#004 - Ulrike Mersinli meets Claudia Béland (English)

00:00:00: Hello, Claudia Béloit.

00:00:08: It's so nice having you here on this podcast!

00:00:13: Hello!

00:00:13: Nice to meet you.

00:00:14: I'm really happy that we could organize this podcast as well.

00:00:18: So i get to explain a little bit more.

00:00:22: what do back in Montreal?

00:00:25: That is so nice...I just read that you are registered nurse and that you are an osteopath as well.

00:00:34: So this is a very interesting combination, so how does both of it influence your work?

00:00:40: or did you get from the one thing to other?

00:00:44: Very good question!

00:00:46: Yeah when I was young trying to find out what i would do for living health career in medical profession of being a registered nurse.

00:01:00: So I did a lot different things on that field, but you know i really like to learn more and was interested pushing a bit my knowledge.

00:01:10: And I really like the more holistic approach in regard of health.

00:01:16: so when i was a nurse, I stayed...I spent a year in Switzerland working at the Luzan as a register nurse there and I heard about osteopathy there and kind of was curious about it.

00:01:31: that's something seems interesting.

00:01:33: So When I came back from Switzerland So I entered the osteopathy course back here in Montreal without really knowing what i was going to do with it.

00:01:44: It started like that, so each time I went into the course and I was interested because this is a good approach for performing later but didn't know if I would still be a nurse or not in my mind at this point, but slowly with the years you know it takes quite a bit of time to become an osteopath.

00:02:12: I really focused my last couple of years on the woman's health world so i decided to study pregnancy optimal fetal positioning, breech positioning.

00:02:27: how can we help?

00:02:29: So that was kind as an osteopath.

00:02:35: So this is how I finished my studies, but with my final paper and then i started to work here in Montreal In a clinic with Natalie Camira and Dino Musi.

00:02:48: At this clinic it's really focused more on women health.

00:02:52: we have you know the whole family coming But This Is Where I Really Started To Learn More About fertility, gynecology urology endometriosis pelvic pain and all of that.

00:03:08: That was a long answer.

00:03:09: I'm sorry

00:03:10: no problem it's totally fine.

00:03:12: i was just wondering how does fit together being like very precise with everything you do?

00:03:22: Like what is in Germany?

00:03:27: It's the same in Canada, where you have to do everything very strategically and where your guidelines go through.

00:03:37: And osteopathy is not just a gut feeling of course but it's more holistic from the baseline.

00:03:48: so how... Do bring all those stuff together?

00:03:53: I think the strong point that comes from my nursing point of view is really empowering the patient, giving them information.

00:04:04: So therapeutical teaching kind of thing.

00:04:08: so i think use a lot of that in my course and give to Osteo try make sure when they are finishing the course that they have all these knowledge, and it can transfer to their clients about.

00:04:23: you know for example if we talk about fertility.

00:04:26: That they will know how to recognize you know the fertile window uh...that they would know how.

00:04:32: support of the fertility more in a holistic point-of view with eating habits lifestyle changes and all of that.

00:04:45: So I think all the patient teaching is really something that comes more from the nursing point-of view, um... And then for sure like i work as an osteopath but you know when there's a red flags on all of That I really use my uh you know nursing hat to make sure that the patient really understands The importance of working in a team with the medical doctors As well.

00:05:09: So it works quite good together,

00:05:12: both of them.

00:05:13: Exactly!

00:05:16: You said that you're in your field more with fertility and everything about women's health so to say?

00:05:28: Of course the men are as important as women but like before when we talked ten years ago or so wasn't for women that much how it is now.

00:05:43: So we have a totally different approach with fertility and the menstrual cycle, what kind of an approach?

00:05:55: The first one when I come to you and want to get pregnant nobody knows because everything's fine.

00:06:07: Okay, maybe a little bit tired but nothing bad.

00:06:10: So they just say okay now you're over thirty or maybe forty it's totally normal that you feel like.

00:06:16: so what kind of approach?

00:06:18: Maybe this is good idea to show your way of working.

00:06:25: Very good question!

00:06:26: First off all my first appointment with someone.

00:06:29: I really take the time You know, get the good basic information.

00:06:34: Uh you know general health because if we talk about fertility for example there's a lot of different factors that could influence fertility.

00:06:43: so sometimes their lab results are all good.

00:06:45: but uh The woman can be for example um no physical activity, so I try to give them complementary information about what they can do to promote their good health.

