Thursday, February 25, 2010
"What do mean how long until the next rest stop? You just went twenty miles ago!"
I apologized to my husband -- blaming it on the coffee I had brought along in the car, but I was secretly thinking that he wouldn't possibly get it. The man is a virtual camel when it comes to holding his urine!
Every kids little league game we went to, the first thing I did was scout out the Ky-bos -- you know those AWEFUL "portable pottys" that so many recreational parks have. I loathed using them fearing the terrible smell, the germs, the disgusting sight in the unflushable stool. Worst of all was the fear of accidently getting locked in one. I saw it happen to a poor woman at a park once.
One time I sat in the broiling 100 degree sun at a tournament game in a small town, not drinking anything for fear my urinary urgency would kick in and I'd have to use the Ky-bo again. The one that I saw housed a large, hairy, jumpy looking spider the first time I used it!
Little did I know at the time, that the more concentrated your urine is, the more irritating it is to the lining of the bladder and therefore the more urgency you get to use the bathroom.
I was overweight and knew that I needed to exercise, but went to an adult ed evening fitness class once and had to leave early because after one jumping jack I had -- horror of horrors:
WET MY PANTS!
At first I thought the dampness of my undies at the end of the day was an accumulation of "fat girl sweat". I was almost in denial until I eventually found myself throwing a box of "mini pads" in the grocery every week along with "fresh wipes" to keep the chronic faint ammonia odor in check.
I finally got up the courage to speak to one of the physicians I work with. After all, I had been a nurse in the women's health field long enough to know the signs and symptoms of urinary incontinence. He sent me to a urologist who diagnosed me with a cysto-urethrocele, uterine prolapse, and rectocele -- all $50 words for my organs had gone South - and not just for the winter! My bladder, uterus, bladder neck, and rectum had all prolapsed. Simply put - female hernias. We tend to think of hernias as only a bulge in a man's groin, but not true. Many women after childbearing and especially as we age and pack on the pounds, develop these hernias.
In my particular case, I had an extensive abdominal surgery to repair all of these defects. The recovery was difficult and involved leaving the hospital with a large catheter in for two weeks and an additional two weeks of self catherizing until I was able to go on my own. This was the mid-ninties and treatment options were limited. Although I had seen a urologist prior to surgery who performed some simple testing on me to determine bladder capacity and visualize my leaking, it was a gynecologist who performed the actual surgery as is customary.
In 1995 a new physician joined our practice right out of residency. Because I had been there so long, I was the nurse who was assigned to all the new physicians who came in so I could "teach them the ropes". This doctor was very interested in female incontinence issues and brought what is known as urodynamic testing into our office. He purchased the equipment and announced that WE would be performing these tests that were once farmed out to urologists -- right there in our office. My first thought was "What do mean WE Kimosabe?" I quickly learned that it was sink or swim. I would learn how to assist with what we called a CMG (cystometrogram) or float on...
At the time I thought that the testing was a pain in the neck. It took significant time to set up the testing equipment and as the doctor performed the test, I had to schedule an hour time slot out of his schedule -- a practically impossible task and women often waited weeks to get in for the test. Then another month to schedule surgery.
In addition to the testing, he brought the latest in innovative surgical repair procedures. Many procedures were now being done vaginally, and with minimal post operative complications. Some were even being done outpatient with the patient being consciously sedated as opposed to general anesthesia -- being "knocked out". My interest was piqued when I saw that the complications that I had experienced were becoming a rarity with the pre-operative testing, selection of the proper treatment options, as well as the newer surgical procedures.
I worked with this particular physician for 13 years as his nurse / sidekick. By this time, most of the physicians in our ever expanding group were on board with doing female incontinence work-ups. I was discovering that with the newly developed medications for urinary urgency, AND with the new trend to advertise prescription medications on television, many women were "coming out of the closet" and talking to their doctors as the commercials advised. Lots of people criticize the drug companies for spending the money on such aggressive marketing tactics, saying it drives up the costs of prescriptions, which ultimately may be true. However, I credit the "gotta go, gotta" commercials for reassuring women that incontinence is a common, valid problem that they don't have to live with because it's a part of being female.
