WILLIAMSTOWN — Every day, about 17 million women in the United States suffer in silence — their secret shame caused by urinary incontinence, pelvic pain and prolapse.

About one in three women suffer from urinary incontinence — leaking after they sneeze, cough or laugh. Another 14 million suffer from prolapse — the sagging and sometimes collapse of the bladder, uterus or anus into the vaginal cavity.

“It’s often a neglected topic of discussion — a lot of people tolerate the symptoms of it because they’re too embarrassed to talk about it,” Dr. Alison Hastings, an obstetrician/gynecologist with Northern Berkshire Obstetrics and Gynecologists at North Adams Regional Hospital, said Monday. “It affects women at a variety ages, not just those who are older or who have had children.”

By the time many women speak to a doctor about their pain, surgery is often the only recourse for pelvic floor dysfunction — a common medical condition involving the weakening of the muscles that make up the pelvic floor and walls, which can be treated and prevented with exercise and diet.

“Many women don’t think it’s a big deal. They’re willing to deal with it,” Brittney Cappiello, a physical therapist specializing in women’s health at Williamstown Physical Therapy, said Thursday. “Women take care of everyone’s needs first. When they do talk about it to other women, usually an older relative, they’re told it’s normal, that it’s something that happens to women after childbirth and as they get older. But it’s not normal.”She decided women in the Berkshires needed to start talking about pelvic floor dysfunction and start preventing the painful and often embarrassing medical condition.

“I’d been kicking around the idea of holding a class for women for about two years,” Cappiello, an Adams native with a master’s degree in physical therapy, said. “When I was working in Washington D.C., physical therapy in the area of women’s health was in high demand. I’ve had many patients that have been referred to me for this particular issue — some from as far away as Greenfield.”

Five weeks ago, she debuted “F.I.T.” — Fitness into Tomorrow — an all-female class aimed at educating women about their pelvic core and teaching them exercises to prevent problems such as pelvic pain and incontinence.

“It seems to be working,” Melissa, a local participant in the 12-member class said Thursday, as she completed a set of side-lunges. “Usually when I cough, I leak a little. It didn’t happen today. It was wonderful.”

The seven-week course features a half-hour of education on topics such as what causes incontinence and pelvic pain, along with an hour-long exercise program that targets the muscles of the pelvic core, Cappiello said.

“Women need to learn that leaking isn’t normal,” she said. “The sooner a woman can get into a class like this or to see a physical therapist, the better. I’ve had some women who have seen eight or nine specialists before they see me.”

Hastings believes pelvic exercises can work as an alternative to surgery or in tandem with surgery to correct incontinence caused by the stress of physical exertion or to correct prolapsed abdominal organs.

“Some patients try it as a non-surgical approach, some in conjunction with surgery — it’s a very reasonable thing to try,” she said. “I’ve had patients, who I’ve referred to Brittney, see a huge improvement with pelvic floor exercises. I’ve had patients both post-surgery and pre-operation that are equally happy with the outcomes. I had one patient, who called Brittany a ‘gold mine’ the other day.”

But the condition isn’t limited to women who have gone through labor and delivery — about 25 percent of female college athletes are also suffering from incontinence caused by weakened pelvic floor muscles.

“Female athletes are always on their feet,” Hastings said. “They’re running, bouncing, jumping — engaging in activities that stress the pelvic floor muscles in the same way the back muscles are stressed by similar activities.”

She added, “There are a lot of things that can affect pelvic floor integrity — prolonged coughing caused by chronic obstructed pulmonary disease; extensive straining from constipation; vaginal delivery and increased abdominal pressure from weight or carrying a large child during pregnancy.”

In addition to exercises including those targeting the pelvic core, women are encouraged to lose weight, stop smoking and limit caffeine.

For more information on F.I.T. or physical therapy options, contact Williamstown Physical Therapy at (413) 458-8090.

To reach Jennifer Huberdeau,
e-mail jhuberdeau@thetranscript.com.

The award, presented by the NEFW annually, is named for the longtime Boston Globe sports editor Jerry Nason, honors “seniors who have persevered against all odds to succeed in football.”

Williams head coach Mike Whalen introduced Caro and presented the award.

2009 Nason Senior Achievement Award

Nick Caro, Williams College
Hometown:  Andover, MA
High School:  Governor’s Academy

Nick Caro made a spectacular diving catch his sophomore year vs. Amherst for a TD to put the Ephs ahead 6-0 and the video highlight of that catch aired on ESPN before he got back to the Williams bench. Later that night the catch was rated in the top 10 on the day in college football by ESPN.

