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DR. SALGO: 20 MILLION WOMEN SUFFER IN SILENCE WITH A SECRET THAT CAUSES EMBARRASSMENT, HUMILIATION, AND CAN OFTEN COMPLETELY ALTER THEIR LIVES. WE'RE GOING TO DRAG THIS SECRET OUT OF THE CLOSET BECAUSE HOPE AND HELP IS ON THE WAY. NEXT, ON SECOND OPINION.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING: THE JOSIAH MACY, JR. FOUNDATION AND THE PARK FOUNDATION.
DR. SALGO: WELCOME TO SECOND OPINION WHERE EACH WEEK WE SOLVE A REAL MEDICAL MYSTERY. WHEN WE CLOSE THIS CASE A HALF AN HOUR FROM NOW, YOU'LL NOT ONLY KNOW THE OUTCOME, YOU'LL ALSO BE BETTER ABLE TO TAKE CHARGE OF YOUR OWN HEALTHCARE. I'M YOUR HOST DR. PETER SALGO, AND AS ALWAYS, WE'VE ASSEMBLED A NATIONALLY RECOGNIZED HEALTHCARE TEAM-EXPERTS IN TODAY'S TOPIC. SOME ARE DOCTORS, SOME ARE NOT, BUT THEIR EXPERIENCE IS DEFINITELY GOING TO HELP US TACKLE TODAY'S CASE. NOW AS USUAL, NO ONE ON THE PANEL KNOWS THIS CASE, EXCEPT FOR ELISSA ORLANDO, OUR RESIDENT CIVILIAN. AND THIS WEEK'S PRIMARY CARE PHYSICIAN, A DOCTOR YOU MIGHT GO TO AS YOUR FIRST INTERFACE WITH THE HEALTHCARE BUSINESS, DR. LOU PAPA. LOU, WELCOME BACK. I'M GOING TO TELL YOU A LITTLE ABOUT GRETCHEN. I'M GOING TO GIVE YOU SOME INFORMATION ABOUT GRETCHEN THAT THE DOCTOR WON'T KNOW UNTIL LATER. GRETCHEN IS 62 YEARS OLD, AND SHE'S MARRIED WITH THREE GROWN CHILDREN. SHE'S 5 FOOT 5, SHE WEIGHS 160 POUNDS, AND SHE DOES EXERCISE, SHE GOES DANCING WITH HER HUSBAND EVERY SATURDAY NIGHT. HOWEVER, EVER SINCE SHE HAD HER KIDS, SHE'S EXPERIENCED SOME URINE LEAKAGE WHEN SHE SNEEZES, COUGHS, LAUGHS OR MOVES SUDDENLY. AND IT'S GETTING WORSE. SHE'S NOW AT THE POINT OF HANGING UP HER DANCING SHOES BECAUSE SHE CAN'T GO DANCING, SHE'S LEAKING URINE WHEN SHE DOES THAT. SHE'S TERRIFIED OF HAVING AN ACCIDENT BEFORE SHE CAN MAKE IT TO THE BATHROOM. SHE DOES SEE HER DOCTOR REGULARLY, BUT SHE NEVER MENTIONS THIS SET OF SYMPTOMS TO HIM. SO MY QUESTION LOU, IS WHY WOULDN'T SHE?
DR. PAPA: I THINK A LOT OF IT IS EMBARRASSMENT, ON BOTH PARTS TO BE HONEST. I THINK THE PATIENT'S EMBARRASSED TO BRING IT UP TO THE DOCTOR, ESPECIALLY IF IT'S A MALE DOCTOR, AND THE DOCTOR'S EMBARRASSED TO BRING IT UP TO THE PATIENT.
DR. SALGO: IS THIS SOMETHING THAT WOMEN DON'T TALK ABOUT? MEN DON'T TALK ABOUT?
DR. BURGIO: ACTUALLY THE RESEARCH SHOWS THAT THE MAJORITY OF PEOPLE WITH INCONTINENCE DON'T MENTION IT TO A HEALTHCARE PROVIDER.
MYERS: THAT'S SOMETHING I HAVE EXPERIENCE WITH, BLADDER CONDITIONS, NOT NECESSARILY TO THE EXTENT OF INCONTINENCE. BUT I KNOW IT WAS MANY, MANY YEARS BEFORE I MENTIONED IT TO A PHYSICIAN. AND IF YOU CAN'T TALK TO A PHYSICIAN, WHO CAN YOU TALK TO? MY DOCTOR NEVER ASKED ME AND I THINK IN A ROUTINE EXAM OR A YEARLY EXAM AT LEAST, IF NOT COMING TO YOU SPECIFICALLY WITH INCONTINENCE, IT'S A QUESTION THAT NEEDS TO BE ADDRESSED BY A PHYSICIAN.
ORLANDO: I DON'T KNOW IF I WOULD THINK OF IT AS A MEDICAL PROBLEM, SO MUCH AS MAYBE A NUISANCE. I MEAN, I CAN SORT OF GO IN THE GROCERY STORE OR THE PHARMACY AND FIND AN AISLE WHERE I CAN DEAL WITH THIS SO WHY WOULD I TALK TO YOU GUYS ABOUT IT?
MYERS: BUT IT IS A MEDICAL PROBLEM!
DR. SALGO: IS IT FAIR TO SAY THAT WOMEN REGARD THIS MORE AS A HYGIENE ISSUE THAN AS A MEDICAL ISSUE AND THEY DON'T EXPECT TO TALK TO THEIR DOCS ABOUT IT?
DR. ROSENMAN: I THINK THAT THEY DON'T THINK THEIR DOCS ARE GOING TO HAVE MUCH TO ADD SO WHY GO THROUGH THE DISCOMFORT OF DISCUSSING IT?
DR. SALGO: I HAVE A NUMBER HERE. $15 BILLION A YEAR SPENT ON INCONTINENCE PRODUCTS, ONLY 1% OF THAT IS SPENT ON MEDICAL INTERVENTION. WHOSE FAULT IS THAT? ARE YOU THE BAD GUY FOR NOT ASKING?
DR. PAPA: I THINK IN SOME RESPECTS WE ARE THE BAD GUY FOR NOT ASKING, BUT WHEN WE DO BRING IT UP LOTS OF TIMES IT'S AN ISSUE OF, WELL IT'S MINOR OR IT'S NOT ANYTHING OF CONCERN AND I THINK IT IS MORE OF A LIFESTYLE ISSUE FOR THE PATIENT. IT DEPENDS ON HOW MUCH OF AN ISSUE IT IS, FOR EXAMPLE, IN GRETCHEN'S CASE IT'S REALLY STARTING TO AFFECT HER ABILITY TO ENJOY HER LIFE AND TO FUNCTION ON A DAILY BASIS.
