should be as wide as possible against your ribcage. Continue to lift the stick up over your head. As you do this, your shoulder blades will begin to narrow towards each other, or retract from the previous position (picture 3).

On your next inhale, begin to reverse the pattern until you come back to the original position. The shoulder blades will widen as the stick comes down toward your forehead, and then narrow slightly as the dowel comes to rest on your thighs.

Do this motion 5-10x every morning. Remember to connect your breath and the engagement of your core to the movement.




Connective tissue disorders and pelvic floor muscle dysfunction: Is there a connection? Part I

By Stephanie Stamas, SPT

Connective tissue disorders (CTD) cause dysfunction in the structures that support, bind, and protect the organs of the body, such as bone, fascia, cartilage, muscle and skin. There are over 200 identified CTDs with the majority of the disorders affecting women more than men. Some CTDs are heritable, such as with Elhers-Danlos Syndrome, Marfan Syndrome and Osteogenesis Imperfecta, although in most cases the cause is unknown. Here at Beyond Basics Physical Therapy, we have noticed that several patients not only report issues involving bowel, bladder, or sexual dysfunction, but also have a history of systemic issues including fatigue, general joint pain, Raynaud’s phenomenon or dryness. These complaints have led us to look into the possible relationship between pelvic floor muscle dysfunction (PFMD) and connective tissue disorders, specifically Ehlers-Danlos syndrome and Sjogren’s syndrome.

Ehlers-Danlos Syndrome (EDS) is a genetic CTD resulting from defective synthesis of collagen. Collagen is a foundational matrix in the body which forms skin, bone, blood vessels, organ capsules and other body structures. There are several subtypes of the syndrome, each affecting a different type of collagen and therefore presenting with different symptoms. Hypermobility-type EDS is the most common subtype and presents with general joint hypermobility, chronic subluxation, skin elasticity, easy bruising and chronic joint pain. Classical-type EDS also presents with general hypermobility and skin extensibility but has increased skin involvement, such as tissue fragility and atrophic scarring over bony prominences. The relationship between EDS and PFMD has been explored in several studies and a correlation between dyspareunia (painful intercourse), stress urinary incontinence, pelvic organ prolapse and EDS have been identified, with the trend toward increased symptoms with classical-type EDS.

Irritable Bowel Syndrome Awareness Month

By Riva Preil

April marks Irritable Bowel Syndrome (IBS) Awareness Month. IBS is a condition characterized by abdominal pain, discomfort, and bloating as well as abnormal bowel habits.  There are four main subcategories of IBS: IBS-D (predominantly diarrhea), IBS-C (predominantly constipation), IBS-A (alternates between diarrhea and constipation), and IBS-PI (post-infectious).  It is unclear to date what causes IBS.  IBS is associated with chronic pain, fatigue, a feeling of urgency prior to passing bowel movements, and tenesmus (a feeling of incomplete emptying of the rectum after passing a bowel movement).  Due to the extreme pain and its effects on the suffering individual, IBS is also associated with psychological disorders, such as anxiety and depression.  In fact, one study indicates that up to 60% of individuals with IBS also present with a psychological disorder.

Testing for IBS includes performing a stool culture (to rule out any infectious disease), blood work (to rule out celiac disease), an abdominal ultrasound (to rule out biliary tract diseases, such as gallstones), and endoscopy.  Unfortunately, there is no current cure for IBS; however there are many treatment options available for symptom management.  One important factor to consider is diet, especially because lactose and fructose tend to exacerbate the symptoms of IBS.  Therefore, the FODMAP diet (which restricts lactose, fructose, and other carbohydrates which the small intestine has difficulty absorbing) is recommended.  In addition, it is important for people with IBS to eat soluble fiber (which can be supplemented through the use of psyllium husks) as opposed to insoluble fiber (ex. bran), which can make symptoms worse.  Some medications (such as tricyclic antidepressants) have been shown to alleviate IBS related pain, and one should speak with their primary care physician regarding medications.  Furthermore, stress relief strategies such as yoga, tai chi, medication, and exercise may reduce the intensity of the pain.  Finally, individuals with IBS often benefit from pelvic floor physical therapy to help manage musculoskeletal related changes that occur in the abdomen and pelvic floor in response to the assault on their system created by IBS.

Pilates: Scapular Stability and Serratus Push-Ups

By Denise Vidal

In our previous two blogs we spoke about the movement of the pelvis in relationship to the legs. Now, we will discuss the relationship between the arms, the shoulder girdle, and the ribs. Like the lower limbs, the upper limbs are only as strong as they are able to maintain proper joint mechanics. One of the most fundamental joint movements of the upper body is the shoulder blades’ ability to glide along the ribcage. If the shoulder blades move well against the ribcage, then the ribs can become a strong base of support for the movement of the upper limbs.

To begin, come onto your hands and knees into what we call a “table top” position. Your hands and knees should be underneath your shoulders and hips, as if you were making a “table” out of your torso (picture 1). If necessary you can put a mat or a cushion under your knees for more support. Or, if being on your knees is not at all comfortable, you can do this exercise standing with your hands against a wall.

In this position start to breathe deeply, seeing your ribs expand as you inhale and your abdominals pull inward as you exhale. In Pilates we like to give the image that you are a pregnant cat and every time you exhale you are lifting your litter of kittens towards your spine. It may sound silly, but this image works for a lot of people! The idea is that you want to gain core support without changing the length of your spine and the width of your ribcage.

On your next inhale, maintain the straightness of your spine and arms as you sink your chest towards the floor and slide your shoulder blades together. In Pilates we refer to this movement as a “schlump” (picture 2). As you exhale, push into your hands and widen your shoulder blades on your back (picture 3). Do this movement 5-10 times, remembering to incorporate your breath and to keep your spine lengthened.

If you are experiencing any shoulder or wrist pain, speak to your doctor or physical therapist before attempting this exercise.