Williams went on to win that showdown with archrival Amherst 20-0 and Caro’s status was cemented in Eph football history. There appeared to be no end to his talents. That is, until game six in 2008 when the Ephs traveled to Clinton, N.Y., to play Hamilton College in a monsoon on grass that resembled a swamp more than a football field.

Caro entered the game as the Ephs’ leading receiver with 32 catches. “Nick was well on his way to establishing himself as the dominant player in NESCAC,” said Eph Head Coach Mike Whalen. “His speed, strength, and athleticism set him apart from every other receiver in the league.”

But all that changed when Caro caught the game’s first pass, heard his leg snap, and was consumed with incredible pain below his knee. He knew it was bad news. He knew his season was over even while he lay on the field waiting to be carried off the field.

The next week, Williams hosted Little Three rival Wesleyan and Caro watched from a golf cart near the bench. When his teammates ran over to him after the win to sing the school fight song it was a personal highlight for Caro. “It meant so much for me to have the players and coaches include me in the celebration of the win and sing,” said Caro. “That’s my Williams highlight.” As you will see, this kid has some other Williams highlights to compare to this one.

Less than two weeks after singing with his team, Caro was surprised to learn that his team had voted him to be one of the three captains for 2009.

He was not prepared for what his doctor, Joseph Czarnecki, had to say after surgery to fix the fractured tibia, clean up bone chips, remove 20% of the cartilage, and repair the MCL. “You’ll never play football again,” was the message Dr. Zarnecki delivered.

“Dr. Czarnecki was great the whole time,” said Caro even in recalling how down he was to hear those words. “He told me what I could expect in re-habbing and how difficult it would be… but always he cautioned me to not expect to play again.”

Nick’s mom came to campus for a week and organized Nick’s friends to help. Everyone signed on to bring meals to his room and perform other small tasks, because Nick was virtually immobile at first. Later on the Security Office was brought in to help transport him to classes and to physical therapy.

He was moved to a handicap-accessible room on campus, where teammate Henry Montalbano volunteered to become his roommate, live-in assistant, and personal attendant through January. “Henry even had to help me in and out of the shower because I couldn’t put any weight on my leg for the first three months,” said Caro.

When Montalbano went away to study for the spring semester, PK Scott Sobolewski filled in. “In addition to being one of the most skilled players on the team,” noted Sobolewski, “Nick has always been one of the hardest workers. As his teammates, we just wanted to reciprocate that commitment to him that he had always showed to the team. With all the time and effort he had dedicated to the team in the weight room and on the practice field, we were more than willing to do anything and spend any amount of time to make sure he got what he needed. We never saw it as a burden because we knew he would’ve done the same for any of us.

“Spending a whole semester watching Nick recover from his injury really made the team appreciate the opportunity we were given as Williams athletes. A lot of the time, players can take their abilities for granted. The team saw what was taken away from Nick and I think it made the team commit to work a lot harder in the offseason in an effort to make the most of our abilities. Nick’s work ethic really translated to the entire team, as we all saw him working tremendously hard and wanted to raise our level of intensity to match his.”

Nick Caro singles out Jen and Dave Armet, the owners of Williamstown Physical Therapy for high praise. “They’re amazing people who did a great job in helping me get back.”  He worked with Jen through January, but had to switch to Dave when his class schedule changed his availability. The first task was to get motion back in the leg and every Tuesday and Thursday Caro spent in therapy was physically exhausting. “They knew when to push me and how much I could and should do,” said Caro.

The Armets developed an appreciation for and a friendship with Nick. “We both were instantly impressed with Nick’s resolve and demeanor, though his daily activities on campus were extremely taxing,” said Jen. “Even Nick was astonished at how weak his leg had become following his surgery, and what initially appeared to be simple exercises for an athlete of his caliber became truly humbling. Nick was very diligent throughout with all of his exercises, and he found humor in the fact that some of our elderly patients had greater ease with simply riding an exercise bike.”

“Each week, Nick’s pain improved, his tolerance to exercise improved, and he could start to see the smallest gains. By February, his academic schedule changed and he shifted to Dave’s weekly schedule to begin progressing with weight bearing and strengthening. His surgeon was still doubtful that Nick would ever play football again or even run, but we tried to focus on more of a ‘let’s focus on improving to the best of your ability and just see what the future brings.’”

Dave added: “When Nick’s progress allowed him to resume running, we discussed the idea of possibly coming back for some of the football season. The suggestion of maybe playing just on special teams (even just for the Amherst game) was an idea that we thought might give Nick some hope for his football future. He said that limited play wasn’t something he wanted to settle for and that he wanted more. It truly revealed the inner drive of this gifted athlete, who deep down inside could not let himself just return to a diminished role even after this devastating injury.  Based on this conversation last spring, it’s not surprising at all for us to see what Nick has achieved this year.

