Samantha Kohane, DPT
Since I was young I had dreams of becoming a Doctor. I earned a Bachelors of Science in Psychology with a minor in General Management from the University at Buffalo in 2007. I was a member of the Varsity Division I crew team, later joined the women’s rugby team and was named the forwards captain my senior year. Training at the collegiate level gave me the chance to push my body to its extremes. It is also where I sustained serious injuries, where I was forced to pause competition to embark upon a rehabilitation journey in multiple areas of my body. My participation in collegiate athletics influenced me to become a personal trainer where I learned the value of one on one, teacher to student ratios for achieving optimal success. During undergraduate, my initial dreams of studying medicine morphed into training and athletic performance. My interest in manual therapy began early, through recovery from neck and low back injuries when various therapists treated me with their “magic hands” in ADDITION to prescribing specific movements to address my deficits. In 2010 I graduated with Bachelors of Health Science and Doctorate of Physical Therapy degrees from Touro College on Long Island, New York. Working as a Physical Therapist at the top orthopedics hospital in New York City, the Hospital For Special Surgery, I gained experience in the acute care setting and transitioned to outpatient orthopedic care. I have taken courses from IPA, Maitland, Kinesiotape, and Graston to name a few, and I am certified in the McKenzie Method. The Mckenzie method of Mechanical Diagnosis and Therapy is a reliable assessment process intended for all musculoskeletal problems, including pain in the back, pelvis, neck and extremities (i.e., hip, shoulder, knee, ankle etc.), as well as issues associated with sciatica, sacroiliac joint pain, arthritis, degenerative disc disease, muscle spasms and intermittent numbness in hands or feet. Most of my expertise in the field of Physical Therapy is in pain and recovery from acute and chronic orthopedic conditions including post-surgical procedures. The value of my hands-on skills has been ingrained in my treatment style since the beginning of my education, and I transitioned to private practice and concierge physical therapy work in New York City to be able to treat my patients the way I believe is most beneficial to their recovery.
MY FERTILITY JOURNEY
A year after getting married the dreams my husband and I shared to start a family were put on pause as we struggled to conceive. We sought out many different practitioners including acupuncturists, holistic workers, and various specialized gynecologists. We finally decided to begin treatment with a reproductive endocrinologist who practiced at a highly regarded institution in New York City. He performed a hysteroscopy to remove uterine polyps because he believed that they were the reason we were failing to get pregnant. In the year following I underwent various treatment technologies including but not limited to ‘timed ovulation’ cycles, oral and injectable medicated cycles, and finally one intrauterine insemination (IUI) cycle. My husband worked with various urology specialists as well, none of which, nor the medications they prescribed had any positive effects. Finally our doctor told us that we would need to do in-vitro fertilization to have any chance at achieving a pregnancy. I was upset and very hesitant, so we took a few months to explore more specialist’s opinions and other holistic doctors. Focusing on getting myself healthier, I spent time going to ‘fertility’ acupuncture, working on diet modification, stress and relaxation techniques, and even did a cycle with a well published doctor who did regular non-medicated monitoring with post-coital testing. This cycle resulted in “inconclusive”. After a few thousand dollars of our hard earned money and more time down the drain, my husband and I decided we had no other choice but to embark upon the IVF path to parenthood. Approximately one more year and hundreds of injections of medication later, too many 6am doctor appointments and much more stress, we found out we had failed our third genetically-tested normal embryo transfer cycle. At that time, statistically with pgs normal embryos (pgs is the chromosomal screening the clinic I was going to uses), three normal embryos should yeild one live birth greater than 80% of the time in the <35 year old category. I will never forget getting that phone call nine days after my embryo transfer procedure when our doctor told us that my Beta HCG level was ZERO, meaning there was no potential pregnancy. The weeks that followed were what I like to call my “spiral” into an anxiety-ridden oblivion. I sank deeper into depression and exhausted myself with the obsession of getting pregnant. I would spend all my free time during the day and stay up for hours every night when my husband fell asleep researching our problem. It was incredibly hard to watch my friends’ pregnant bellies grow, I was always happy for them and would attend every baby shower, but remember having to leave early one time to hysterically cry while driving home. The feeling after this type of failure for me is not easy to describe, it is like the most longing for anything one could imagine, extremely low as if I had lost a loved one, sometimes empty and mindless sadness, and other times angry and battling my own head about why life isn’t fair. It always felt like I was the only one struggling this hard or trying this hard even though I knew the reality, that there were so