Stuart Doorbar-Baptist is a specialist Men’s Health Physotherapist who has been instrumental in creating a framework for physiotherapy treatment of Men’s Health issues, particularly pelvic floor rehabilitation both prior to and post-prostatectomy. He lectures in Mens Health at three universities and is involved with ongoing research to improve health outcomes for men experiencing a range of conditions including prostate cancer, pelvic floor rehabilitation, erectile dysfunction, Peyrones disease, incontinence and more.
Stuart continues to consult from Sydney Physiotherapy Solutions in Macquarrie Street, Sydney, but is now also available at 6S PHYSIO on the Central Coast.
If you or someone you know is searching for a highly experienced physio, you will nt find a more committed Mens Health Physio than Stuart.
TRANSCRIPTION:
[00:00:05.270] – Darren
Hi there, this is Darren from 6S PHYSIO and I’m here with my good mate Stuart. Stuart is going to be joining us shortly within the 6S family and he’s going to be bringing an awesome new niche to our services, and that is Men’s Health. It’s a terrifically important service that we’re really pleased to be able to offer and we’re really pleased to be able to have Stuart doing this for us because Stuart is pretty much a genuine bona fide expert. So let’s learn a little bit about Stuart. So Stuart, tell us about your journey as a physio. When did you study physio? When did you start practicing?
[00:00:47.780] – Stuart
Back in the early nineties. I went to Uni in Manchester in the UK and got my degree there. And then I worked for a couple of years in Sheffield in the north of England, where I did like a rotational physio position going through a whole bunch of different places. Burns units, plastic surgery, amputees, spinal injuries, like just every kind of aspect of physio you could ever kind of conceive. And so I did that for two years and then I came out to Australia.
[00:01:18.330] – Darren
Cool. And at that point, did you go back into the hospital system or did you go into private practice?
[00:01:23.340] – Stuart
No in Australia, I kind of bounced around private practices for a while and then to get residency I had to go and work out in a rural hospital. So I went, ended up at John Hunter Hospital up in Newcastle, which isn’t really that rural, but it was considered rural enough for us. So we went out there for two years and then got my residency and then came back to Sydney and then just kept on working in the private practice arena.
[00:01:53.250] – Darren
And at some point or another we ended up working together and we worked together for about – was it about seven years? – We worked together in a private practice, which had about three or four locations through the northern suburbs of Sydney. And yeah, Stuart and I have got plenty of stories from back in those days of all shapes and sizes. So at some point you made a decision to go into Men’s Health. What was that point? What was that point? What made you shift into the direction of Men’s Health?
[00:02:28.810] – Stuart
I think when you’ve been a physio for a while, there’s a limited number of courses that you can do. And I felt like I kind of had done most of the things that there was to do and there was just one course that was being offered that I hadn’t ever really considered before, and that was a Men’s Health course. And at the time there was a lot of movement towards kind of the importance of deep muscles in low back pain and those kind of things. So I thought, well, I’ll go on that, give it a go and see what happens. What was really interesting was that I then started when I went on this course to think, actually, this just sounds like a woman’s health course where the sex has been changed from Her to Him, it didn’t really sound very specific to men at all. It just sounded like a fairly generic course about incontinence and dysfunctional urology. And so when I spoke to the people that ran the course, I was actually really gobsmacked that a lot of the research they were basing this course on was all female based literature. There was no real evidence base behind it from a male perspective.
[00:03:40.610] – Stuart
And that really kind of stood out and made me think.
[00:03:45.650] – Darren
Look, I recall doing some of those early courses. It’s just mostly for the back rehab thing. And a lot of those concepts we’ve let go of or we’ve let pass or whatever in terms of musculoskeletal stuff. But this is where it comes into its real strength, I guess, is that application to pelvic function, whether it is women’s health or whether it’s men’s health, and we can talk about the mechanisms by which people end up with that trauma or those problems in a minute. But we have, of course, as you know, we’ve started Maddie with the Women’s Health side of things, and she makes a lot of use of real time ultrasound to view those pelvic floor muscles. And I believe you do a bit of that as well.
