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4A Daily News – Monday, September 19, 2011 Vitality & health For the 25 million U.S. adults with urinary incon- tinence, a little leakage can carry a lot of shame. But many people don't do anything about it. "Urinary incontinence is a very insidious process," said Dr. David Glazier, co-director of the pelvic floor center at Vir- ginia Urology in Rich- mond, Va. "It occurs very slowly; (people) think it's a normal part of aging." Women — 75 percent to 80 percent of sufferers, thanks largely to the won- ders of childbirth — endure leakage for an average of eight years before seeking help, Glazier said, even though it's highly treatable. Increasingly, women are taking action. They are "more physically active, fit, and they're not going to tolerate wearing pads all the time," said Dr. Vivian Aguilar, a urogy- necologist at Cleveland Clinic Florida who sees many incontinence patients in their 30s, 40s and 50s. The most common types of incontinence among women are stress and urge incontinence. Pelvic organ prolapse can be a cause. Most women see improvement or cure through behavioral modi- fication (losing weight, limiting caffeine, alcohol and artificial sweeteners) and Kegel exercises to strengthen the pelvic floor muscles, considered the frontline treatment for both types, said Dr. Mar- garet Roberts, attending physiatrist with the Reha- bilitation Institute of Chicago. But a third of women don't do Kegels correctly, she said, and those frontline treatments don't work for everyone. Here are other solu- tions, which depend on what type of incontinence a woman has, drawing from the expertise of Glazier, Aguilar and Roberts: STRESS INCONTI- NENCE What it is: Leaking urine as a result of abdominal pressure, such as laughing, coughing, sneezing, running, jump- ing or having sex. It hap- pens as the valve muscle around the urethra weak- ens and wears down with time, and commonly starts after childbirth, which stretches out the tissues that support the urethra and bladder. It is the most prevalent type of incontinence among women, affecting one- fourth of women over 17, and it becomes increas- ingly common with age. weeks, and then once a month after that. Unlike Interstim, it's not covered by most insurance. Botox: The FDA in August approved Botox bladder injections to treat urinary incontinence in people with neurologic conditions such as spinal cord injury or multiple scerlosis. The effect lasts for up to 10 months, so you'll need repeat visits. Some people have trouble emptying their bladder afterward and must use a catheter. Augmentation cysto- plasty: The end-of-the- road treatment for overac- tive bladder, this involves cutting into the bladder to increase the capacity and decrease contractility. Afterward patients may have to catheterize them- selves. PELVIC ORGAN PROLAPSE Medication: There are no FDA-approved med- ications for stress inconti- nence. Duloxetine (Cym- balta), an antidepressant, is approved in the Euro- pean Union for stress incontinence and is some- times used off-label in the U.S., but it carries an FDA-issued black-box warning of suicide risks. Bulking agents: Inject- ing collagen or carbon spheres into the tissue around the bladder neck and urethra helps close the bladder opening to reduce leakage. Over time, the body might eliminate the agents so you have to repeat injec- tions. Slings: A small ribbon of mesh, usually inserted through the vagina, is placed around the urethra to support it. This com- mon outpatient surgical procedure, usually done under general anesthesia, has a 90 percent success rate, but it carries risks. The FDA in 2008 warned of serious complications with mesh used for stress incontinence and prolapse procedures, including infection and migration or erosion of the mesh into the vagina, potentially causing pain during inter- course. The procedure also can be performed using tissue from your own body. Burch procedure: Through an incision in the abdomen, a surgeon pulls up the bladder and sutures it to ligaments behind the pubic bone, giving sup- port to the urethra. It has a slightly lower success rate than a sling, but it has fewer side effects, accord- ing to a study published in the New England Journal of Medicine. URGE INCONTI- (MCT) — The calendar says Sep- tember, so it must be National Honey Month. Gee, has it been a year already? Check out what all the buzz is about by taking our quiz. 1. Which of these three sweeteners contains the most calories per table- spoon? a) White sugar b) Honey c) Brown sugar 2. How much honey do Americans consume per year? a) 206 million pounds NENCE What it is: Having the sudden urge to urinate and not always making it to the toilet. While the caus- es aren't well understood, it happens when abnormal nerve signals cause blad- der contractions when you're not ready and can be brought on by infec- tion or nerve injuries, such as multiple sclerosis or stroke. It is associated with overactive bladder, which also includes uri- nary frequency (needing to urinate more than seven to 10 times per day), and nocturia (waking up at least twice a night to pee). Urge incontinence and overactive bladder affect one-fifth of adults older than 40 and are twice as frequent in women as in men. Medication: Medica- tions such as VESIcare, Ditropan and Toviaz help with overactive bladder symptoms by relaxing the bladder muscles. Neuromodulation: Interstim is the brand name for a pacemaker- like device that is implanted under your skin, just above the but- tocks, to deliver electric pulses that calm the blad- der. You do a two-week trial before implantation to confirm it works before committing. Possible complications include discomfort and infection. Because it's metal, you can't have an MRI. A less invasive option is peripheral nerve stimu- lation, wherein a doctor places a small needle in one of the nerves in the foot, next to the ankle bone, and sends an elec- tric signal to the bladder nerves to calm down. You must do half-hour ses- sions once a week for 12 Nutrition Quiz: Honey b) 300 million pounds c) 410 million pounds 3. What percentage of that honey was produced in the United States? a) 23 percent b) 44 percent c) 61 percent 4. To honey nerds, the best-tasting nectar comes from mono-floral honey _ derived from a single plant species. Which of these plants is not listed among top varietal honey producers? a) Sage