Dear Doctor: Tayyaba Ahmed
The pelvic rehabilitation physiatrist who wants to make a global change for women’s health.
Meeting Dr. Tayyaba Ahmed was exciting and refreshing; from following her on social media, I knew that she had a message that needed to be shared. I stopped by her office, located right by Bryant Park. It is a beautiful space — the waiting room feels like a yoga or meditation studio with natural decor, quiet music, and a calm ambiance. We chatted how she found this unique specialty, how she identified a global health issue, and all the exciting developments that are coming in the rare field she works in.
“I grew up knowing I wanted to be a doctor. I wanted to do something that made a difference. When I was in medical school, I was applying to a few fields — pediatrics and anesthesia. A friend of mine had done a PMR (Physical Medicine Rehabilitation) rotation at NYU and she thought I would like it. I wasn’t loving what I was doing, so I decided to try it. My friend was right, and I did my PMR residency at NYU. Now, I get to help people who are in that in-between place of leaving the hospital and full recovery to get better.”
Pelvic Rehabilitation Research
There is no formal training for pelvic rehabilitation. I’ve learned a lot from my colleague and partner, Allyson Shrikhande, as well as from different courses and conferences. Every day we continue to learn. We have tried a lot of different techniques, evaluating what we know about the different muscles, joints, and nerves of the pelvis.
We do a lot of research here, and most of our patients are a part of our research. There’s not a lot of literature on what we do, so we’re trying to create that. When we have a male patient come in with pelvic pain, I literally have to give him an article from 2017 called “Chronic Pelvic Pain in Women.” I tell him that it applies to him as well — because unfortunately that is the best we have right now.
Starting a Pelvic Rehabilitation Practice
Our practice, Pelvic Rehabilitation Medicine, started in 2017. Dr. Shrikhande had a vision, and invited me along for the ride. Later, Dr. Charity Hill joined our team as well. We wanted to create a place where people could get pelvic health rehabilitation, and where we could spearhead their entire treatment plan instead of having them see many doctors who are disconnected. Often, our patients come to us feeling really lost because they don’t have anyone helping them navigate all their health issues. We try to be that person for them.
Treating the Pelvic Floor
Your pelvic floor holds up your bladder, your uterus, and your descending colon. When your muscles are tight, it has a negative effect on all of the above. We focus on the muscles, which is something that a lot of other doctors you’d see for these issues aren’t trained in. Relaxing a tight pelvic floor helps the urinary and bowel symptoms — as well as pain with sex — to get better. We also evaluate every patient’s, back, hips, and abdomen for hernias. We’re basically looking for anything that could be causing pain. All of your muscles are connected, so it’s important to check out everything that can impact your pelvic floor.
Pelvic floor dysfunction can be caused by several things, including endometriosis, fibroids, colitis, chronic yeast infections, chronic UTIs, PCOS, hernias, postpartum trauma, and many more conditions. Often, we see it in people who have Type A personalities and clench their pelvic floor in response to their stress. For most, pelvic floor dysfunction is not something that happens overnight. Many of our patients have had tight pelvic floors for years before they seek treatment.
To treat pelvic floor dysfunction, we start with conservative approaches like pelvic physical therapy, yoga, meditation, and breathing techniques (because your diaphragm is connected to your pelvic floor). Then, we may prescribe suppositories with muscle relaxants, which are an easy local way to access the muscles causing the problems. We also use nerve medications to treat the neurogenic inflammation.
Patients are always so grateful to have answers. Many times, patients will cry during their initial visit out of distress, and then again at the end of the consult but this time happy tears because they feel like they finally have hope. It’s rewarding that what I’m doing is actually changing lives.
An Exciting New Treatment Option
A new treatment we’re working on is Alpha-2 Macroglobulin (A2M), which helps relieve pelvic pain and pelvic floor tightness. It is similar to PRP (platelet rich plasma), which is a process where blood is drawn, spun in a centrifuge, and the platelet rich plasma is injected back in. However, PRP intentionally causes an inflammatory response, which is the key difference between it and what we do. For A2M, we draw the blood, spin it out, then filter it again to get the alpha-2 (carrier protein). From there, we inject it in the pelvic floor. It’s a regenerative process, which is preferred over putting steroids or man-made chemicals in a patient’s body. It’s still very new and also expensive, so unfortunately many people can’t afford it yet.
Endometriosis is a Global Health Crisis
Endometriosis is a very common condition that often gets misdiagnosed for seven-to-ten years before it is diagnosed properly. This is because when women first get their period, they’re often told that their pain is normal. There’s a difference between menstrual cramps and debilitating pain — being on the floor, vomiting, and in the ER once a month. Unfortunately, there is no definitive way to diagnose it without doing surgery and getting a biopsy of the specimen.
We at Pelvic Rehabilitation Medicine have partnered with Northwell Hospital in a study called the ROSE Study. The purpose is to create a blood test using menstrual flow to diagnose endometriosis.
Anyone can participate in the study, if they have a history of heavy or painful periods. We have been struggling to get participants because when someone has painful periods, the last thing they want to do at that time is be a part of a study. Also, this test unfortunately can’t determine if someone currently has endometriosis as this would affect integrity of the study. However, for a woman with endometriosis, with a possibility that their daughter may have endometriosis, we hope they will be able to diagnose the daughter’s endometriosis when it comes their time.
Endometriosis is highly confusing because it has a multitude of symptoms, including painful periods, abdominal bloating, abdominal cramping, and chronic constipation — all of which are also often GI symptoms. People can also experience urinary frequency or pain, which would lead them to a urologist. Where I come in is when patients are experiencing pain with sex, which is often because they have really tight pelvic floor muscles. Many times nobody has stepped back and looked at the bigger picture, and asked them about a history of painful periods.
Spreading the Word
If people in the United States are barely getting diagnosed properly, imagine what it’s like in Africa or Southeast Asia. I’m Pakistani and my husband is Indian, and I started to realize that not a lot of Southeast Asians like myself were coming in and getting diagnosed. I didn’t know a lot about this until I starting researching and writing about it for Brown Girl Magazine.
In my culture, everything is incredibly private. I realized that I had to do something for my community. I was asked to speak at a business roundtable on the future of healthcare, which is where I addressed that we need to do something for the rest of the world. We need people to invest in endometriosis, and address the inadequacies in diagnosis and in treatment.
As a way to raise awareness about my field and endometriosis, I started my own educational Instagram account in February 2018. I can’t give any medical information over social media, but I try to give people hope who are outside the U.S. and have no access to pelvic healthcare. I get a lot of people messaging me from all over the world. I often tell them to call the office if they want advice, but many times they cannot even make overseas calls. For these people, I often suggest books and literature, which they can access online. Some goods ones are The Ultimate Cock Block or A Headache in the Pelvis. Another good one is Heal Pelvic Pain by Amy Stein. I also try to do podcasts interviews with different hosts, so more people can get access nationwide.
Lightning Round
New Yorkers are unique because…we’re always on the go. This is good because we are always moving and getting our exercise in just by walking to work.
One thing I hope my patients take away with them after seeing me…that they feel hopeful.
If I didn’t live in NYC, I’d live in…LA. If I didn’t practice medicine, I’d love to live in Paris.
I do what I love because…it’s challenging. Going to work isn’t depressing. I’m excited to see new patients, I get to investigate, and help them!
Favorites
NYC park: Central Park.
Coffee or Tea: I love bubble tea — Vivi’s is better than any other bubble tea I’ve had.
Yoga spot: Mang’Oh Yoga.
You can learn more about Dr. Tayyaba Ahmed here.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