DR. SALGO: AMY ROSENMAN, YOU'RE A UROGYNECOLOGIST.
DR. ROSENMAN: YES.
DR. SALGO: YOU KNOW HOW MANY WOMEN ARE AFFECTED BY THIS. HOW BIG A PROBLEM IS IT?
DR. ROSENMAN: WELL ABOUT 30% OF ALL WOMEN HAVE THIS PROBLEM.
DR. SALGO: 30% OF ALL THE WOMEN IN AMERICA.
DR. ROSENMAN: 30% OF ALL THE WOMEN IN AMERICA. BUT THAT DOESN'T MEAN THAT IT'S NORMAL, RIGHT? BECAUSE 70% DON'T.
ORLANDO: WELL WHY NOT? I ALWAYS ASSOCIATE IT WITH AGING. AND THE NATION'S GETTING OLDER SO ISN'T IT JUST BECAUSE WE'RE GETTING OLDER?
DR. BURGIO: AND THAT'S ONE OF THE BARRIERS TO PEOPLE SEEKING TREATMENT IS THEY ATTRIBUTE IT TO AGING AND YOU CAN'T DO ANYTHING ABOUT AGING, YOU'RE GOING TO GET OLDER, SO THEY THINK IF IT'S ATTRIBUTED TO AGING, THEN THERE'S NOTHING YOU CAN DO ABOUT IT.
DR. ROSENMAN: IT'S NOT A NORMAL PART OF AGING. IT'S NOT A NORMAL PART OF AGING.
MYERS: I THINK WE'RE MISSING SOME IN OUR 20'S AND OUR 30'S.
DR. DUECY: IT DEPENDS ON THE GENERATION AS WELL.
DR. SALGO: WHY IS THAT, WHAT DO YOU MEAN BY THAT?
DR. DUECY: IT DEPENDS ON HOW WE WERE RAISED. SOME OF OUR OLDER PATIENTS, OUR SENIOR PATIENTS, ARE MUCH MORE RELUCTANT TO MENTION A PROBLEM LIKE THIS, WHILE SOME OF OUR YOUNGER PATIENTS ARE MUCH MORE ACTIVE IN THEIR OWN MEDICAL CARE, AND REALLY FEEL MORE COMFORTABLE IN DEMANDING A CURE FOR SOMETHING THAT'S BECOME BOTHERSOME FOR THEM.
DR. SALGO: TERRY-JO MYERS, YOU'RE A PROFESSIONAL ATHLETE. YOU WERE ON THE LPGA TOUR. LET ME ASK YOU THE OBVIOUS QUESTION. COULD YOU GET THROUGH EIGHTEEN HOLES?
MYERS: NEVER, NEVER COULD GET THROUGH EIGHTEEN HOLES. I HAD TO GO TO THE BATHROOM, PROBABLY EVERY FIFTEEN TO TWENTY MINUTES. PORT-A-JOHNS ON THE LPGA TOUR, WE HAD THE ABILITY TO GET TO A BATHROOM. NO. MY WHOLE LIFE REVOLVED AROUND THE BATHROOM. IF I LEFT THE BUILDING, COULD I MAKE IT TO THE NEXT STOP? BUT...
DR. ROSENMAN: THAT'S TESTAMENT TO YOU, THAT YOU MADE IT WORK. BECAUSE A LOT OF PEOPLE WOULD WITHDRAW AND CHANGE THEIR CAREERS OR IN THIS CASE, GRETCHEN'S GOING TO STOP DANCING WHICH WOULD BE A TRAGEDY.
DR. SALGO: WHAT IS INCONTINENCE? HOW WOULD YOU DEFINE IT?
DR. DUECY: WELL IT'S SIMPLY THE INVOLUNTARY LEAKAGE OF URINE. LEAKING URINE WHEN YOU DON'T WANT TO. WHEN IT'S NOT TIME TO GO TO THE BATHROOM.
ORLANDO: I HEAR LEAKAGE, I HEAR BLADDER CONTROL A LOT. I HEAR INCONTINENCE. ARE THEY ALL THE SAME THING?
DR. BURGIO: BLADDER CONTROL GOES A LITTLE BIT FURTHER AND IT REFERS TO OVER ACTIVE BLADDER OR THE FEELING THAT YOU HAVE TO GO TO THE BATHROOM A LOT. HAVING FREQUENT URGES AND HAVING TO RUN TO THE BATHROOM, DROP WHAT YOU'RE DOING, FIND THE BATHROOMS THAT ARE AVAILABLE. SO THAT IS SORT OF A LOSS OF CONTROL. YOU MIGHT NOT ACTUALLY HAVE HEAVY LEAKAGE OF URINE, BUT YOU DO NEED TO GET TO A BATHROOM A LITTLE MORE FREQUENTLY THAN THE AVERAGE PERSON.
DR. ROSENMAN: BUT THEY'RE UNIVERSALLY ANNOYING SYMPTOMS, RIGHT? BECAUSE IT HAS AN IMPACT IN THE QUALITY OF LIFE THAT IS OVERWHELMING.
DR. SALGO: BUT IS THERE ONLY ONE CAUSE FOR THIS, OR CAN THIS BE CAUSED BY LOTS OF DIFFERENT THINGS?
DR. ROSENMAN: MULTIPLE CAUSES, THE ONE THAT WE HAVE ALLUDED TO WITH GRETCHEN IS WHAT'S CALLED STRESS INCONTINENCE. THE PATIENTS WHO HAS SOME CHILDBIRTH TYPE INJURY THAT OVER TIME GETS WORSE BECAUSE WE ARE UPRIGHT BEINGS AND GRAVITY TAKES ITS TOLL, IN MANY WAYS.
DR. SALGO: THANKS A LOT.
DR. ROSENMAN: AND THEN AT MID-LIFE, ADD HORMONAL CHANGE TO THAT, THAT ALSO TAKES ITS TOLL ON THE TISSUES IN THE PELVIC AREA, SO THAT SYMPTOMS TEND TO GET WORSE MENOPAUSALLY.
ORLANDO: BUT YOU JUST USED THE WORD "INJURY" WHICH IS REALLY SURPRISING TO ME TO HEAR WITH SOMETHING LIKE URINE LEAKAGE. SO WE'RE TALKING ABOUT SOMETHING IN OUR ANATOMY? THIS IS NOT JUST, YOU KNOW, YOUR MUSCLE CONTROL, AND THINGS GETTING AWAY FROM YOU? YOU'RE TALKING ABOUT AN ANATOMICAL PROBLEM?