[00:04:36.450] – Stuart
What we what I found was I went back to Uni. I went and did a research masters through Sydney Uni, looking at how we can use ultrasound to better teach men how to identify the muscles specific to urination, to urinary control. And it was then it was quite interesting because, again, there wasn’t much literature on it. And at the end of my research, we managed to get the paper that I produced published in an American journal. From there, I then started to work with a couple of urologists in Sydney, and I started to kind of develop this conceptual framework for how to progress men through a series of exercises in order to regain continence following prostate surgery. And from there, it just literally just kept on growing from strength to strength.
[00:05:26.990] – Darren
Got you. Yeah. Take us through the because men’s health is a fairly broad sort of topic. We’ve started talking about guys who have probably had prostate cancer and have had prostatectomies where they’ve actually had their prostates removed. What other sort of things does a men’s health physio do?
[00:05:48.330] – Stuart
We look at men who suffer with dysfunctional urology. So people that suffer with lower urinary tract symptoms like urgency, frequency, hesitancy, slow flow. Now, some of that can be caused by the prostate itself being enlarged, but also some of the symptoms that people complain of can also be explained by having a pelvic floor that is overreactive to normal stimuli. So what we’re finding is that, in fact, some men that have what’s called prostatitis or other people call it persistent pelvic pain. In fact, it’s nothing to do with the prostate. It’s more to do with a dysfunction within the pelvic floor itself.
[00:06:29.750] – Darren
Got you. And you use various different tools to assist with this sort of thing. I believe you use the Focus Shockwave for, well, this and other issues. Things like erectile dysfunction.
[00:06:42.530] – Stuart
Yeah, erectile dysfunction, especially following prostatectomy where the nerves have been bruised. We want to try and optimize penile blood flow, and Focus Shockwave has been shown to improve this kind of early revascularization. So we’re using that for those guys. We’re also using Focus Shockwave for people who have persistent pain and again, trying to optimize penile and perineal blood flow.
[00:07:07.880] – Darren
Yeah, good stuff. All right, so what’s the usual process? How does someone end up seeing you? If a man or his partner identifies that he has a problem that needs some help, what would be the usual first steps that they would take to get in touch with you?
[00:07:29.550] – Stuart
Well, often I’ve worked very closely with urologists, so I’m getting a lot more direct referrals straight from the urologists themselves. So now that they’re starting to trust that we look after their patients really well, we’re getting a lot of direct referral from there. From there moving forwards, a lot of our referrals are now coming from word of mouth, from men who’ve had a great outcome from what we’ve been doing and then just telling their friends. The incidence of prostate cancer is horrifically high. It’s about one in five men are going to get diagnosed with prostate cancer in their lifetime. And because of that, it’s almost incredible, once you start to speak about this with people around and about, you actually realize how prevalent the condition is.
[00:08:11.180] – Darren
Yeah. Got you. Is there a genetic link?
[00:08:14.250] – Stuart
There is, yes. If you have a family history, especially if you’ve had a family member that’s passed away from it, then there’s normally a very high likelihood that there is a genetic kind of component to it.
[00:08:25.410] – Darren
Got you. Yeah. Well, in that case I can identify because my father actually does have prostate cancer and he’s undergoing treatment. So if somebody comes to see you, they’ll be seen in private rooms. You’ll be able to share your experience in dealing with hundreds of patients by now. Thousands?
[00:08:49.900] – Stuart
Thousands. Yeah, we’ve been doing it now for about 15 probably about 15 years. Yeah, just over 15 years. And so, yeah, we’ve seen thousands of guys both pre and post prostatectomy. We’ve seen guys with dysfunctional urology problems of urgency, frequency, hesitancy. We’ve seen guys with erectile dysfunction. Peroni’s disease where the penis suffers with a curvature issue. There’s a whole range of different conditions that we’ve seen. Prostatitis as well, pelvic pain. So it’s a huge ranging area. And yeah, the key thing is that no two patients are really dealt with exactly the same. It’s a very multifactorial issue, and we look at things from a very holistic perspective. So we look at a very biomedical and psychosocial background as well. So there’s a lot of psychology that comes along with urination.
[00:09:44.130] – Darren
Yeah, exactly. I guess it’s a topic a lot of guys are probably hesitant to mention and discuss. And I guess we males are probably learning to be a little bit more open with our mental health as much as our physical health as well. So I guess our message, you and I, our message is today for anyone who is watching and who actually has a partner or themselves has an issue, put your hand up, go and see your GP if you want to get a referral. That way you can actually come directly to us as physiotherapists, in which case Stuart would probably be happy to guide you in the right directions as to who you should consult with, whether he can sort of start you off. Would that be correct, Stuart?