“He personifies what people often describe as an infectious personality. He’s an incredibly likable young man, who interacted with so many of our patients of all ages. I never saw anything but a positive attitude during his PT. He was able to laugh, joke, and have fun during what were undoubtedly some of the most difficult days of his life. We couldn’t help but look forward to seeing Nick show up for his treatment.”

Jen agreed: “We were fortunate to get a chance to really get to know Nick — conversing about topics ranging from sports to current events to food to life on campus. During these interactions Nick’s sincerity is the trait that most impressed us and allows us to think of him as a friend and not just another patient. He’s become one of the most beloved student-athletes that we’ve worked with.”

Caro also valued the relationship, saying, “I spent so much time with Jen and Dave that over the summer I’d email them updates and just chat about how I was doing and what I was feeling. Their place was the first stop I made when I came back to campus for pre-season, just so they could see me walk in and we could catch up with each other.”

When the team hosted a recruiting event late last spring, Caro was so frustrated with how things were going that he found himself strapping on his brace and going to the field to jog. “I’m not sure you could call it a jog,” he said, “but I felt like I was making progress, though my leg really hurt after that.”

On June 2nd when Caro visited Dr. Czarnecki, he received another surprise. “He told me that my leg was growing back better than he ever expected,” said Caro, “and that if I wanted to try football again I could, because I was at no greater risk of breaking my leg.” My mother saw me light up and said, “You have to try to play. I know how much it means to you.”

“I was shocked to hear my mom say she was supportive of me trying to play again because of all that she had been through to get me to this point, but I knew she was right. I had to do whatever I could to get back and be a playing member of the team,” Nick said. “That’s what I missed the most – being a part of the team and working with my football brothers on getting better and better. I wanted to get back for them, for all the help they had given me.”

Even though he knew he could try to come back and play, Caro didn’t make the final decision until two weeks before the season began because he wanted to make sure he was going to make it back.

Caro’s physical response to the good news from Czarnecki was to become obsessed with preparing his body. “I worked out twice a day riding the bike or on the elliptical machine and did some pre-approved weightlifting. I was as cut as I could be without being able to run. I was down to 220 from 233.”

“Even when Nick wasn’t sure he if he was going to play this season, he still focused on trying to lead the team in other ways,” stated coach Whalen. “He attended speed workouts, watched film with our younger receivers, and organized throwing sessions with the QBs in the off-season. Once he realized that he might have the opportunity to try to play this season his workouts only intensified.”

Managing Caro’s availability during the season has required player and coach to work closely and pick their spots.

Because the pain is so pervasive after a game or practice, the plan was to use Nick as little as possible, limiting him to one practice and a game each week. “Nick Caro at 80% is better than most of the kids in our league,” said Whalen.

“I still have a lot of ‘junk’ in my leg like screws that have to be removed the day after Thanksgiving,” noted Caro in explaining how difficult it is for him to work hard on the field in consecutive days. Rest is the best solution, but on game days heat at halftime helps. Soft and muddy fields are especially demanding on his leg, but Caro gives as much as he can and then he’s supposed to let coach Whalen know when his leg has had enough.

A large part of Nick coming back to play this season was to support his football brothers. “I couldn’t not give it everything I had to come back for all that they did for me,” noted Caro. “I wanted to show them by my hard work that I appreciated all that they did and that I would do it for them. The hardest part about not playing and contributing was not really being part of the team. I just really missed being one of the guys and being in the locker room and in the huddle.

“Every day for a year I thought about playing against Hamilton again, not to get back at them for the injury, that was just part of the game and the injury wasn’t intentional, but just so I would know that I was back. Even when I was told not to think about playing, I couldn’t help thinking about what it would be like to play against Hamilton.”

In the 2009 season opener, Caro caught 10 passes for 100 yards and the Ephs defeated Colby 23-19 on the road. At Trinity in game two, he caught two TD passes and had 6 catches for 99 yards in a last-minute loss, 26-21.

Playing so much in the first two games took its toll on Caro, and coach Whalen decided to shut him down for the Bates game to try and have him ready for Middlebury.

Caro caught 5 more passes at Middlebury for 69 yards in helping the Ephs down the Panthers 37-27.

Next up was Hamilton at home. Caro knew now that he would play against Hamilton, although he wouldn’t consider himself all the way back until he played in the game and walked off the field with his health.

Caro proved early vs. Hamilton that he was back in a big way, scoring the first three Eph TDs in the 42-0 win. He tied the Williams single game mark with the 3 TD catches. He registered 97 yards receiving on the three catches (his only catches of the day) and he broke a 61-yarder.