DR. ROSENMAN: WHEN YOU TALK ABOUT STRESS INCONTINENCE YOU'RE TALKING ABOUT AN ANATOMIC PROBLEM.
DR. SALGO: THAT'S GRETCHEN'S PROBLEM.
DR. PAPA: FOR THAT ONE TYPE OF URINARY INCONTINENCE.
DR. ROSENMAN: IT HAPPENS TO BE AN OVERWHELMING TYPE. AND IT IS THE TYPE THAT AFFECTS MORE YOUNGER ACTIVE WOMAN. WHEN YOU TALK ABOUT URGENCY INCONTINENCE, YOU TALK ABOUT THE WOMAN WHO LEAKS ON THE WAY TO THE BATHROOM. HOW MANY PATIENTS OF OURS TELL US, "I FEEL THE URGE TO GO, THE CLOSER I GET TO THE TOILET, THE WORSE IT GETS. I LEAK AS I'M GETTING READY TO SIT DOWN." AND IT'S ACTUALLY CALLED KEY-IN-DOOR SYNDROME. AS THEY PUT THE KEY IN THE DOOR, THEY FEEL THAT URGE TO GO.
MYERS: I WAS JUST GOING TO SAY, YOU JUST MENTIONED YOUNGER, ACTIVE, SO WHY AREN'T YOU AS PHYSICIANS ASKING THESE YOUNGER PATIENTS THAT YOU HAVE, IF THIS IS A PROBLEM?
DR. SALGO: WHICH BRINGS US BACK FULL CIRCLE.
DR. DUECY: I THINK IT'S A LOT OF THINGS. I THINK IT'S PEOPLE ARE EMBARRASSED BECAUSE MAYBE THEY DON'T FEEL LIKE THEY KNOW WHAT THE RIGHT ANSWER IS. MAYBE THEY DON'T KNOW WHO TO SEND THEM TO. THE OTHER THING IS TIME. NOWADAYS IN OUR OFFICES, I HATE TO ADMIT IT, BUT WE DON'T HAVE AS MUCH TIME AS WE USED TO, TO SPEND WITH A WOMAN TO BRING OUT WHAT IS A VERY EMBARRASSING PROBLEM.
DR. SALGO: LET ME STOP THINGS FOR JUST A MOMENT OVER HERE BECAUSE WE'VE COVERED A LOT OF GROUND. URINARY INCONTINENCE IS NOT JUST EMBARRASSING OR A NUISANCE. IT IS A REAL MEDICAL PROBLEM, AND THAT BY DEFINITION MEANS, INAPPROPRIATE URINE LEAKAGE, AND IT SHOULD NOT BE IGNORED. IT REQUIRES A MEDICAL WORK-UP. LET ME GET BACK TO OUR CASE OVER HERE, BECAUSE I CAN TELL YOU SOME MORE. GRETCHEN STILL HASN'T TALKED TO HER DOCTOR, I'M GIVING YOU KNOWLEDGE THAT HER DOCTOR DOES NOT HAVE, WHICH I THINK IS VERY TYPICAL BASED ON WHAT YOU'VE TOLD ME. BUT WHAT SHE HAS DONE IS WATCHED TELEVISION. AND SO ON TELEVISION, SHE SEES A DRUG BEING PROMOTED WHICH SAYS IT STOPS PEOPLE FROM LEAKING. SHE THINKS TO HERSELF, FINALLY THERE IS A CURE. AND SHE GOES TO SEE YOU LOU, AND INSTEAD OF SAYING, "I'M SORRY I DIDN'T TELL YOU ALL OF THIS BEFORE", SHE SAYS "I WANT A PILL, CAN YOU PRESCRIBE IT PLEASE, I'M IN A HURRY."
DR. PAPA: THAT'S THE DOOR OPENING AGAIN. THAT'S AN OPPORTUNITY TO DISCUSS THAT ISSUE.
DR. SALGO: ARE YOU GOING TO GIVE HER A PILL?
DR. PAPA: NO, I'M NOT GOING TO GIVE HER A PILL.
DR. SALGO: WHY NOT?
DR. PAPA: BECAUSE NOW I'M GOING TO GET THE INFORMATION I NEED TO GET BECAUSE I DON'T KNOW WHAT PILL SHE'S TALKING ABOUT. I DON'T KNOW IF IT'S APPROPRIATE FOR THE TYPE OF INCONTINENCE THAT SHE HAS. THERE MAY BE OTHER WAYS THAT WE CAN ADDRESS THIS THAT WON'T INVOLVE MEDICATION.
DR. SALGO: SHE SAW THE PILL. SHE WAS PROMISED IT WAS GOING TO WORK. SHE'S UNHAPPY.
DR. PAPA: THAT'S GREAT, BUT IT MAY NOT BE APPROPRIATE FOR HER. YOU KNOW, YOU DON'T GET YOUR TREATMENT FROM COMMERCIALS. YOU GET YOUR TREATMENT FROM YOUR DOCTOR.
DR. SALGO: WELL I'LL TELL YOU WHAT HER DOCTOR TOLD HER. HER DOCTOR SAID, "I DON'T WANT TO GIVE YOU A PILL." SO YOU MUST HAVE BEEN READING HIS MIND, LOU. INSTEAD, HE SAID, "I WANT YOU TO KEEP AN INCONTINENCE DIARY." TO WHICH GRETCHEN SAYS, "I ALREADY KNOW THAT I LEAK WHEN I EXERCISE OR SNEEZE. WHAT THE HECK DO I HAVE TO DO THAT FOR?"
ORLANDO: WHAT IS THAT?
DR. SALGO: CAN YOU TELL US WHAT IT IS?
MYERS: I HAD TO KEEP A VOIDING DIARY, WHICH STATED TO MY DOCTOR AFTER I THINK THREE DAYS, YES, I WENT TO THE BATHROOM 50 TIMES A NIGHT AND 40 TIMES DURING THE DAY. BUT I TOLD HIM THAT. I SAID THIS IS HOW MANY TIMES I'M GOING.
DR. ROSENMAN: YOU KNOW, IT REALLY HELPS. AND I'LL TELL YOU I HAVE ALL MY PATIENTS DO A DIARY WHERE THEY ALSO, IF THEY CAN MANAGE IT, MEASURE HOW MUCH THEY URINATE, SO IT'S HELPFUL TO KNOW HOW OFTEN ARE YOU REALLY GOING, DOES IT SEEMS LIKE YOU'RE GOING FREQUENTLY BECAUSE YOU'RE IN THE MIDDLE OF A TOURNAMENT, OR IS IT THE SAME WHEN YOU'RE IN A TOURNAMENT OR OTHERWISE? IS IT STRESS RELATED? IS IT DIET RELATED? I HAD A PATIENT WHO DRANK ON HER INPUT AND OUTPUT RECORD, A FIFTH OF VODKA A NIGHT. AND IT WAS FASCINATING THAT SHE HAD INCONTINENCE DURING THE NIGHT.