00:07:03: And then i want to make sure that they really understand like depending on the process that they choose for fertility if there are with a medical team or if they work it by themselves um...that they are able to identify the fertile window because A lot of women will rely on their phone application, you know where it makes a calculation.

00:07:26: Okay?

00:07:26: You're going to ovulate this

00:07:27: day.".

00:07:28: So this is sometimes a bit misunderstood from woman that they think the app will give them exactly the ovulation date.

00:07:37: so this is just like basic thing first appointment.

00:07:39: we want make sure that, you there you know we want to make sure all the ingredients are there.

00:07:48: if it is so then I will work more on the osteopathic approach.

00:07:53: So, i wanna make sure um...I'm not going to approach this woman differently in my way of assessing y'know uh..the dysfunction ,i'm gonna try to find out what is the priority but to also include a part of really pelvic assessment.

00:08:11: So we know, well as osteopathy and if you just look at medical information about fertility... We want have good vascularization ...we wanna have good access for the eggs to meet up.

00:08:26: so if there's a lot of tension in the area and for example, the ligaments of the uterus are not well balanced we can end up having a uterus that is a bit flex or in rotation.

00:08:40: Or it could be even in a torsion victim from a lot of pressure, the organs and structures above it.

00:08:50: That would be more about the osteopathic approach that I will start to put into place normally when i follow for fertility every month, like once per month between the menstruation phase and before the ovulation.

00:09:12: So it gives us a small window where we can work to prepare the body for uh the incoming ovulation.

00:09:19: so why is it important to um go right into a certain kind of window?

00:09:26: Um you mean timeline?

00:09:30: yeah it's just Mandatory like if someone comes after the ovulation, I will you know work on them anyway.

00:09:40: It's just.

00:09:40: there are some techniques that we might want to You know be more cautious If there is a chance of them being pregnant especially.

00:09:52: It's not really a no-no, but you can be at the moment of cycle where embryo is in the tube for example.

00:10:02: If we do techniques on tubes it might not have been the wisest thing to do.

00:10:07: so just give them confidence as well and make sure they are well preferred for this ovulation.

00:10:13: But I explained that client too.

00:10:16: We're going fix your uterus.

00:10:18: You want us to complete work including nervous system.

00:10:22: well, not just only in relation to the nerve that goes through uterus but also A lot of these couples who are going through fertility process, they have a lot of stress.

00:10:38: There's a lot anxiety sometimes.

00:10:40: so just like working on the nervous system will be good complementation to your approach as well.

00:10:47: So I prefer to work in that time window.

00:10:50: also make sure... Sometimes there could be stress.

00:10:55: if you worked their body after ovulation They think they might get pregnant, so they might want to avoid being manipulated at this time.

00:11:05: So this is why I choose this period.

00:11:09: if there's... If it's more like a plan intervention for example, the couple will go through IVF and we have a few of months before the IVF.

00:11:24: Okay,

00:11:27: so what's the most common thing would women have when they come to you?

00:11:36: So as I said i really have more woman than man.

00:11:39: So I do have a few men but like on my week I will have maybe one man and the rest with be all women.

00:11:48: um...so very common is fertility.

00:11:52: that maybe on the top five.

00:11:54: I work a lot also with endometriosis client, that's my top-five too because like i did a lot of workshop with association here so my name is around and where collaborate with endoclinics in Montreal clients.

00:12:18: And then I have all other women's health issues, so because i work in fertility ,I will get the pregnant woman after that postnatal woman after.

00:12:27: So sometimes it comes with prolapse It comes with urinary incontinence .It comes with pelvic pain and Then my my clients.

00:12:37: we'll get a bit older and then we'll go to menopause perimenopause Maybe other kind of symptoms around these periods as well?

00:12:45: That would be mainly my focus, gynecological issues often comes with digestive issues as well.

00:12:55: So it might not be like the reason why they come.

00:12:58: but when we ask questions you will say oh yeah by bowel movement is that so good?

00:13:04: and we know there's an interrelation in different systems just hormonally pressure-wise, so I will address all these other systems as well at the same time.

00:13:19: You just mentioned pelvic pain in general?

00:13:23: So maybe we can focus on that for a moment...

00:13:28: Yeah!

00:13:29: ...I think many people don't really understand what's about pelvic pain and what does it mean describe.

00:13:42: Yeah, so we first can talk about what is chronic and what is acute?

00:13:48: So pelvic plane like now.

00:13:51: I kind of included abdominal pelvic pain because sometimes it will be just above the pubic bone.