many others going through it too. I called and emailed anyone with the slightest connection to fertility with questions and cries for help. A caring friend and colleague trying to get pregnant at the time had a large fibroid removed by a well known ob-gynecologist who specialized in all surgeries for the uterus. This friend is a very knowledgeable physical therapist who researches everything the way I do and I always trust her with recommendations. She told me, “if there is anything wrong with your uterus THIS is the doctor who will find it”. Her physician took a thorough history and physical examination including an ultrasound of my pelvis and suggested with high likelihood that I had a disease called endometriosis. I was completely blown away because I had already been through such a journey up to this point, and none of the many specialists I had seen had asked me the questions this particular doctor did or even mentioned such a diagnosis. He told me there are three indications for highly suspecting endometriosis in women. Painful periods, position specific or constant painful intercourse, and bowel or GI changes with ovulation and/or menses. In combination with “infertility”, he was strongly convinced of my diagnosis, as he operated on many endometriosis cases per week. He suggested a laparoscopy to confirm and remove the lesions caused by the disease, and because we had already failed so many attempts trying to conceive, I considered it. In the months waiting to see this specialist I had switched clinics from one well known hospital system to another to work with a Reproductive Endocrinologist who has been in the field over 30 years. He had assisted our close friends after their long struggle to achieve a pregnancy with their twin boys and again later with their daughter. This new doctor I cycled with suggested doing an ERA, which basically does a deep dive into uterine receptivity ie when is the right day in a medicated cycle to perform an embryo transfer. This cycle also resulted in “inconclusive” for everything, for the best day of my cycle as well as inconclusive for inflammation and the diagnosis of endometriosis markers. It was a complete waste of over two months of my life including the prep, doctors appointments, scans, multiple injections, oral and topical medications ending in the most painful uterine biopsy of my life (that I was not anesthesized for or warned about). Although this particular RE was highly regarded, I decided to go forward with the laparoscopy with the previous ob-gynecologist based on my own research (reading on the internet, and speaking to multiple women who had similar convincing situations through friends and a support group) and a gut feeling that I JUST HAD TO do something different before starting over and beginning yet another cycle of IVF. When I woke up from surgery my doctor visited me bedside and confirmed that I did, in fact, have this horrible disease, and he assured me that he had “removed all visible adhesions”, and my “uterus and ovaries looked beautiful”. He instructed me to return to my in-vitro doctor and “go make babies”. During my week of recovery, now with confirmation that I had endometriosis I continued into a deeper “spiral” into my google blackhole. I was both relieved and confused, and even more scared that I would never be able to become pregnant than I had ever been even in the past. What was this disease that is so often misdiagnosed or brushed aside when a woman is trying to get pregnant? Why is there an inflammatory process going on inside my body that can cause scar tissue, pain, and fertility problems? Wasn’t it normal to have painful periods every month, doesn’t every woman have Advil in their bag for that? During my week of recovery from laparoscopy and hysteroscopy, switching from walking to lying in bed every 30 minutes to mobilize the large amount gases injected into my stomach region and gas pain in my chest and shoulders that almost sent me to the ER, I continued reading about and researching this poorly understood disease. It was during this week of staycation that my husband and I decided I should take that I was lucky enough to discover two of the people that would go on to change my life. One of which was a brilliant woman who had been through a fertility hell similar to my story and decided to leave her corporate job to help coach women along their own paths. Her name is Tasha Blasi. Everyone going through fertility challenges should have Tasha as her support. She helps you find the right doctor for your current fertility problem and has a program that changed my life and habbits from nutrition to the mental aspect of going through fertility struggles. The other person I discovered was Dr. Jennifer Mercier. I read about the technique she developed through her own experiences working in the fertility world, reproductive endocrinology and surgery internships, and with her own painful endometriosis and pregnancy stories. Like myself she decided not to pursue medical school, rather work in a much less lucrative field but where her passion drew her, working with women in a birth center as a midwife and doula, training in an intensive massage licensing program to focus on the female pelvic region. While I watched her movie and testimonials of her patients and read her book, I thought about how much MY body had endured up to this point while trying to have a baby. So far two surgeries, multiple doctors and protocols, too many drug and ivf cycles with no pregnancy and now this new diagnosis of endometriosis. Endometriosis is a disease