DR. SALGO: SO HER INCONTINENCE WAS NOT HER PRIMARY PROBLEM.
DR. ROSENMAN: IT WAS FASCINATING, AND ALL I SAID TO HER WAS, "THERE MAY BE AN ASSOCIATION HERE." I'VE LEARNED THAT JUST COMING RIGHT OUT AND TELLING A PATIENT "YOU'RE DRINKING TOO MUCH," THAT DOESN'T GO TOO FAR. I SAID, "THERE MAY BE AN ASSOCIATION HERE. YOU MAY WANT TO CONSIDER REDUCING IT OR STOPPING IT AND SEEING IF THERE'S A BENEFICIAL EFFECT." AND SHE DID, AND SHE THOUGHT SHE HAD DISCOVERED A NEW CURE FOR INCONTINENCE. SO I FIND THAT THE VOIDING DIARY IS A VERY CHEAP, VERY NON-PAINFUL WAY TO EVALUATE THE BEGINNING.
DR. SALGO: GRETCHEN WANTS SOMETHING DONE, IN ADDITION TO KEEPING THIS DIARY, AND HER DOCTOR PRESCRIBES SOMETHING CALLED KEGEL EXERCISES.
DR. SALGO: WHAT ARE THESE KEGEL THINGS?
DR. BURGIO: KEGEL EXERCISES ARE BASICALLY PELVIC FLOOR MUSCLE EXERCISES. THE PELVIC FLOOR MUSCLES ARE THE MUSCLES THAT SURROUND AND HELP TO SUPPORT THE BLADDER AND THE URETHRA. AND LEARNING TO CONTROL THEM AND MAKE THEM STRONGER HELPS TO CONTROL THE BLADDER.
DR. SALGO: DOES ANYBODY WANT TO BITE THE BULLET ON THIS ONE AND DESCRIBE ON NATIONAL TELEVISION HOW TO DO KEGELS?
ORLANDO: AND HOW MANY DO YOU HAVE TO DO?
DR. SALGO: AND HOW MANY DO YOU HAVE TO DO, AND HOW OFTEN?
DR. ROSENMAN: A BASIC PLAN THAT I GIVE TO EVERY PATIENT ON A PIECE OF PAPER IS, TO TRY TO STOP THE STREAM OF URINE WHEN YOU'RE URINATING ONCE, TO DISCOVER WHICH ARE THE CORRECT MUSCLES, BUT IT IS NOT THE RIGHT TIME TO DO YOUR KEGELS WHILE YOU'RE VOIDING. SO YOU FIGURE OUT WHICH MUSCLES BY TRYING TO STOP THE STREAM OF URINE AND I CAN'T DESCRIBE THIS WITHOUT USING MY HANDS. [LAUGHTER] I DON'T KNOW IF YOU'VE HAD THIS EXPERIENCE. AND THEN ONCE YOU'VE FIGURED THAT OUT, YOU TAKE THAT EXERCISE AWAY FROM...STEP AWAY FROM THE TOILET...AND YOU CAN DO IT SITTING, STANDING, OR LAYING DOWN, WHERE YOU'RE GOING TO GRASP THOSE SAME MUSCLES, HOLD THEM FOR A COUNT OF 3 SECONDS, WHICH IS LIKE 1 KANGAROO, 2 KANGAROO, 3 KANGAROO, REALLY 3 FULL SECONDS, AND THEN RELAX FOR 3 TO 5 SECONDS, AND THEN HOLD FOR 3 TO 5 SECONDS AND THEN RELAX, AND YOU DO THEM IN A SERIES OF 10 AND YOU DO THEM 3 TIMES A DAY.
ORLANDO: I'M NOT GOING TO DO THAT. I MEAN I KNOW WHAT YOU'RE TALKING ABOUT. I HATE THE WAY IT MAKES ME FEEL, IT MAKES ME NERVOUS TO DO THEM. I DON'T...I'M NOT GOING TO DO THEM.
DR. ROSENMAN: BUT IF YOUR DOCTOR TOLD YOU THAT 70% OF WOMEN WOULD BE DRY IN SIX MONTHS, WOULD THAT MOTIVATE YOU A LITTLE BIT?
DR. PAPA: I THINK THAT ALSO GETS TO THE POINT WHY DOCS DON'T DISCUSS IT BECAUSE THAT SENSE THAT YOU KNOW, NO ONE'S REALLY GOING TO DO THAT.
DR. SALGO: GRETCHEN AGREED TO DO THESE KEGEL EXERCISES AND SHE CAME BACK TO SEE HER DOCTOR TWO MONTHS LATER BECAUSE THEY HAVEN'T FIXED HER PROBLEM. IS SHE DOING THEM WRONG? IS IT NOT ENOUGH TIME? WHAT DO YOU THINK?
DR. BURGIO: MOST PEOPLE WON'T ACTUALLY FOLLOW THROUGH AND DO THEM FOR LONG ENOUGH TO GET ANY BENEFIT.
DR. DUECY: WELL USUALLY WE SAY YOU SHOULD SEE SOME IMPROVEMENT WITHIN SIX WEEKS IF YOU'RE REALLY DOING A FULL REGIMEN THOROUGHLY AND CORRECTLY. PROBABLY THE FIRST THING, IF YOU HAVEN'T DONE IT IN THE FIRST VISIT, IS TO GO AHEAD AND CHECK AND MAKE SURE SHE'S DOING THEM CORRECTLY. JUST TALKING THEM THROUGH HOW TO DO IT IS NOT ALWAYS THE BEST WAY TO TEACH THEM HOW TO DO IT, AND SENDING THEM HOME DOING IT INCORRECTLY WILL ACTUALLY MAKE THINGS WORSE.
DR. SALGO: IS THERE SOME WAY THAT YOU CAN TRAIN A WOMAN ON-SITE TO DO THEM?
DR. BURGIO: ABSOLUTELY.
DR. SALGO: I HAVE A FEELING THAT SHE WAS SENT HOME WITH INSTRUCTIONS TO COUNT TO KANGAROO AND...
DR. BURGIO: WE DID A SURVEY OF OVER 500 WOMEN AND FOUND THAT NONE OF THEM HAD BEEN TAUGHT WITH ANYTHING MORE THAN VERBAL OR WRITTEN INSTRUCTIONS. AND THERE ARE LOTS OF OTHER WAYS TO TEACH THEM.