00:13:58: they could have a pain close to an ovary or sacroiliac joint coccyx pain, it could be vulvodynia all of that.

00:14:16: Pudendol nerve pain... It will also included in pelvic pains.

00:14:22: so more like to you know name it as an area, but then we have acute and chronic.

00:14:28: So the acute will be... It's been there for a little bit of time not too long when it passed certain amount of time in that literature is not so clear now.

00:14:39: before they were telling after six months We kind of call it chronic.

00:14:44: Now you know discussion has made between could it be after three months?

00:14:50: What is important to note Is That When The word chronic doesn't mean that it's going to last forever.

00:14:58: It means more, there are some changes in the physiology of the nervous system.

00:15:03: That will make some modification inside the nervous systems.

00:15:10: So inside brain and spinal cord Inside a little nerve which sends pain messages And is very important as a therapist.

00:15:22: what is this new system that we're working with.

00:15:28: The chronic aspect will bring more sensitivity, so we call it central sensitization meaning These little cells will be more trigger, more easily to send the pain signal.

00:15:45: So it's very important to modify our approach.

00:15:49: if we talk about endometriosis We also have an inflammatory aspect.

00:15:54: so even If we know were gonna work on you know working The viscera is making sure they slide well and sometimes It just not possible too You know Put into action modification of the nervous system.

00:16:11: So we have to, you know take different paths uh to help these person.

00:16:17: um without really creating more like a flare reaction.

00:16:22: I think that what you said is very powerful to understand that chronic doesn't mean it's forever.

00:16:29: so i think many patients think that when when

00:16:32: a doctor

00:16:33: or somebody else

00:16:35: It's really important and then Sometimes, it's hard to believe when you are a client stuck with this pain because you had for awhile and lose your confidence in the capacity of resolving these old systems.

00:16:55: It takes more than just one osteosession.

00:17:03: mind, body practice a lot of stress management nervous system exercise.

00:17:09: So it's a bit of a challenge you know and we really want to make sure that the client who work with really understand this part because if could be a bit challenging for them as well.

00:17:21: And that something when I use their word chroniced explain how they're nervous is then became do that little precision, okay the word chronic just to let you know it doesn't mean that its forever.

00:17:38: We want if we have progress within six months or a year ,we're not going see progress every day and probably out then down up but look at the general curve better life quality.

00:17:54: So I know your teaching as well.

00:17:59: Do you see differences in the metacognition of therapists where they are working with their clients?

00:18:13: Please be aware that chronic is not meant to be forever.

00:18:19: and some, I don't know.

00:18:21: it's sometimes a cultural aspect or social sociological aspect how people learned in their therapy practices.

00:18:32: So do you notice differences?

00:18:36: It just like from yeah probably yes um You know.

00:18:41: i just want to clarify that.

00:18:44: For me, chronic doesn't mean that it's forever but it does not mean that will resolve also.

00:18:53: It could be a different path for everyone.

00:18:56: I would rather say that chronic cannot resolve.

00:19:05: for some people, even for some clients.

00:19:08: They will take this word chronic as okay.

00:19:10: I'm stuck with that for the rest of my life.

00:19:12: but from my experience and what i've seen it's really possible to improve from a chronic condition.

00:19:24: probably for new therapists is something they might not believe because clients working with different approach, but this is where it's really important to have integrative approach.

00:19:38: With other teammate.

00:19:40: you're not going be the only one working with these clients because they need a team to really build up that plan to resolve their problem.

00:19:50: Yeah so there are probably differences between perception and culture as well.

00:19:58: So I think it's just interesting to see because uh, It always depends how you Yeah.

00:20:03: Not not just how you got Teached by anybody.

00:20:07: but like when you say it like that and the words are very powerful And others say it in another way so they might have an influence on the person, of course.

00:20:19: Yeah with their talking.

00:20:21: so

00:20:22: I think that's a very good point.

00:20:24: The word you're going to use are really powerful because They come to us as they are vulnerable the client we see.

00:20:33: So it is important not be affecting your confidence.

00:20:45: first appointment when I receive someone who has like, for example a diagnosis of either any any diagnoses that come with chronic pelvic pain and though or painful bladder syndrome, coccyx pain.

00:21:01: So i tell them okay we're gonna work together as a team uh...and we're going to you know maybe integrate some other members in our team but i really want you to trust your body term than just like every day, because you're going to find days where your not gonna feel so good probably.

00:21:21: but I want fill up here toolbox.

