Urinary incontinence affects millions of women – 38% of women over the age of 60 – yet only 45% ever seek help for it. Men suffer from the problem too but at about half the rate. Only 22% of men seek help.
Why is this a taboo subject? One reason is that it’s an embarrassing – even infantilizing – problem. But patients’ shame is, well, a shame. Because urinary incontinence – the involuntary leakage of urine – can often be treated quite successfully. The first step is to make a proper diagnosis. One common type is “urge incontinence” – the bladder contracting when a person isn’t ready to urinate and can’t get to the toilet fast enough. Another common type, especially after childbirth or in athletes, is “stress incontinence.” It happens when there is a weakness in the pelvic muscles supporting the bladder and urethra (the structure through which urine exits the bladder), causing the urethra to lose its seal and allowing urine to escape when there is increased pressure on the bladder (e.g. coughing, sneezing, laughing, lifting, or exercise). As women get older, it’s more likely they will develop urge rather than stress incontinence. A very simple three question test has been created to help with the diagnosis.
It’s important to get a complete, head to toe medical evaluation because urinary incontinence may be a symptom of an underlying condition (e.g., neurological problem, diabetes, urinary tract infection, chronic bladder inflammation, or even a tumor) or may be a result of medication. Talk to your primary health provider and/or gynecologist. If needed, a specialist (e.g., urologist or urogynecologist) can be consulted.
Treatments for urge incontinence include bladder retraining and pelvic muscle exercises, medications to relax the bladder, and decreasing fluid intake. Approaches to stress incontinence include weight loss if obesity is present, a vaginal pessary, and surgery.
In today’s segment of CBS Doc Dot Com, Dr. Lori Warren and Dr. Jody Blanco, gynecologists with expertise in urinary incontinence, discuss the problem. You’ll meet a woman who overcame her embarrassment, sought help from Dr. Blanco, and is now symptom free after surgery.
There are several online resources on the subject, listed at the end of an excellent discussion in the online medical database, UpToDate.com.
I’ve been fairly quiet about Jenny McCarthy’s campaign against childhood vaccinations, partly because Dr. David Gorski has covered the issue so thoroughly already, and partly because of my “do not engage” policy relating to the deeply irrational (i.e. there’s no winning an argument with “crazy.”) But this week I was filled with a renewed sense of urgency regarding the anti-vaccinationist movement for two reasons: 1) I received a personal email from a woman who is being treated with hostility by her peers for her pro-science views on vaccines and 2) a friend forwarded me a video of Jenny McCarthy speaking directly to moms, instructing them to avoid vaccinating their kids or giving them milk or wheat because of their supposed marijuana-like addictive properties.
Anti-Vaccination Views Are A Status Symbol?
I was surprised to discover that some pro-science moms are being mocked by peers who are uninterested in evidence, choosing to believe any dubious source of health information that questions the “medical establishment.” This concerned mom writes:
I am the mother of two young children, and I live in the trenches of the anti-vax woo. In my circle of about 14 mothers, my anecdotal analysis is that the rate of complete vaccination hovers around 60%. The mothers in this group are all very well educated, middle-class or affluent, predominantly stay-home mothers. One problem is what they consider reliable sources of information. They rely on anecdotes and dismiss scientific evidence in part because they are very anti-medical establishment. The group is self-validating and many shared values (and myths) increase in intensity over time.
Many of the mothers practice “Natural Family Living” which has some appealing aspects, but also harbors elements of a cult. In this environment, anti-vaccination becomes a very powerful status symbol… I have lost friendships and been partially ousted from this circle because of my views.
This note struck a chord with me, since I experienced similar hostility in the past for voicing my concern about pseudoscience and misleading consumer health information. I was accused of being “paternalistic, narrow-minded, a dinosaur – part of a dying breed, a racist against complementary and alternative medicine, and a Bible school teacher, preaching evidence-based medicine,” insulted for my desire to be accurate about what was known and not known about treatment options, and my expertise, training, and academic credentials were called into question publicly on many occasions. I endured all of this primarily at the hands of someone who supposedly believed in “natural healing” and the “art of kindness” as an integral part of patient care.