ORLANDO: HOW? LIKE THIS? [LAUGHTER]
DR. BURGIO: WELL A VERY COMMON WAY...
DR. ROSENMAN: AT THE TIME OF THE EXAM YOU CAN ACTUALLY PRESS ON THOSE MUSCLES.
DR. BURGIO: ...WHEN YOU DO A PELVIC EXAMINATION, WHEN YOU'RE EXAMINING THE WOMEN AND FEELING THE WALL OF THE VAGINA, YOU CAN ASK HER TO SQUEEZE AND GIVE HER FEEDBACK ABOUT WHETHER THAT'S THE RIGHT MUSCLE OR NOT. AND IF IT'S NOT THE RIGHT MUSCLE, YOU CAN SEE IT, YOU CAN FEEL IT, AND YOU CAN COACH HER UNTIL SHE GETS THE RIGHT MUSCLE.
DR. SALGO: WHAT ABOUT BIOFEEDBACK? DOES THAT HAVE A PLACE IN ALL OF THIS?
DR. BURGIO: IT'S AN EXCELLENT WAY TO TEACH SOMEONE.
ORLANDO: WHAT'S THAT?
DR. ROSENMAN: IT'S AN EXTENSION OF WHAT KATHY JUST MENTIONED. IT'S USING A VISUAL FEEDBACK. YOU CAN PUT A LITTLE CATHETER IN THE VAGINA OR YOU CAN PUT A LITTLE ELECTRODE, I KNOW THIS SOUNDS...
DR. SALGO: OH, THAT SOUNDS PLEASANT.
DR. ROSENMAN: IT SOUNDS UNPLEASANT
ORLANDO: THERE'S STILL THAT PILL OUT THERE. [LAUGHTER]
DR. ROSENMAN: THIS IS AN ELECTRODE THAT'S LIKE AN EKG ELECTRODE.
DR. SALGO: OH, SO IT'S NOT SHOCKING HER.
DR. ROSENMAN: IT'S NOT ELECTRIFYING.
DR. SALGO: IT'S JUST MONITORING.
DR. ROSENMAN: EXACTLY.
DR. BURGIO: YOU'RE JUST MEASURING THE MUSCLE...
DR. ROSENMAN: YOU'RE MEASURING THE MUSCLE ACTIVITY IN THAT AREA AND SHOWING THE PATIENT ON A SCREEN WHEN THEY ARE CORRECTLY USING THE MUSCLE.
ORLANDO: I WOULD JUST STOP DANCING. I MEAN, THIS IS A LOT OF STUFF YOU'RE TALKING ABOUT HERE. I'VE GOT TO DO KEGELS, THEN TRAIN MUSCLES, THERE'S NOT REALLY ANY MEDICATION YOU'RE TELLING ME, IT'S TAKING WEEKS AND WEEKS AND WEEKS. I'D JUST STOP DANCING BECAUSE IT'S JUST TOO MUCH.
DR. PAPA: BUT YOU KNOW THAT'S A THEME THROUGH MANY DISEASES. I MEAN PEOPLE THAT ARE OBESE, THEY'RE GOING TO STOP DIETING, IT'S TOO HARD. PEOPLE THAT ARE SUPPOSED TO START EXERCISING FOR THEIR ARTHRITIS, THEY'LL JUST TAKE ADVIL. I MEAN IT TAKES WORK, YOUR HEALTHCARE TAKES WORK. AND YES THERE ARE PILLS OUT THERE, BUT REMEMBER WHAT THEY'RE TALKING ABOUT HERE HAS NO SIDE EFFECTS. PILLS DO.
DR. SALGO: LET ME GIVE LOU SOME OF THE WORKUP HE WANTED, SINCE HE'S SITTING THERE GOING, "I WONDER WHAT'S WRONG?" I CAN TELL YOU SHE'S WORN PANTY LINERS DAILY SINCE SHE WAS 38 YEARS OLD, WHICH IF I RECALL CORRECTLY IS ABOUT THE TIME SHE HAD HER THIRD CHILD. SHE DRINKS COFFEE WHEN IT IS SAFE, AND THAT'S ALL THE CHART SAYS ABOUT WHEN SHE DRINKS COFFEE. WHEN IT IS SAFE.
MYERS: THAT MEANS SHE'S NOT LEAVING THE HOUSE FOR 3 OR 4 HOURS.
DR. SALGO: OK SHE'S HAD THREE PREGNANCIES, THREE BABIES. SHE HAD A HYSTERECTOMY AT AGE 37 FOR ABNORMAL BLEEDING AND FIBROIDS, AND SHE WAS TOLD THAT THAT MAY HAVE CHANGED THE ANATOMY OF HER PELVIS. WHAT DOES ALL OF THAT MEAN?
DR. PAPA: WELL IT MAKES ME THINK OF THE FACT THAT THE ANATOMY OF HER PELVIS IS CHANGED. THE WAY THAT YOU'RE ABLE TO URINATE IS A VERY DELICATE BALANCE, AND WHEN YOU HAVE SURGICAL PROCEDURES LIKE THAT, IT CAN CHANGE THE ANATOMY SIGNIFICANTLY. AND THAT MAY CHANGE HOW MUCH I'M GOING TO GO DOWN THAT PATH OF TRYING THE EXERCISE, I MAY GET A SPECIALIST INVOLVED AT THAT POINT, BECAUSE IT MAY NOT BE AS EASY AS I THINK.
DR. SALGO: ALL RIGHT WE'RE GOING TO CALL AMY. YOU'RE THE SPECIALIST, WHAT TESTS DO YOU WANT TO RUN?
DR. ROSENMAN: WELL FIRST WE DO A URINALYSIS ON EVERYONE AND MAKE SURE THAT SHE DOESN'T HAVE SOME INTRINSIC BLADDER CONDITION, AN INFECTION OR MALIGNANCY. IT SOUNDS LIKE SHE'S GOT MODERATE STRESS INCONTINENCE. AND YOU CAN'T BE A 100% CERTAIN FROM A HISTORY ALONE, BUT THIS IS A PATIENT WHO'S GIVING US A RELATIVELY STRAIGHTFORWARD COMPLAINT OF, "I LEAK WHEN I COUGH, WHEN I SNEEZE, WHEN I LIFT, WHEN I DANCE."