of inflammatory cell and tissue chronically growing anywhere in the peritoneum that can progress into visual scar tissue and adhere organs together (the peritoneum is the tissue that lines the stomach and its organs). Being a physical therapist with my background in hands-on therapy, I KNEW I could only benefit from this work performed on my own abdomen. My non-pregnant lower belly had significantly grown over the last two and a half years time, I had gained 20+ pounds despite a relatively clean diet. I found a Mercier therapy practitioner which is not easy locally and enrolled in the Shared Fertility Program with her. In the next six weeks, for one hour each week I endured the deepest manual work to my lower abdomen I could have ever imagined. My familiar abdominal, pelvic and rib work was extremely different from this deep female-organ visceral work . The chiropractor performing Mercier Therapy executed it by the book, as I now know, and I felt immediate changes in my lower abdomen: as if I could move and even breathe more freely, lighter after each session’s soreness subsided. I knew within the first few minutes of my first session that this was something that would change my life. I didn’t know how much and how intensely at the time, but it was big, as an uncontrollable wave of emotional release at the beginning of my first two sessions occurred; the deeper the therapist worked the better I would feel in the following days. During those same weeks participating in the Mercier therapy program, the angel I had hired as my fertility coach urged me to change to a new facility and doctor to a clinic with a lab that had the best SART scores locally (Society for Reproductive Technologies) and I soon began another IVF cycle. This cycle was the one that finally resulted in my miracle, Rayna Claire. Our little girl has shown my husband and I the most love we could ever have imagined. She has given our family more hope and joy than I have witnessed in my entire life. I truly believe had I not allowed Mercier Therapy to rehabilitate my deep pelvis after everything I went through including the laparoscopy shortly before another cycle in 2018, we would not be blessed with our daughter today. I thought about my career, and everything I had studied and practiced as a physical therapist for so many years. I love what I do as a musculoskeletal PT and how I can change the lives of my patients, some days more than others. I thought constantly about how I saw negative pregnancy test after negative test, and results showing Beta hcg zero following more zeros. So much failure with so many natural and assisted fertility cycles before getting this diagnosis, deep work to rehabilitate and finally achieving a successful pregnancy in the cycle that followed shortly after.. Was doing this program an inconvenience? Was I sore after the sessions and sometimes even bruised? Did I have to take a short break from my doctor’s schedule to complete the sessions? Was it frustrating and scary to spend more money and energy on something else to try to achieve a pregnancy with no guarantees? YES YES YES YES ..But it helped me in so many ways I cannot put into words. The more I thought about it the more I got angry. Why doesn’t everyone sitting in the waiting room at the fertility centers know about this non-drug, non-surgically invasive therapy? Why do people know they need to rehabilitate their knee after surgery but they don’t know they need to restore movement and blood flow to their pelvis after gynecological procedures or if they potentially have scar tissue in that region? What about the couples who do NOT need or want assisted reproductive technologies and are trying naturally to get pregnant and don’t know they even have pcos, endometriosis, or other conditions that could lead to mobility and bloodflow restrictions? Or those that know deep down that their body CAN do it, even though they have failed month after month? Rehab of the pelvis, ie restoring the tissues to their optimal condition is important with and without a future goal of getting pregnant. It is important for women’s overall health, getting into shape before or after a baby or pelvic surgery, prevention of bowel/bladder issues and back pain to name a few. As I think about the last seven years, it becomes more clear that my journey was meant to take me here, writing this VERY much shortened version of IT, and sharing with whoever cares to read. I would go through it all over again for one second with my beautiful baby girl. My body shatters thinking about all those who haven’t yet had a chance for their own miracle.
Thankfully Dr. Mercier accepts physical therapists into her training program. Thankfully Dr. Mercier already knew me, because I flew out to Chicago for a week to work with her and receive treatment from ‘the creator of the technique herself’ as I now continue along my journey to give my daughter a sibling. (One day hopefully I will be able to share the second chapter of my struggles, which unfortunately goes even darker than the first.) I want my girl to have the best gift I can think of to repay her for what she has given me. I am honored that Dr. Jennifer Mercier contacted me when a space opened in her course inviting me to train with her, and that I was able to make the trip. I now have this amazing tool, knowledge, and the most beautiful hands on technique learned through both my personal and formal training experience. It is an honor to be able to help women in my community of Long Island and New York City the way that I was served when I most needed.