[00:10:35.030] – Stuart
Yeah, I think women historically tend to band together. They tend to discuss even intimate problems within their collective framework. Men, on the other hand, tend to view dysfunction as almost a sign of weakness, and it does affect our masculinity in ways that we don’t want to admit. And so it is difficult to kind of have that first conversation, whether it be with your GP or whether it would be with us. It’s often quite rewarding for men to actually be able to open up and say what their problems are and instantaneously. A lot of them feel significantly better just by having that first conversation. And having a plan and a framework to work within often gives men a significant degree more control than they’ve had before.
[00:11:23.290] – Darren
Yeah, I think it’s one of the things that I think we as physiotherapists benefit from, is that we actually can spend the time with someone to actually get to some of those, I guess, deeper issues, actually acknowledge those personal struggles, and, as you say, every single patient’s different. I’d hate to think that any GP would rush you, but Stuart, being very much a specialist in this area, is someone who could actually get you started with a very sympathetic ear and give you good advice right from day one. Stuart’s going to be on the central coast on a regular basis and he will also be backing up the visits when he is at the central coast with Telehealth. Is that right, Stuart?
[00:12:26.490] – Stuart
Yeah. So one of the wonderful things about COVID was that it actually forced us in a way to try and stay in touch with patients from a distance. And what we’ve actually found now is that we’re actually managing to do some of our therapy more remotely. So the ultrasound part, of course, we’ve not quite figured out how to do that remotely – that’s quite necessary to do in the clinic – but once we’ve done that, and once people have got a sense as to what the muscles feel like and they can actually see it in real time, it stops becoming something very esoteric and very sensory and it starts to become a process that’s much more real for people. Once you’ve got that, then, of course, from there on in, it’s just about training and training and getting an outcome from repeated training efforts, which is like anything that we do in Physio.
[00:13:17.910] – Darren
Yeah, exactly. And of course, you have all sorts of other things you want to monitor, things like urinary output, so people often fill in diaries to actually keep track of what’s happening with urinary output. You would have the opportunity to talk to Stuart about possibly the effects of some of the medications you’re on, which could be fed back to your GP or to your specialist. Here we are, we’re on Zoom. So this is effective communication and yeah, harnessing that’s been, as you say, it was forced upon us, but we’ve actually harnessed it quite well. So, look, if anyone has any questions, don’t hesitate to get in touch with us at 6S PHYSIO. We’ll be able to put you in touch with Stuart, organize an appointment where you can sit down with him. Have you got anything to add there, Stuart? What sort of things would you like to add to what people need to know about you and your services?
[00:14:15.710] – Stuart
I think there is a huge stigma associated in general with men that don’t like to complain, if they’ve had surgery for prostate cancer and they’re left with slight dysfunctions, they kind of almost feel like it’s inevitable and it’s the price they pay for having the surgery they’ve had. But it doesn’t have to be that way. And I think rather than just accepting your lot, I think I’d encourage people to kind of at least give it a go to try and change the outcomes, because change is possible. Change is always possible.
[00:14:50.630] – Darren
Good stuff. That’s a great message to finish on there, Stuart. Look, if anyone wants any further information on men’s health and being able to be put in touch with Stuart, don’t hesitate to pick up the phone and give us a call. You might want to throw in comments if we put this up on social media, you might be able to put in some comments to ask some questions, but I would recommend you get on the phone, give us a call, we’ll book in a time with Stuart and you’ll be very glad you did. As I say, Stuart’s been a mate of mine for many, many years now. He’s a great bloke, very easy to talk to. He’s a very funny man too, when you get him away from this sort of formal setting. But thank you very much, Stuart. We are really looking forward to working with you. It’s going to be fantastic. The Central Coast is going to get a real champion for men in you. So thank you very much and we’ll talk to you soon.
[00:15:39.290] – Stuart
Sounds good, Darren. Thanks for interviewing us.
[00:15:41.800] – Darren
Catch you later.
[00:15:42.920] – Stuart
Bye.