DR. DUECY: THERE'S A PELVIC EXAM. A HEAD TO TOE PHYSICAL EXAM TO ASSESS HER OVERALL HEALTH, HER NEUROLOGICAL STATUS, TO SEE IF THERE ARE ANY PROBLEMS WITH HER NERVOUS SYSTEM. WE USUALLY DO SOMETHING CALLED A STRESS TEST, WHEN SHE HAS A FULL BLADDER, WE ACTUALLY LOOK, AND HAVE HER COUGH OR SNEEZE OR DO JUMPING JACKS, WHATEVER IT TAKES TO ELICIT HER PARTICULAR SYMPTOM TO SEE IF SHE'S LEAKING, IF WE CAN SEE IT. A COMPLETE, JUST KIND OF EVALUATION OF THE ANATOMY OF HER PELVIS, TO SEE IF THERE IS AN ISSUE WITH PROLAPSE, TO SEE IF THERE'S NOT AN ISSUE WITH PROLAPSE, WHICH GIVES YOU DIFFERENT WAYS TO GO.
DR. ROSENMAN: I WOULD ASK HER SPECIFIC QUESTIONS ABOUT URGENCY. DO YOU LEAK ON THE WAY TO THE RESTROOM? HOW MANY TIMES AT NIGHT DO YOU GET UP? DO YOU FEEL EMPTY AFTER YOU VOID? BUT IF SHE WERE TO TELL ME AND GIVE ME THE IMPRESSION THAT, "NO IT'S REALLY WITH ACTIVITY THAT I'M LEAKING," THEN THE ONLY OPTIONS ARE PHYSIOTHERAPY AS WE'VE DISCUSSED WITH KEGEL EXERCISE, OR SURGERY.
DR. SALGO: SO YOU'RE TELLING ME LOU IS RIGHT. GO AHEAD.
DR. DUECY: THERE ARE ALSO SOME NON-SURGICAL MANAGEMENT IN BETWEEN THAT CALLED PESSARY USE, WHICH SOME WOMEN FIND ADEQUATE AND HELP THEM AVOID SURGERY IN THE LONG RUN.
DR. ROSENMAN: BUT PESSARIES ARE NOT EFFECTIVE WITH INCONTINENCE.
ORLANDO: WHAT'S THAT? WHAT IS THAT?
DR. DUECY: A CONTINENCE RING, INSTEAD OF A ...
DR. BURGIO: THERE ARE SOME PESSARIES SPECIFICALLY FOR INCONTINENCE...
DR. ROSENMAN: YES.
ORLANDO: SO THAT'S SOMETHING THAT YOU PUT IN THE SYSTEM TO TURN IT OFF?
DR. DUECY: YOU PLACE IT IN YOUR VAGINA, YOU TAKE IT IN AND OUT YOURSELF. DEPENDING ON THE PATIENT WHO'S COMFORTABLE WITH THAT SORT OF A THERAPY, THAT MIGHT BE ALL THAT THEY WANT.
DR. SALGO: SO WE'VE COME ALMOST FULL CIRCLE HERE HAVEN'T WE? WE STARTED OUT WITH AN INCONTINENT WOMAN AND WE'VE COME BACK TO AN INCONTINENT WOMAN AS A SYMPTOM NOT AS A DISEASE, THAT THERE ARE LOTS OF DIFFERENT CAUSES HERE. SO LET'S STOP FOR A MOMENT. IT IS NOT A DISEASE, AND IT IS A SYMPTOM. THERE ARE A NUMBER OF MEDICAL PROBLEMS THAT CAN GIVE YOU THIS SYMPTOM. IT'S IMPORTANT TO IDENTIFY WHAT THE PROBLEM IS IN ORDER TO FIX IT, AND THAT'S WHERE WE'RE GOING NOW. GRETCHEN'S DOCTOR THINKS SHE HAS A BLADDER PROLAPSE. BASED UPON THE EXAM, BASED UPON THE HISTORY, AND KNOWING GRETCHEN'S HISTORY, WHAT DO YOU THINK IS WRONG WITH HER?
DR. DUECY: WELL, IT SOUNDS A LITTLE BIT LIKE MIXED URINARY INCONTINENCE, WHICH IS A COMPONENT OF BOTH STRESS, WHICH IS THE LEAKING WITH THE COUGHING, SNEEZING, DANCING, AND URGE OR OVERACTIVE BLADDER, WHICH IS WHAT YOU SEE ON THE COMMERCIAL YOU TAKE THE PILL FOR. YOU CAN HAVE BOTH AT THE SAME TIME OR YOU CAN HAVE EITHER SEPARATELY. AND FROM A FEW OF THE CLUES THAT SHE GAVE IN HER FIRST INTERVIEW, IT SOUNDS LIKE THERE MIGHT BE A LITTLE BIT OF BOTH GOING ON.
DR. ROSENMAN: JUST ACTUALLY KNOWING THAT THERE'S A SIGNIFICANT PROLAPSE, WHICH IS DROPPING OF THE BLADDER, THESE ARE PATIENTS WHO WILL DESCRIBE A BULGE AT THE VAGINAL OPENING. "I FEEL LIKE I'M SITTING ON AN EGG," AND THEN YOU LOOK AND YOU SEE AN EGG-LIKE GLOBE COMING THROUGH THE VAGINA, AND IT'S ACTUALLY THE WALL OF THE VAGINA WITH THE BLADDER RIGHT BEHIND IT.
ORLANDO: DOES THE HYSTERECTOMY HAVE ANYTHING TO DO WITH IT?
DR. DUECY: IT COULD. IT COULD. THERE'S SOME NERVE CHANGES, SOME NERVE INTERRUPTION TO THE BLADDER WHEN YOU'RE TAKING THE UTERUS OUT. THERE'S DIFFERENCES IN PELVIC SUPPORT, THE WAY THE MUSCLES SUPPORT THE REMAINING PELVIC ORGANS. WE CHANGE THINGS WHEN WE TAKE THINGS OUT.
DR. SALGO: SO THIS IS ALL ANATOMY?
DR. ROSENMAN: IT'S ANATOMY THAT AFFECTS FUNCTION.
DR. SALGO: LET ME TELL YOU WHAT GRETCHEN'S DOCTOR TOLD HER THAT SHE SHOULD DO. GRETCHEN'S DOCTOR SAYS SHE SHOULD HAVE SURGERY. GRETCHEN SAYS, I DON'T WANT SURGERY. SO GUESS WHAT HER DOCTOR DID AFTER ALL OF THIS? HE GAVE HER A PILL. THE PILL WAS OXYBUTYNIN. WILL A DRUG WORK WITH BLADDER PROLAPSE, SPECIFICALLY THIS DRUG?