I am troubled by the mounting antagonism towards those of us who’d like to use critical thinking and scientific reasoning to learn what we can about medicine and our health. I’m not sure what to do about it except to encourage one another to stand strong for science and reason – to expect all manner of attacks and insults, and to be firmly committed to the objective quest for truth. It shall set us free.
Jenny McCarthy – Inaccurate, Unhelpful And Dangerous Advice
Although I find Jenny McCarthy’s advice and opinions painful to watch, I committed myself to viewing her recent video at my friend’s request. In order to spare you similar discomfort, let me simply summarize what she said so you can get a high level overview of the sort of bizarre and misinformed claims she promotes (feel free to check out the video for yourself).
“Autism is not primarily a genetic disorder, but caused by vaccine-related toxins (including mercury, aluminum, ether, anti-freeze ,and human aborted fetal tissue) and pesticides.”
A recent study published in Nature links genetic alternations in DNA that codes for neuronal cell adhesion molecules to autism spectrum disorders.
There is no conclusive evidence of a link between pesticides and autism.
“Kids get ‘stoned’ by wheat and dairy toxins. Giving them wheat or dairy proteins is like giving children marijuana.”
There is currently no evidence that any diet improves or worsens the symptoms of autism spectrum disorders. In fact, whole grains and dairy products are an important part of a healthy diet for most children.
“Food allergies are like Iran and Iraq. Glial cells (they’re like chef cell) provide food to the neuron kings. Glial cells can turn into Rambo to fight Iran and Iraq. If a child is allergic to everything, the Rambo cells stop feeding the neurons and the neurons starve. That causes the symptoms of autism.”
I don’t know what to say about this strange analogy – clearly no science-based information here.
“To treat autism, you need to give your child supplements to fight off the yeast in their bodies. I recommend Super Nathera, Culturelle, Cod Liver Oil, Caprylic Acid, CoQ10, Calcium, Vitamin C, Selenium, Zinc, Vitamin B12, B6, and Magnesium.”
There is no evidence of efficacy for any of these supplements in the treatment of autism.
“You need to consult with a DAN! Practitioner.”
DAN! Practitioners recommend chelation therapy for the treatment of autism. There is no evidence that chelation therapy has any benefit for children with autism, and in fact, can be fatal.
“Whatever you think becomes your reality. Imagine your child going to his/her prom and he’ll be cured.”
I think it’s pretty clear that Jenny McCarthy’s recommendations range from ineffective (imaginary healing) to harmful (malnutrition related to absent dairy and wheat in the diet, excessive levels of vitamins) to deadly (chelation therapy with DAN! Practitioners). Will mothers watching her new show on Oprah fall for her pseudoscience and poor advice?
I was pleased to see this open letter to Oprah from one concerned mom. Here’s an excerpt:
To me, it is clear that a significant number of people look up to you, and trust your advice and judgment. That is why it is such a huge mistake for you to endorse Jenny McCarthy with her own show on your network.
Surely you must realize that McCarthy is neither a medical professional nor a scientist. And yet she acts as a spokesperson for the anti-vaccination movement, a movement that directly impacts people’s health. Claims that vaccines are unsafe and cause autism have been refuted time after time, but their allure persists in part because of high-profile champions for ignorance like McCarthy. In fact, ten of the thirteen authors of the paper that sparked the modern anti-vaccination movement retracted the explosive conclusions they made due to insufficient evidence. Furthermore, it is now clear that the study’s main author, Andrew Wakefield, falsified data to support these shaky conclusions.