b) California poppy •Weight Loss • Kickboxing • Muscle Tone • Boot Camps • Strength Training & Sport Specific Training J J & No Gym, No Problem! We come to you! or email: in.homefitness@yahoo.com Call Jacob (530) 529-0095 c) Yellow star thistle 5. Which state produces the most honey per year? a) California b) Florida c) North Dakota wn: 51; white: 48); 2: c; 3: c;ries; bro 4: b; 5: c. y: 64 calo-ANSWERS: 1: b (hone Sources: www.honey.com; www.mayoclinic.com; www.starthistlehoney.com FIRST ANNUAL In Home Fitness BOOSTER FALL BONANZA Featuring "1987 State Championship Girls Basketball Team" Saturday, October 15, 2011 Social Hour: Tri-Tip Dinner: 6:30pm Dancing: Live Band - Northern Heat Tyler-Jelly Building Red Bluff Fairgrounds Pre- Ticket: $30 (available from a Red Bluff Spartan Athlete) Tickets at the Door: $40 Sponsored By 5:30pm 8:30pm James W. Tysinger, Jr. M.D. Eye Physician & Surgeon Fellow American Academy of Ophtalmology We accept Medical, Medicare & most Insurances Office Hours: Tues-Wed-Thurs 8am-4:30pm Mon & Fri 1pm-5pm For Emergencies, After Hours, Week-ends, Call 530-567-5001 345 Hickory St. Red Bluff Tel: (530) 529-4733 Fax: (530) 529-1114 When childbirth, hys- terectomy or other surgery weaken the mus- cles and tissues support- ing the pelvic organs, a woman's bladder, uterus, bowel or rectum can shift from their normal posi- tions and drop into the vagina. Stress inconti- nence can result, or the drooping organs can kink the urethra, causing uri- nary retention. POP affects as many as half of women who have given birth, but only 10 to 20 percent experience symp- toms. Pessary: A diaphragm- like device that you insert into the vagina to help keep the organs in place. You must remove and reinsert the pessary regu- larly for cleaning. Surgical repair: Sur- geons can fix prolapse as they would a hernia, pulling up and securing collapsed organs. When prolapse is accompanied by incontinence, they would install a sling dur- ing the same procedure. For women who have had several unsuccessful repairs, some doctors insert mesh through the vagina to hold up the sag- ging organs, but mesh has risks. In July, the FDA updated its warning on using mesh to correct pro- lapse, citing serious com- plications including mesh protruding through the vaginal wall and organ perforation during inser- tion. The greater risk does not come with greater clinical benefit, the FDA said, and removing the mesh may not be possible and may not resolve com- plications. ___ Learn more: National Association for Conti- nence, nafc.org. fitness Always running to the bathroom? When someone you love CHICAGO (MCT) — is old and lives alone CHICAGO (MCT) — Used to be, the phone or a good neighbor were the best bets for keeping tabs on someone you love who's elderly and living alone —especially if you lived too far to buzz over every day. But more and more, a host of technological devices and Internet-based solutions are crowding the elder-care land- scape, making it more convenient, and far less worrisome, to know all is well with an aging relative or friend. We talked to gerontology nurses and gerontologists to get the lowdown on what's smart, what's dignified, and what's best avoided. Far more important than all the high- tech in the world is the simple act of talking about it to make sure any high-tech monitoring is seen not as an invasion of privacy but rather a means of allowing a person to more safely live alone. "Sometimes in our eagerness for safety, that whole aspect of a person's autonomy — and dignity — is being trampled," says nursing professor Margaret Bull, who spe- cializes in elder-care issues at Marquette University in Mil- waukee. "As much as possible, match what's in that person's com- fort zone," advises Dena Schulman-Green, a gerontologist at Yale University's College of Nursing, who often opts for low-tech elder-care solutions but certainly not always. "Some older adults are very into technology, and using such devices makes them feel part of the modern world, and less of a burden to their kids." HELPING HANDS Here's a list of techno-innovations, approved by nurses who spend their lives looking out for the elderly. Skype (skype.com): This free, Internet-based two-way teleconference service tops the list for ways to keep in daily touch. For no charge, you can add a video component so you can see the person, and keep watch for changes in appearance or manner. "That face-to-face contact is really important, especially if you're concerned about social isola- tion," says Lesley Boaz, a geriatric nurse practitioner and professor at Marquette's College of Nursing. Cellphone with GPS device: Needn't be anything fanci- er than a flip phone that's tucked in the pocket of an elderly person, with the GPS connected to the caregivers smart- phone. That way you can track from afar, and know whether your elderly someone has made it to, say, the dentist's office, or somehow boarded the wrong bus. Lotsa Helping Hands (lotsahelpinghands.com): Great website for anyone who's trying to coordinate a battalion of family and friends who will all be pitching in with various assignments. It's a free site, and caregivers set up a mem- bers-only community (you can invite whomever you choose). When there's a job that needs to be done, say, a ride to the doctor, or a trip to the grocery store, it's posted on the calendar and an email alert goes out to all the community members. Philips Lifeline (lifelinesys.com): One of the tried-and- true home-monitoring systems; provides basic but essential features for about $38 a month. If there's an emergency, users push the button on a necklace pendant or wristwatch, alerting the Lifeline call center. (AutoAlert option automat- ically places a call if it detects a fall.) An operator talks to the client through a speakerphone device to find out what's happening. If there's no answer, the call center contacts caregivers and emergency medical services. Don't try these, please: Tracking devices, worn around the wrist, or — worse — microchips, "it's like a dog; defi- nitely slips into the penal," says Boaz, who wholly disap- proves. Ditto on video cameras in the bedroom or bath- room. "Complete invasion of privacy." In the end, she says, "human contact is irreplaceable. I am not saying you need to move 500 miles to be close to mom or dad. There are other humans out there. What it takes it carefully thinking all this through."