00:21:23: So that when these days are present You really know how deal with it and don't panic Because stress will influence pain as well.

00:21:34: The patient teaching is the key i think To build of team work.

00:21:41: Very interesting with the factor of stress.

00:21:44: So I think this is something that's really hard because when people say, oh i'm not supposed to have stress, it stresses bad for me so its just like a circle or im getting pregnant!

00:21:57: So this is bad and i am NOT SUPPOSED TO HAVE STRESS, THIS IS STRESS FOR ME BECAUSE YOU KNOW WHAT I MEAN?

00:22:04: What

00:22:04: kind

00:22:05: tools do you use in your toolbox?

00:22:10: give them on their hand

00:22:12: to work with.

00:22:12: Yeah, I think one of the simplest tool that is recognized by research for the nervous system is really that breathing...I don't know what's a good word in English?

00:22:25: In French we call it cohérence cardiaque so Core

00:22:33: and heart breathing.

00:22:34: Yeah, so you're gonna take like five seconds to breathe in to inhale And then five seconds two exhale for five minutes.

00:22:43: So that's a very simple tool.

00:22:45: I think it's the because life goes by far sometimes like you know these clients will have work, we'll have kids.

00:22:51: We'll have many things.

00:22:53: so it's not always realistic to give them a meditation program where they take one hour every day because this will help for their chronic pain.

00:23:07: but You know, I want to start with something that is really easy to integrate in the daily habit.

00:23:14: So i think five minutes are realistic once a day but then if they can add it three times per day would be ideal.

00:23:26: so thats one idea and some woman will tell you its not working.

00:23:36: see a straight change.

00:23:38: You really have to create the habit of putting it into your schedule, that five minutes in the morning wherever it fits and you're going end up having good impact on your nervous system.

00:23:52: Also, other people might like to dance.

00:23:55: Might like you know sing a song.

00:23:57: so I'm gonna try to evaluate with them what is the easiest tool that they can integrate?

00:24:03: So i made a little pdf.

00:24:04: uh...that's given my course through The Osteopath That They Can Share With Their Clients.

00:24:09: Stress Management Tools where I have a list of possibilities you're going to look at the list and pick up one, that you can apply every day.

00:24:19: You know do it once a week or another on the other days.

00:24:23: So thats part of this support I try give my client.

00:24:25: And i also share with students who come through course.

00:24:29: so they have something They can share their clients afterwards.

00:24:34: It's very powerful to have something empowering To do.

00:24:39: Exactly.

00:24:40: This is game changing as well When we go back.

00:24:44: pelvic pain, is it always well?

00:24:49: Always.

00:24:49: But more often that the pelvic floor is very tight or more

00:24:59: loose.

00:25:00: now I think we use the word pelvic pain, but it doesn't always include pelvic floor dysfunction.

00:25:08: If you talk about endometriosis for example sometimes the pelvic floor could be in a dysfunction.

00:25:15: that's not same with pain on ovulation site or like... It is definitely something able to evaluate and address.

00:25:36: But when it's a really complicated situation with the pelvic floor, I will include in the whole session to work with, with the client.

00:25:55: On my side I would support this therapy by you know making sure that this pelvic floor doesn't have a good reason to get overly tense.

00:26:06: for example if we just worked the pelvic floor but let's say there is lot of congestion in the abdominal cavity lack of mobility You will get extra intra-abdominal pressure.

00:26:19: so i I call the hypopressive keys, which are different structures inside the patient's body that will maybe contribute to have that pelvic floor more engaged because it is creating tension.

00:26:35: So my colleague in Physio won't look at this.

00:26:40: so make sure you use your osteopathic approach pressure system, a better balance inside the pressure systems so that the local treatment by the physio will be more effective.

00:26:54: So I work a lot with the pelvic floor physio in these cases.

00:27:00: That's very interesting and Germany it is same.

00:27:02: we have people who do for example Physiopelvica.

00:27:05: i don't know if you heard of it?

00:27:07: Yeah!

00:27:07: This was something common.

00:27:10: but where you can have pelvic pain, is there a range?

00:27:20: I think it's possible to have it anytime.

00:27:24: Sometimes it comes from different contributing factors.

00:27:28: so let say for example if your kid fell down on the pubic bone and then had some bladder infections while you were teenager build up of different factors that will, and now I'm in chronic pelvic pain just because all these contributing factors have created this pattern.

00:27:53: And you're stuck with diagnosis of painful bladder syndrome back, we know that.