The problem with the use of medications, however, is that many primary care physicians -- the good ol' family doctor -- are prescribing it willy nilly as a first line of therapy, without properly working up the issue. Granted, it is less invasive and if it works, well great. Trouble is the dry mouth and constipating side-effects of the medication aren't worth it if it doesn't solve the problem. Urgency isn't the most common form of incontinence.
While we continued to add new physicians to our group, I asked not be assigned to the new docs. I was finding that I really enjoyed working with the large population of incontinent patients that the physician I had been working with saw. Things began to "click" with just how everything tied together as far as symptoms, diagnosis, and treatment.
About 5 years ago, when I first started losing weight, we bought some new sophisticated equipment for testing and working up female incontinence. Everything was now computerized and we added components to diagnose voiding dysfunctions -- abnormal peeing as well. The testing takes an hour and the other doctors nurses didn't appreciate scheduling or assisting with the process any more than I did at first. I looked like the supreme "suck up" because I was so enthusiastic about the subject and now looked forward to setting up and assisting with the testing.
One day I had a patient who had drove 75 miles into our office for the testing and I was mortified to receive a call from the doctor saying that he was about to get into some emergency surgery and I would need to reschedule his afternoon's worth of patients. I told him that this woman had driven 75 miles and I really didn't feel like I could easily reschedule her. What could I do? Could he come when he was done with surgery and I'd stay late? He thought a moment and said why didn't I just do the test? After all I had seen him perform it hundreds of times.
ME? ME? NO NO -- YOU KIMOSABE -- NOT ME! ME TONTO!
Yes I could put a catheter in a woman in a coal mine at midnight wearing sunglasses, but there was so much more to the testing. My head was spinning, but for the sake of the patient I agreed to try. I was shaking so badly that first time and it was a crude report to say the least, but it essentially gave the dr. the information he needed to select the best treatment option for the patient. He began suggesting that I test other patients on a regular basis.
The idea of me performing the urodynamic testing caught on quickly and all the other physicians, anxious to free up their own schedules, began asking me to test their patients too. While I was adequate, I never like doing anything half-way. Especially when it comes to the quality of care that a patient deserves. So I formally requested to be sent to training not only in the technical aspects of the testing, but the interpretation of the testing as well. In turn I proposed that a new nurse be hired to work with the doc that spurred my interest in what is known as "urogynecology", and I would perform urodynamics for all the drs. in our group.
They readily agreed and I now perform the testing and generate reports for approximately 300 patients a year. I also work with patients on pelvic floor rehabilitation -- kegel exercises and behavior modification techniques to correct voiding dysfunction. I am hoping to expand into biofeedback as an addition to my pelvic floor therapy. I fit pessaries - a rubber donut shaped device that fits in the vagina to alieviate symptomatic prolapses in woman who are poor surgical candidates. AND I teach self catherization to the occasional patient who warrants it. Rarely post operative patients these days. It's mostly women with neurological disorders like multiple sclerosis, myasthenia gravis, or even common diabetic neuropathy.
I am a member of the Society of Urological Nurses and Associates - SUNA - and fairly well versed in female urinary incontinence if I do say so myself. I am in the process of studying to pass their national certification exam to obtain "official" certification. This is quite an undertaking as it encompasses not only female incontinence and voiding dysfunctions, but males with benign prostate hypertrophy - enlarged prostate issues, sexual dysfunctions, as well as pediatric incontinence issues like bedwetting.
Well dear Spark friends, I've glazed your eyes over enough with my enthusiasm for my profession -- which I fondly refer to as my "Passion for Pee"!
I am going to blog next about the more specifics of different reasons for why people lose urine or feel the urge to urinate constantly. I promise I will use the same "patient friendly" lingo that I use with my patients to put it into terms that are readily understood. I'll cover causes, symptoms, testing, and treatments available.
SOOO -- if the whole subject of wetting your pants or running to the bathroom 24/7 isn't your interest, feel free to skip it.
BUT if you are one of those "closet leakers" - and we aren't talking household pipes -- or you "know somebody" who may have this issue -- you know, a "friend of a friend"....
If you are afraid to exercise. Laugh. Sneeze. Drink the 64 ounces of daily recommended water...
If you feel like your husband or significant other is a camel compared to your number of trips to the bathroom....
Then STAY TUNED...