DR. ROSENMAN: WELL SHE'S GOT MULTIPLE CAUSES OF INCONTINENCE AND THIS DRUG WILL HELP ONE OF THEM. SHE'LL HAVE LESS OF AN URGE TO GO TO THE BATHROOM. THE PROBLEM IS SHE MAY EMPTY HER BLADDER LESS EFFECTIVELY. SO, IT MAY GET A LITTLE BETTER, IT MAY GET A LITTLE WORSE.
DR. SALGO: HOW DOES THIS DRUG WORK, OXYBUTYNIN, BY THE WAY? WHAT IS THE MECHANISM?
DR. DUECY: IT ACTUALLY HELPS RELAX THE MUSCLE THAT'S SURROUNDING THE BLADDER. THE WALL OF THE BLADDER IS KIND OF A CIRCULAR MUSCLE THAT ENCOMPASSES THE WHOLE BLADDER AND IT HELPS RELAX IT SO THAT THE BLADDER WILL NOT CONTRACT AS OFTEN. THE WOMEN WHO HAVE AN OVERACTIVE BLADDER, THE BLADDER CONTRACTS AT MUCH LOWER BLADDER VOLUMES THAN IT WOULD IN A WOMAN WHO DOESN'T HAVE THE CONDITION. SO THAT'S WHY SHE FEELS LIKE SHE HAS TO GO TO THE BATHROOM MORE OFTEN EVEN THOUGH ONLY MAYBE A LITTLE BIT OF URINE COMES OUT AT A TIME. IT WILL ALLOW HER MORE SPACE BEFORE SHE HAS TO RUN TO THE BATHROOM.
DR. ROSENMAN: IT'S A TOOL.
MYERS: IT IS A TOOL.
DR. ROSENMAN: IT'S A TOOL.
DR. PAPA: BUT LIKE ALL TOOLS, IT HAS A SHARP EDGE. AND THERE ARE SOME SIDE EFFECTS THAT ARE ASSOCIATED WITH IT. THAT RAISES CONCERN, ESPECIALLY THE OLDER YOU ARE. THERE IS A COMPLAINT OF DRY MOUTH, THERE'S LIGHT-HEADEDNESS, AND CHANGES IN POSTURAL BLOOD PRESSURE WHERE IT INCREASES THE RISK FOR FALLS, EVEN FRACTURES IN ELDERLY PEOPLE.
DR. SALGO: WELL GRETCHEN COMES BACK TO HER DOCTOR TWO WEEKS AFTER STARTING OXYBUTANAN. AND HERE'S WHAT THE DOCTOR FINDS. HER FREQUENCY OF INCONTINENCE IS LESS, BUT THE VOLUME THAT SHE PASSES WITH EACH URINATION IS NOW GREATER AND NOW SHE'S COMPLETELY STOPPED DANCING. AND TO MAKE THINGS WORSE, WHEN HER DOCTOR CHECKS HER BLOOD PRESSURE, LOU, AGAIN, YOU'RE A MIND READER, HER BLOOD PRESSURE IS THROUGH THE ROOF. NOW WHAT ARE YOU GOING TO DO?
DR. ROSENMAN: EITHER CHANGE THE MEDICATION OR CHANGE THE APPROACH TO THE TREATMENT.
DR. SALGO: WHAT ARE THE OPTIONS? IF YOU CAN'T GIVE HER THE MEDICATION, CAN YOU DO THIS TIMED VOIDING BLADDER TRAINING STUFF?
DR. ROSENMAN: SHE HAS A DROPPED BLADDER, WE'VE ASCERTAINED SHE'S GOT PROLAPSE, SO A PESSARY IS APPROPRIATE, WHICH IS A RING THAT CAN GO IN THE VAGINA AND CAN FORM A PLATFORM TO ALLOW THE BLADDER TO SIT INSIDE INSTEAD OF PROLAPSING DOWN AND SHE MAY EMPTY BETTER.
DR. SALGO: CAN YOU IMPLANT CHEMICALS THAT HELP MAKE THE BLADDER MORE CONTINENT? CAN YOU PUT LITTLE INJECTIONS AROUND THE BLADDER MOUTH?
DR. ROSENMAN: NOT FOR THIS CONDITION. YOU WOULDN'T DO THAT. I THINK YOU'RE ALLUDING TO COLLAGEN INJECTIONS?
DR. SALGO: YES, BECAUSE I CAN TELL YOU THAT'S WHAT GRETCHEN IS GOING TO ASK ABOUT NEXT.
MYERS: BOTOX? [LAUGHTER]
DR. ROSENMAN: THAT'S A DIFFERENT ONE. COLLAGEN INJECTIONS ARE HELPFUL WHEN THE PROBLEM IS LIMITED TO THE SPHINCTER OR THE MUSCLE THAT CLOSES THE BLADDER. IF IT CLOSES INCOMPLETELY, AND THAT ALLOWS ANY LITTLE HICCUP OR INCREASE IN PRESSURE TO CAUSE LEAKAGE, MAKING THAT AREA STRONGER WITH A LITTLE BIT OF COLLAGEN, IS VERY EFFECTIVE.
DR. SALGO: I HEARD THE WORD BOTOX OVER HERE. WHERE DID THAT COME FROM, I THOUGHT THAT WAS COSMETIC RIGHT?
DR. ROSENMAN: BOTOX IS NOW UNDER STUDY. IT IS NOT SHOWN TO BE EFFECTIVE YET, BUT THERE ARE SOME PILOT STUDIES LOOKING AT BOTOX FOR OVERACTIVE BLADDER. BECAUSE IT IS A SMOOTH MUSCLE AND IT CAN PARALYZE THESE MUSCLES SO WE CAN'T DO THIS, BUT IT CAN ALSO PARALYZE THE BLADDER MUSCLES.
DR. SALGO: LET ME MOVE FORWARD A LITTLE BIT HERE BECAUSE I KNOW WHAT HAPPENS. I GUESS GRETCHEN WAS TOLD THAT NOT ALL INCONTINENCE IS THE SAME, AND THAT VARIOUS PEOPLE HAVE DIFFERENT NEEDS AND DIFFERENT TREATMENTS. SHE'S FINALLY HAD IT. SHE AGREES TO HAVE SURGERY. AND HER DOCTOR WANTS TO DO SOMETHING CALLED COLPOSUSPENSION.
ORLANDO: WHAT'S COLPOSUSPENSION?
DR. ROSENMAN: COLPOSUSPENSION MEANS TO SUSPEND THE VAGINA. "COLPO" IS THE LATIN FOR VAGINA, SO COLPOSUSPENSION MEANS TO RE-SUSPEND, TO RE-PLACE IT UP BACK WHERE IT BELONGS, SO YOU DON'T HAVE THIS BULGE AT THE OPENING OF THE VAGINA.