00:28:05: okay there was this and this.

00:28:07: That probably triggered all of that.

00:28:09: so it's also very important to understand the history behind these pain syndrome because really the diagnosis doesn't give you more than they're just pained there.

00:28:20: So if you want to understand what is this path leading us into those symptoms?

00:28:31: So sometimes it comes later in life because of hormonal changes that could also trigger can be a contributing factors, but it also can appear in younger age as well.

00:28:45: I think about young kids or young adults.

00:28:49: we don't talk as much.

00:28:51: It's more like on the menopause perimenopause now very popular.

00:28:57: so yeah totally important.

00:29:00: But I know that, for example kids who do a lot of sports have issues to hold the urine and so on.

00:29:12: Exactly!

00:29:13: And young kids everybody would say well this is a young girl why should she have any problems?

00:29:18: So Is there something you see sometimes?

00:29:23: As you said, it's not very common to talk about it.

00:29:28: So I do have younger kids who come...younger women in their teenage age will have for example a painful period that would last half of the month stuff like that.

00:29:45: if not i think when i go back into history didn't have the knowledge to know, okay is this normal?

00:29:57: Is not normal.

00:30:00: So I do have a bit of younger clientele but it's not that big part of my practice.

00:30:05: It's true that comes later in life

00:30:10: Yeah But its interesting because maybe we don't talk about and thats more like taboo.

00:30:18: so everything around beyond the naval talked about.

00:30:24: So

00:30:25: this is pretty

00:30:26: easy, yeah?

00:30:27: I think now it's more talked about than it was but it's true that there's like even like a have a teenage girl at home and you know i try to teach her stuff in.

00:30:38: she said oh mama mama.

00:30:39: so you know she feels like a bit.

00:30:41: don't talk about that y'know.

00:30:43: also its still there.

00:30:46: okay i dont want to talk too much what happening Sometimes it can lead to people who go into the chronic phase, because they didn't know that they could get help for that earlier.

00:30:58: And and in its a key point... Because the faster you act once the symptom is there.. The less chance you have of it become chronic!

00:31:07: When it becomes chronic It's much more challenging path To really resolve it

00:31:15: Even though when your whole nervous system still growing implement more and more of the bad things, so to say.

00:31:24: Yeah good point.

00:31:27: what's about young boys for example having?

00:31:32: I know that some young men or a man can have pain in their

00:31:40: testes?

00:31:45: Yeah, so young men is also a possibility.

00:31:49: Sometimes there's a lot of little boy who will have like very close veins in the testes.

00:31:56: for example on left side it more prone.

00:31:58: if you remember well your anatomy we know that the left testicle vein would go up to the left kidney vein.

00:32:08: so the path is a bit different on the left than on the right.

00:32:11: So, the left side is more prone to varicose.

00:32:15: most of the time it's not really symptomatic but it can be you know heavy creating a bit of discomfort especially when Also, like these little boys sometimes they will try to train and everything but the muscles are not quite ready so the inguinal ring could be really tight.

00:32:39: So yeah it's possible to have pelvic pain in young kids too or from trauma as well.

00:32:45: lots of this little boy who is active that would play games you know do sports.

00:32:53: So it's something that we can address in osteo as well.

00:32:56: And, and It's really important to remember also are your nerve anatomy when you think about pelvic pain because all these nerves sometimes could be You know this function or they could under tension along their path.

00:33:15: so knowing the nerves is a good access for a therapeutic plan as well.

00:33:28: So I just thought about boys playing football, maybe I don't know.

00:33:35: this is something i hear quite often from the boys after-boys that they have pain in their engine.

00:33:42: Oh yeah!

00:33:46: Well, that's just because of the sports and I don't know.

00:33:50: But maybe something to look at when it is quite often so...

00:33:56: I think its always worth an osteosession or try.

00:34:01: sometimes i will get clients with really like uncommon symptoms.

00:34:14: for delivery.

00:34:15: She had many kids and after her second one, she felt like the clitoris was a bit different.

00:34:25: She couldn't feel it properly you know?

00:34:28: Like some stuff that... You ask questions but its not clear in your head is coming from nerves or vascular or local.

00:34:36: so I always tell them okay trying from your history, try to make a plan.

00:34:42: I'm not quite sure but let's try!

00:34:43: Let's try and i do my best.

00:34:45: and when i'm working...I am always having my anatomy in my head like okay um what is working?

00:34:52: What could pull on this you know?

00:34:54: From the tension that I find on her body often most of the time results, maybe not a hundred percent back to normal.