“When Nick broke the long run against Hamilton after catching a 5-yard slant pass, he looked like he did before the injury,” commented Whalen. “The only difference was that in the past he would not have had to break any tackles because no one would have been able to catch him!”

By halftime with the Ephs up 35-0 Caro knew he would be walking off the field with a victory and his health and he also knew he wouldn’t play in the second half. With Little Three games vs. Wesleyan and Amherst looming, coach Whalen would protect his leader.

Nick worked for Sports Information last spring tallying in-game men’s and women’s lacrosse stats. “We have a portable press box that has three steps to get into and quite frankly, Nick looked like he was about 85 years old when he’d try to go up those steps,” noted Eph SID Dick Quinn. “I’d heard how hard he was re-habbing and trying to come back, but it was clear he was in for a long fight.”

“I know that several of our younger receivers have been inspired by Nick’s performance this year,” said Whalen. “When they see him make a big catch or watch him block down field, they feel a need to raise their own level of play.”

Nick Caro’s serious leg injury set him back and took away some of his physical talent and it also denied him the chance to study in the Middle East in order to work on his speaking of and knowledge of Arabic. He could have turned sour and given into depression and despair, but instead he turned to his inner strength and reached out to his teammates for help and, in turn, inspired them to reach beyond their abilities for the betterment of the team.

Hard luck again visited Nick Caro when he suffered two additional injuries in the Ephs win over Wesleyan that prevented him from competing against Amherst in “The Biggest Little Game in America” and his final collegiate contest.

Injuries are part of football, just as there are ups and downs in daily life. It’s how you approach your injuries and ups and downs that define you.

Nick Caro, winner and leader.

Nick Caro statistics for 6 games played in 2008:

32 catches (2nd on team) • 556 yards (1st on team for the year) • 17.4 per catch • 3 TDs • Long: 56 • 92.7 yards/game

Nick Caro statistics for 6 games played in 2009:

27 Catches (2nd on team) • 406 Yards (2nd on team) • 15.5 Yards Per catch (2nd on team) • 5 TDs (1st on team) • Long: 61 • Yards/game: 67.7 (1st on team)

School Records Held by Nick Caro ‘10:

Most Receiving Yards Game: 218, vs. Middlebury 10/11/08; Most TD Catches Game: 3, vs. Hamilton 10/31/09

See original article on Williams.edu Sports Information site here.

To read more about Nick and his accomplishments, click here to read an article on www.boston.com.

He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and cried horribly. Then, to everyone’s amazement he quieted down.

A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.

As the farmer’s neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!

The Moral:
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.

The father smiles and says: “My son, pay attention.”
And then he screams to the mountain: “I admire you!”
The voice answers: “I admire you!”Again the man screams: “You are a champion!”
The voice answers: “You are a champion!”

The boy is surprised, but does not understand.

Then the father explains: “People call this ECHO, but really this is LIFE.
It gives you back everything you say or do. Our life is simply a reflection of our actions.
If you want more love in the world, create more love in your heart.
If you want more competence in your team, improve your competence.

This relationship applies to everything, in all aspects of life;
Life will give you back everything you have given to it.”

YOUR LIFE IS NOT A COINCIDENCE. IT’S A REFLECTION OF YOU!

-Author Unknown

The Professor next picked up a box of sand and poured it into the jar. Of
course, the sand filled up everything else. He asked once more if the jar
was full. The students responded with an unanimous “Yes.”

The Professor then produced two cans of beer from under the table and
poured the entire contents into the jar, effectively filling the empty
space between the sand. The students laughed.

“Now,” said the Professor, as the laughter subsided, “I want you to
recognize that this jar represents your life.

The golf balls are the important things – your family, your children, your
health, your friends, your favorite passions – things that if everything
else was lost and only they remained, your life would still be full.

The pebbles are the other things that matter like your job, your house,
your car. The sand is everything else – the small stuff.”

“If you put the sand into the jar first”, he continued, “there is no room
for the pebbles or the golf balls. The same goes for life. If you spend all
your time and energy on the small stuff, you will never have room for the
things that are important to you. Pay attention to the things that are
critical to your happiness. Play with your children. Take time to get
medical checkups. Take your partner out to dinner. Play another 18. There
will always be time to clean the house, and fix the disposal. Take care of
the golf balls first, the things that really matter. Set your priorities.
The rest is just sand.”

When he had finished, there was a profound silence. Then one of thestudents raised her hand and with a puzzled expression, inquired what the
beer represented.

The Professor smiled. “I’m glad you asked. It just goes to show you that no
matter how full your life may seem, there’s always room for a couple of
beers.”