DR. BURGIO: WELL POOR GRETCHEN, SHE'S TALKING ABOUT SURGERY BEFORE SHE'S TRIED ALL OF THE CONSERVATIVE MEASURES. I WOULD BACK UP AND THINK ABOUT THE WHOLE TOOLBOX THAT WE HAVE OF CONSERVATIVE MEASURES.
DR. DUECY: THERE'S ALSO OTHER OPTIONS THAT THE SURGEON PROBABLY SHOULD DISCUSS WITH HER. THERE'S OPEN ABDOMINAL, THERE'S LAPAROSCOPIC AND THERE'S ALSO VAGINAL APPROACHES THAT ARE VERY MINIMALLY INVASIVE. IT COULD HELP HER GET BACK TO DANCING A LITTLE BIT MORE QUICKLY.
DR. SALGO: IS ANY ONE OF THESE APPROACHES BETTER THAN THE OTHER IN TERMS OF LONG-TERM SUCCESS? ...THERE'S A DEATHLY SILENCE!
DR. ROSENMAN: BECAUSE IT'S VERY DIFFICULT TO LOOK AT LONG-TERM SURGICAL SUCCESS. THERE ARE OBSERVATIONAL STUDIES, THEY ARE NOT LONG-TERM PROSPECTIVE RANDOMIZED STUDIES, BUT YOU CAN OBSERVE HOW PATIENTS DO OVER A LONG PERIOD OF TIME, AND YOU CAN QUOTE THOSE KINDS OF STATISTICS TO A PATIENT. IN HER CASE THEY WOULD BE IN THE REALM OF 80% SUCCESS FOR AT LEAST 10 YEARS.
DR. SALGO: BEFORE WE MOVE ON WITH THE CASE, I WANT TO SUM UP A FEW KEY THINGS TO REMEMBER. THERE IS HELP TO TREAT INCONTINENCE. AND TREATMENTS CAN INCLUDE MEDICAL, BEHAVIORAL, AND SURGICAL INTERVENTIONS. AND THESE CAN RESTORE CONTINENCE. THERE IS HOPE IN THIS DISEASE. DO YOU WANT ME TO TELL YOU WHAT HAPPENED TO GRETCHEN? SHE HAD SURGERY. SHE IS NOW LEAKAGE FREE AND SHE'S BACK TO DANCING. THAT'S NICE. HOW DO YOU THINK GRETCHEN'S FEELING RIGHT NOW?
MYERS: SHE IS FEELING AWESOME, BECAUSE I KNOW, ONCE MY SYMPTOMS SUBSIDED, AND I WAS ABLE TO GET BACK TO A VERY SUCCESSFUL CAREER ON THE LPGA TOUR AND GET MY LIFE BACK.
DR. SALGO: NOW, TERRY-JO, WITH ALL OF THIS THAT'S GOING ON, YOU DIDN'T GO PUBLIC WITH THIS RIGHT AWAY. WHAT MADE YOU GO PUBLIC WITH THIS PROBLEM?
MYERS: I HAD TO GO PUBLIC, FINALLY REALLY FOR MY HOMETOWN, "WHY IS SHE PLAYING SO POORLY? WHY DOES SHE HAVE SUCH UP AND DOWN YEARS? WHAT'S GOING ON?" AND I FINALLY HAD TO COME CLEAN AND SAY, "I HAVE INTERSTITIAL CYSTITIS." IT'S REALLY HAD A HUGE IMPACT ON MY CAREER AND MY LIFE, I'VE WANTED TO TAKE MY LIFE BECAUSE OF THIS, SO HERE YOU ARE.
DR. SALGO: YOU WANTED TO TAKE YOUR LIFE BECAUSE OF THIS?
MYERS: IT HAD GOTTEN TO THE POINT. I MEAN JUST IMAGINE GETTING UP 50, 60 TIMES A NIGHT TO GO TO THE BATHROOM. HAVING TO FIND A BATHROOM CONSTANTLY ALL DAY LONG. YOU HAVE NO SLEEP, SO NOW IT'S ALMOST TO THE POINT OF 12 YEARS WHERE I HAVEN'T SLEPT A NIGHT. I'M IN A LOT OF PAIN, THE PAIN FEELS LIKE I HAVE PAPER CUTS THAT LINE MY BLADDER WALL AND THEN URINE HITS THE PAPER CUTS. AND AS WE DISCUSSED, AND YOU SEE PATIENT AND PATIENTS WITH INCONTINENCE, YOU CAN'T EMPTY YOUR BLADDER COMPLETELY, SO YOU CONSTANTLY HAVE THE INSULT OF URINE IN THERE. SO IMAGINE THAT KIND OF LIFE, AND THAT'S WHY WE WERE SPEAKING TOO, THESE PATIENT ARE GOING TO BE SOME OF YOUR MOST REWARDING PATIENTS BECAUSE YOU HAVE GIVEN THEM BACK A LIFE.
DR. SALGO: WELL, THANK YOU SO MUCH FOR BEING HERE. NOW, WE'VE COVERED A LOT OF GROUND TODAY. LET ME JUST SUM UP THE KEY THINGS TO REMEMBER. URINARY INCONTINENCE IS NOT JUST EMBARRASSING OR A NUISANCE. IT IS A REAL MEDICAL PROBLEM, AND THAT BY DEFINITION MEANS INAPPROPRIATE URINE LEAKAGE, SHOULD NOT, CANNOT, MUST NOT BE IGNORED. IT REQUIRES A MEDICAL WORKUP. URINE LEAKAGE IS NOT A DISEASE, IT IS A SYMPTOM AND THERE ARE A NUMBER OF MEDICAL PROBLEMS THAT CAN GIVE YOU THIS SYMPTOM. SO IT'S IMPORTANT TO IDENTIFY WHAT THE PROBLEM IS IN ORDER TO FIX IT. NOW THERE IS HELP TO TREAT INCONTINENCE. TREATMENTS INCLUDE MEDICAL, BEHAVIORAL AND SURGICAL INTERVENTIONS THAT CAN RESTORE CONTINENCE. THERE IS HOPE. AND OF COURSE OUR FINAL MESSAGE IS THIS: TAKING CHARGE OF YOUR HEALTH MEANS BEING INFORMED AND HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR. I'M DR. PETER SALGO, AND I'LL SEE YOU NEXT TIME FOR ANOTHER SECOND OPINION.
SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE. THE ADDRESS IS PBS.ORG.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING: THE JOSIAH MACY, JR. FOUNDATION AND THE PARK FOUNDATION.
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