00:35:05: But it's worth trying even if you're not sure you understand.

00:35:09: but any symptoms... You have to think about what would be the contributing factors and your hypothesis as an osteopath that could trigger this pain?

00:35:21: Think about nervous vascular neighbors around them.

00:35:27: Very often you will find good results just like by trying stuff, even if he never treated something like that before.

00:35:35: Yeah Just a gut feeling

00:35:39: But also based on your knowledge of the nervous system Exactly, exactly.

00:35:46: So and your tools in your hands as well we have a wonderful tool where we feel the tension so sometimes like you could be surprised on what you can feel it.

00:35:58: okay I wasn't expecting this tension to be there but let's work on that You know?

00:36:05: This is totally interesting i think.

00:36:08: still like we said fertility menopause and so on.

00:36:13: I think there's some stuff where you can go already, get to learn a lot of stuff at the UGO for example?

00:36:24: What do?

00:36:28: Yeah, so UGO has different modules.

00:36:31: So I come in the second module...so it's basically urology with intro to gynecology!

00:36:40: We do a lot of revision physiology, but then we have a lot of tools that we want to share with the students so they can have good techniques for any problems in relation to urology.

00:37:01: So most time will focus on urinary incontinence and stress or urgency, stuff like that.

00:37:15: We do a big part on pelvic organ prolapse as well.

00:37:20: we talk about pelvic pain.

00:37:21: there's little part of pelvic pain with the painful bladder syndrome.

00:37:27: how can you address it?

00:37:31: So this is all in an environment where we support our anatomy background and My goal is really to offer very precise tools in the palpation.

00:37:48: So we talked about intuition and all of that, but when they come out of my course you have a tool for working on this structure.

00:37:59: so it's not just oh I'm going feel attention now i want you work with me.

00:38:03: let get at level course because I really try to have put on the focus, on the precision of techniques.

00:38:18: So this is in Ugo and then we do internal work as well so you know like a good base for learning how.

00:38:37: But as you said, You have just a tiny space for the chronic pelvic pain.

00:38:43: So that's why you decided to do another course

00:38:46: To offer exactly

00:38:49: so maybe we can say two three words however about this course As well.

00:38:55: Yes!

00:38:56: This course will be really focusing on, it's chronic pelvic pain but in women.

00:39:02: so I want to cover the endometriosis again.

00:39:08: a painful bladder syndrome, sorry.

00:39:16: And I included also apart on Prudendolne vrelgia.

00:39:21: because these three problematics are often interlinked it's not very rare that we will find the tree of them together.

00:39:31: so this course would have more like general part about what pelvic pain is a bit what we covered in this little podcast, but much more deep.

00:39:42: And then um... We will have uh part on these pathology and we will cover the other possibilities of different diagnosis.

00:39:51: Uh ...and then the big part that I want to focus on is the tools.

00:39:55: i want to share tools with the student about.

00:39:59: if someone comes to your office you know, nine on ten of pain at the moment.

00:40:05: What can you do?

00:40:06: what Can You offer them so that they come out Of your office feeling

00:40:10: better?".

00:40:11: So That's a bit of A challenge and...you don't want to irritate Them as I said..You really Want them too.

00:40:17: okay already have improvement after They leave Your Office.

00:40:21: so that-that's The kind of tool that i want To share with the students in that course.

00:40:27: So it is all about hands On.

00:40:30: Yeah, I think that's what the osteopath are looking for when they register into a course.

00:40:36: So and I take it very important also to share this knowledge with those students even if they have a lot of experience sometimes just way off working ideas because i have so much clients with pelvic pain that we don't really Invent technique anymore, but we can share ideas and way of practicing in a way of methodology.

00:41:08: it would be stuff that maybe they know but with a little twist, you know?

00:41:13: A little way of working.

00:41:14: That can make a difference in the case of chronic pelvic pain for example.

00:41:19: The focus is there just working on that with all the knowledge and then going into that as

00:41:26: I think.

00:41:27: very nice.

00:41:28: Claudia thank you very much for that interview

00:41:31: For this pleasure

00:41:34: Nice interview!

00:41:36: And I hope we'll see you here very, very soon.

00:41:41: Yes!

00:41:41: Thank you so much for having me in this interview.

00:41:44: it was a pleasure and i can't wait to meet all the students in Germany going in December of two thousand

00:41:54: twenty six.

00:41:54: We can't Wait To See You Here

00:42:00: Bye bye.