You know you’ve stumbled upon someone pretty special when you come across a PhD candidate who’s doing the “research translation bit” BEFORE finishing their PhD. That’s exactly what Perth physiotherapist Jo Milios has done in setting up PROST! for patients with prostate cancer.
You set up PROST! Exercise Club 4 Prostate Cancer in Perth. Can you tell us a bit about the program or perhaps share some outcomes from some of the participants?
PROST! Exercise 4 Prostate Cancer Inc, is a community program based at the Subiaco Football Club in Perth, Western Australia where men diagnosed with Prostate Cancer meet twice/week to run through a one hour cardio and resistance program that is specifically tailored to the needs of men undergoing treatment for prostate cancer. This includes a focus on pelvic floor muscle training as most men will experience urinary incontinence, erectile dysfunction and fatigue. Men get to work out with others in the same predicament which provides support and mateship at the same time as helping to improve fitness and muscle strength. Many participants have enjoyed significant improvement in all of these key aspects and many say the PROST! Club is the best thing they’ve done for themselves in years.
Aligning a men’s health club with a football club seems to be a pretty good fit. How did you go about making this happen?
It was a punt! I was aware that I needed to somehow link ‘balls and balls’ and to ask men to meet at a place where they might feel comfortable as the traditional support group style of sitting and talking about things is not what men typically do. Rather, men are about action and task achievement so the goal was to pull all these aspects together.
Fortunately, the Subiaco Football Club didn’t hesitate to offer me their gymnasium and oval twice/week at times not needed by the club. Ross Glendinning, from the West Coast Eagles and a former Brownlow Medal winner then approached me and soon became our Patron. The rest, is history!
Can you tell us about what a prostate cancer diagnosis can mean, and what your role is as a physiotherapist in improving quality of life for these men?
For a man newly diagnosed with Prostate Cancer there is usually an element of shock and despair. If caught early enough, there can be a complete cure via a surgical procedure known as a radical prostatectomy. If the cancer is advanced radiation and hormone therapy may be the form of treatment implemented, but each bloke will be different and the individualisation of each case cannot be under-estimated.
As a physiotherapist I’m firstly concerned with assisting recovery in the physical side effects from treatment which include urinary incontinence, erectile dysfunction and fatigue. There are numerous ways in which to help men deal with these and simple tasks like performing pelvic floor muscle exercises correctly is critical. Education about what to expect is an important aspect of my work, then providing men with the tools to fix themselves is the most essential component of my work. Men generally want to be able to help themselves and improving general fitness for a start, is an easy way for a man to prepare for treatment.
You work as part of an interdisciplinary team. Can you tell us a bit about the patient’s journey during their treatment with a Urologist, Sexual Health Physician, Exercise Physiologist and Psychologist?
Most men will be diagnosed from a prostate biopsy which has been provided by a Urologist after a man’s GP has been concerned about a rising PSA blood test result. Once diagnosed and the options for treatment are discussed, the patient should then be referred to a Physiotherapist for Pelvic Floor Muscle training, at least 4-6 weeks prior to treatment if possible.
Once the treatment, such as the surgery takes place and the catheter removed, men work closely with their continence nurse or Physiotherapist to get through the initial weeks of incontinence. At around 4-6 weeks post-op, most men will be close to becoming dry and no longer needing continence pads and a visit to a sexual health physician at this point is highly recommended. Here, the focus will be on the prescription of medication such as Viagra and Cialis which aim to improve local blood flow and the provision of a Vaccum Erection Device (VED) to help stretch out the penile tissues.
After a clearance from their GP or Urologist, men are then encouraged to utilise an Exercise Physiologist, such as we have at PROST!inc to build on improving strength, endurance and improved cardiovascular function. If along the way, a man is feeling down or struggling, referral to a psychologist is highly recommended so a treatment plan can be devised to assist mental health recovery as well as physical.
What do you think are the barriers to men seeking health care and support?
Mostly themselves! Traditionally men are reluctant to seek help and when it comes to their most personal and private parts this is even more of a struggle! Men don’t like to be seen as weak or to have any cracks in their armour and unfortunately, a diagnosis of Prostate Cancer tests their masculinity literally.
How did you identify that men’s health issues, in particular mental health concerns relating to prostate cancer weren’t being addressed?
Several patients wrote to me after articles were published in local newspapers about my work, highlighting their gratitude that I was creating the opportunity for discussion about their innermost feelings and insecurities. This mirrored what I was seeing I my clinics and from almost 11 years ago when I first started in Men’s Health, there has been huge growth in male attitudes towards managing health issues.
Public health campaigns like “Movember’’ have also helped to bridge this gap. Today men seem to be more willing to ask for help and I now feel better equipped to direct them to relevant resources and support networks such as PCFA and Andrology Australia.
Why do you think the general public isn’t aware of the greater prevalence of prostate cancer in men compared with breast cancer in women?
Once again, the traditional aspects of male culture not wanting to display weakness would be the main issue I think. Women are so much better at talking about their health issues and have campaigned long and hard to get the Breast cancer message out there. What women have achieved is testament to the value of communicating their issues. Men, in general, lag along way behind. I do however, see a much more open male connectedness occurring and especially men under 60, are far more willing to put their hand up and ask for help than their older peers.
Can you tell us about what your aims are with your PhD?
The aims of my PhD are to help improve the quality of life for men diagnosed with Prostate Cancer, before, during and after their treatment. The PROST! exercise group was my goal, but rather than wait 5 years to finish a PhD, I decided I’d do the translation bit first. All men should understand what is happening to them and why, throughout their prostate cancer experience, be able to have a pathway to recovery and access support along the way. I’ll only be happy when ALL men understand they have options for a complete recovery.
Jo Milios is a Perth-based Physiotherapist who specialises in Men’s Health, focussing on Prostate Cancer Pre& Rehabilitation, Incontinence, Erectile Dysfunction (ED), Sexual Health issues, Pudendal Neuralgia, Chronic Pelvic Pain and Exercise prescription.
Jo set up ‘PROST! Exercise 4 Prostate Cancer Inc.’ in 2012, a not-for profit organisation, with the aim of providing an exercise and peer support program for ANY man with Prostate Cancer no matter his age, stage or prognosis. The PROST! exercise club is based at Subiaco Football Club in Leederville and for a small fee, an Exercise Physiologist trained in prostate cancer recovery, is delivering this program on Tuesday & Thursday mornings.
PROST! inc is proud to announce the release of an exercise DVD , called, ‘JOGA! 4 MEN!’ a unique blend of Yoga, Pilates & Physiotherapy for the everyday man, no matter his age or fitness ability. At $25/copy, all funds raised will go directly back into clinical research & education programs for men, to assist others in building their own mood, muscle and mateship.
For further information:
Website : www.menshealthphysiotherapy.com.au
Phone: Carine & Busselton (08) 9203 7070 – Palmyra (08) 9339 1932
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