We have come close to eradicating life-threatening and crippling illnesses because of vaccines, but are now struggling to prevent outbreaks because of parents’ philosophical beliefs that vaccines are harmful. Realize this: when someone chooses not to vaccinate their child, they aren’t just putting their own child at risk, they are putting everyone else around them at risk. Diseases with vaccines should normally be of little concern even to unprotected individuals due to herd immunity – with the majority of the population immune, unprotected individuals are less likely to come into contact with the pathogen. Unfortunately, herd immunity disintegrates as fewer people are vaccinated, putting everyone who hasn’t yet been vaccinated at greater risk for infection. Now, the rates of infection by diseases for which we have safe and effective vaccines are climbing, thanks to anti-vaccination activists like Jenny McCarthy.
You reach millions of people everyday and your words and endorsements carry an incredible amount of weight. If you say to buy a certain book, people will buy it. If you do a segment on a certain charity, people will contribute. And if you say that what Jenny McCarthy is saying has merit, people will believe you…
Conclusion
A certain segment of society appears to be emotionally invested in medical beliefs that are not based on science, but rather anecdotes, conspiracy theories, and magical thinking. Those who recommend a more objective method of inquiry may be subject to ridicule and hostility by that segment. Nonetheless, it is important (for public health and safety purposes and the advancement of science) for critical thinking to be promoted and defended. While some celebrities, like Jenny McCarthy, are committed to misinforming the public about their children’s health – parents who recognize the deception are speaking out against it. Perhaps the best way to combat Jenny’s propaganda is to boycott Oprah. Refusing to support the promotion of dangerous pseudoscience may be our best defense.
Outdoor enthusiasts are often stricken with infections for which they might be prescribed antibiotics in the class known as fluoroquinolones, one common member of which is ciprofloxacin (Cipro). They should be aware that a fairly well accepted complication of taking a fluoroquinolone for more than a few days is development of tendinitis leading to tendon rupture, notably of the Achilles tendon. The risk is such that the Food and Drug Administration (FDA) requires the makers of such drugs as ciprofloxacin and levofloxacin (Levaquin) to publish a black box warning on the packages alerting users to potentially serious side effects. The full list of drugs affected by the warning include ciprofloxacin (marketed as Cipro and generic ciprofloxacin); ciprofloxacin extended release (marketed as Cipro XR and Proquin XR); gemifloxacin (marketed as Factive); levofloxacin (marketed as Levaquin); moxifloxacin (marketed as Avelox); norfloxacin (marketed as Noroxin); and ofloxacin (marketed as Floxin and generic ofloxacin). As new fluoroquinolones appear on the market, they will undoubtedly be included in the warning program. The warning does not apply to eye and ear drops – only to medications taken orally or by injection.
Many patients and health care professionals are not aware of this risk, which is very real, having been officially reported in literally hundreds of patients. Although the drugs are phenomenal in terms of their ability to fight certain bacterial infections, users should be aware of this possible side effect, so that they can discontinue taking the culprit medication and switch to an alternative antibiotic(s) if need be. If tendon pain develops (typically about a week after initiation of therapy) when a person is taking a fluoroquinolone antibiotic, that is the time to make the switch. Simultaneously, anyone affected should diminish or avoid exercise and cease stressing the affected area until such time as the situation is resolved, as would be determined by decreased pain and other signs of inflammation. Most patients can be expected to recover within 10 weeks after discontinuing the antibiotic, but it may take longer.
Fluoroquinolones are widely used to treat infections in adults. They are not commonly prescribed for children because of a risk for eroding cartilage; however, if the medical necessity is important, they can be used in young individuals. The tendon rupture problem is therefore largely a problem of adults, and typically affects the Achilles tendon, with onset of symptoms within the first few weeks after the initiation of antibiotic therapy. Other tendons, including those of the upper extremity, may be involved. It is perhaps the large forces placed upon the Achilles tendon that makes it so prominent in this particular medical situation. Furthermore, the risk of fluoroquinolone-associated tendinitis and tendon rupture appears to be greater in persons older than 60 years of age, in those taking corticosteroid drugs (“steroids”), and in kidney, heart, and lung transplant recipients.
Nurses are experts at navigating through rough waters. We are always there for our patients in their time of need. Check this nurse out. She is using her critical thinking skills while she sails her boat through a stormy ocean. It’s true. Nurses can do just about anything, just so long as they have a good mentor to show them the way.
From time to time, I get letters from new psych nurses asking me for advice.
I was very lucky when I first started out as a psych nurse. Nurses and doctors who gave me valuable tips when I was new in the field surrounded me on the unit, and made sure that I didn’t get myself into trouble. Here are some pearls of wisdom that my mentors passed onto me when I was the new kid on the block. I hope they help you, too.
Pearl of wisdom #1: The first rule that I learned was that I never was to accept abuse from a patient. Patients may be angry about how things are going in their life, but they must learn to vent their anger appropriately. That means no hitting, swearing, or throwing stuff at other people. Period! Just because someone has “problems” doesn’t give them a license to act inappropriately on the unit. Seriously. Nurses are not punching bags. We have rights. Nurses must teach their patients to function in the real world, and we do them a disservice if we allow our patients to act out on a psych unit.
Pearl of wisdom #2: The second pearl of wisdom has to do with the myth that nurses can say something wrong to a psych patient. Many nurses are afraid that a patient will crumble if they say the wrong thing to the wrong person. I’ve never seen this happen during my nursing career. Just listen to your patients with your ears and with your heart. Everything else will fall into place.
Pearl of wisdom #3: Never turn your back on a patient. This is self explanatory. Psych units are unpredictable.
Pearl of wisdom #4: Don’t get offended if a patient hates you. That probably means that you are doing your job. Many patients come to the hospital because they have boundary issues, and issues involving the need for immediate gratification.
Pearl of wisdom #5: Never forget that you are a REAL nurse. You may not be caring for a wounded body, however you are caring for a wounded soul.
The patient sits across the exam room and looks at me with a combination of surprise and hurt. He had answered all of my questions to the best of his abilities, hoping that I would figure out what was causing the symptoms and fix his problem. A bit of doubt shows on his brow as he goes over what he feels and what happened in the past. Did he say things wrong? Did he mistake the way it felt? Is he just bad at explaining things?
“I am not accusing you of being untruthful. Your symptoms are your symptoms, and you felt what you felt. Unfortunately they don’t always read the medical textbooks and so make me earn my keep. I believe your symptoms are real; I just don’t understand how they fit together. It’s confusing.” I say this as reassuringly as possible. He relaxes visibly as I speak.
But that doesn’t change the fact that the symptoms defy logic. It’s my job to figure things out and fix things, right? Isn’t this an admission of defeat? Isn’t it a confession of my inadequacy? Won’t this undermine the thing that I have said is the cornerstone of a doctor/patient relationship: trust?
Some people seem impatient for an answer, but most are OK with me not knowing for a while. The thing that makes it acceptable for me to be confused is the longstanding nature of the relationship of a patient with their PCP. This is one page in the book, not the whole story. This concept – of the patient’s “story” – is one I actually use in this situation. I say:
You know when you see a movie that is really confusing in the start? You don’t know who is who, or why one person was mad at the other, etc. It is just hard to figure out what is going on. But later on in the movie things become clear. You say “Oh, so that’s who that guy was! That’s why she was so mad at him.” It all clears up over time. With your illness, we may just be at that confusion part of the movie. It may just take time for us to be able to make sense of what is going on.
I have to say that I actually am glad for those cases where things are confusing at the start. No, I am not happy for the patients, but the hard stuff is what separates the good docs from the bad ones. If I can sort through things and come up with an answer when one wasn’t apparent, I am showing the merit of all of my hard work. I justify my salary. I go home feeling like I am more than just a bunch of algorythms.
I don’t want everyone to be confusing, but just because things seem to not add up it doesn’t mean we won’t come to a good answer eventually.
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“That doesn’t make any sense.”
I have to say that I actually am glad for those cases where things are confusing at the start. No, I am not happy for the patients, but the hard stuff is what separates the good docs from the bad ones. If I can sort through things and come up with an answer when one wasn’t apparent, I am showing the merit of all of my hard work. I justify my salary. I go home feeling like I am more than just a bunch of algorythms.
