Tips for Seeing Your Physician

TRANSCRIPT

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers all available at NAFC.org.

This podcast is supported by our sponsor partner Medtronic, maker of InterStim systems for bladder and bowel control. To learn more about InterStim therapy, visit Talkleaks.com.

Welcome to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today is Steve Gregg, the executive director for the National Association for Continence. Welcome, Steve.

Steve Gregg: Thank you, Bruce. Good to be here.

Bruce Kassover: Thanks, Steve. Joining us again today is Dr. Kathleen Kobashi, a good friend of the podcast and chair of the Department of Urology at Houston Methodist Hospital and a specialist in women’s health and bladder control issues. Welcome, Dr. Kobashi. Thanks for joining us again.

Dr. Kobashi: Thanks so much. It’s a pleasure to be here.

Bruce Kassover: Excellent. Today we wanted to really focus on tips and strategies for patients when they come to see a urologist. What should patients do even before they come to see you to better prepare themselves for their appointment?

Dr. Kobashi: You know Bruce, that’s a great question. I think what would be really helpful if patients come in having thought about what really bothers them as far as their bladder control issues, like what type of situations do they find themselves in that that affect their quality of life?

What’s the sort of, if they’ve got leakage, what’s the character of their leakage, one thing that could be very helpful is if they keep a little record for a day or two about how often they’re going and how often they’re leaking and maybe how much fluid they’re drinking and what type of fluid they’re drinking.

If they don’t come in with that, we’re probably going to ask them to do it, but it sort of takes a couple of, gives us a little head start if they come in with that information.

Bruce Kassover: And so I’m going to do a little shameless plug then. If patients go to NAFC.org, they’ll find that there’s a bladder diary right there that they could download for free and use that to keep track of their symptoms, so thank you for mentioning that.

I’m sure that when patients come in, there’s a lot of nervousness, maybe discomfort about discussing some of their symptoms. What do you do to get patients to open to you?

Dr. Kobashi: Well, I mean, first and foremost, I want to, I tell them that they’re not alone. I’m happy that they’re sitting in my office.

I tell them, this is why I have a job. So, and it sort of lightens it up a little bit, but I mean, it’s true. The fact is that it’s a very common issue that millions of Americans are dealing with every day, and if it starts to get in the way of what you do every day, if you start to alter your lifestyle and it affects your quality of life in a negative way, then it’s absolutely worth getting out and talking to somebody about it.

And the urologists and urogynecologists and pelvic floor specialists can certainly offer some very successful treatment options that are not big surgeries or anything there, but there are a lot of things that can be done to help.

Bruce Kassover: I know that patients a lot of times are listeners and they tend, they can often be passive in the doctor patient relationship. They just sit there and answer your questions and wait for you to give guidance. And I’m wondering if you have some advice to help make patients more active participants in their own consultation.

Dr. Kobashi: That’s very important. Actually, these patients have to be not only active in the initial visits, but as you go through the treatment, things like a bladder diary or bladder training, which I think NAFC also has sort of educational materials.

But as they go through all of this journey, they have to be an active participant in order for it to be successful. Studies have clearly shown that that patients who understand the rationale behind their condition and their treatment are more satisfied with the outcome. Even if it’s not perfect, they understand, and I think, you know, that active participation and understanding the reasons why we’re doing the things that we’re doing to try to make things better somehow makes them more satisfied with their treatment outcomes.

Bruce Kassover: Makes perfect sense. Now, I know that in the medical community, some of the language they use when you talk about patients following up is compliance or adherence, which I think makes it sound a little like, you know, “You will comply!” But do you have any advice to help patients really stick with whatever the plan is?

Dr. Kobashi: Yeah. I mean, I think it’s, it is important to engage them and say, you’re, you know, we can’t do it without you. So we’ll, and we’ll go through this journey together. And so I think that just, the constant encouragement and then the reinforcement about the importance of their active attention to this and their active role is paramount.

However, on the other hand, there are some treatments that we’ve been utilizing for the last couple of decades now, and they’ve just become refined over the years where, where we actually tell patients, you know, when this becomes, when these treatments are successful, you can kind of forget about these things. You know, you can kind of go along your life, go about your life without having to worry about your bladder taking control. I mean, you’re in control.

So, yeah. You know, we really want to get patients to a place where they don’t have to be thinking about where the next bathroom is all the time, you know, so they can sort of forget about it and live a normal life. But, you know, but at the very beginning, you have to step off the line together, and that means physician and health care provider in lockstep with their patients.

Bruce Kassover: Now you talk about being encouraging, but I would imagine that when you consider how many different treatment options there are, and there, there is everything from, you know, from behavioral modification through medicines to surgery, that you don’t always see results as quickly as people would love to see them.

You know, you don’t, sometimes results are slow. Sometimes there are false starts and things that simply don’t work. What do you do when it comes to discouraging experiences? How do you get patients to continue along if they’ve tried things that haven’t been working for them?

Dr. Kobashi: Yeah, no, that’s a great point. And I think first and foremost, as you start the journey together, I think it’s important for them to have the big picture perspective. So we try to use friendly, non-intimidating language. And so I tell them, you know, we’re going to start with plan A. And plan A I call “the homework.” That is this bladder training program, you know, dietary modification, just simple things like that.

We may or may not add a medication. Some people want medication right off the bat. Some people will never want medication, but you know, so that’s sort of first and second line therapies. And I say, “If plan A doesn’t fly, there’s plan B, C, and D in no particular order. But there are three third line therapies which we can go into or not go into here, but there there’s plan B, C, and D in no particular order that are very successful if plan A doesn’t fly. And I don’t tell you this,” – this is what I say to my patients – “I don’t tell you this because I’m not optimistic that plan A is going to fly, but I don’t want you to get discouraged if it doesn’t fly. So, I’ll see you in four to six weeks and we’ll see how you’re doing. And then if we need to talk about plan B, C and D in more detail at that time.”

And, you know, oftentimes I will just do a quick description of what B, C and D are. It’s a pacemaker, it’s Botox injections in the bladder or a little, sort of, modern day acupuncture. There are three options that are very successful and they all have different pros and cons, but I tell them that early. So, you know, we used to give them a prescription and say, “Call me if it doesn’t work.”

And you would never see them again, right? Because there’s, they wouldn’t know there’s a reason to come back. Right. And they would just say, “Well, this is the way it is.” So I tell them that there’s a reason to come back if it doesn’t fly, right, and that that’s encouraging in-and-of-itself because I get a lot of patients who say, “Wow, I just thought there was nothing else to do.”

And, you know, so they feel like there’s some hope. We also have a little handout that’s got a bladder in the middle and it’s got stress incontinence and overactive bladder here. And so patients can see that there’s 2 different kinds of leakage. Every patient gets that. But I think it’s important for the patients to have an overall perspective that there’s different kinds of leakage, right? So if they’ve got a mixed picture and they’ve got a little bit of two types of leakage, then we’re going to have to do two different types of strategies to try to get their bladder under control. And so we’re not going to do both strategies at the same time.

We’re going to start with one and see what difference we make, you know, what effect we have. And then as necessary, we’ll add the other strategy. So it’s important, I think, for patients to, like, realize the reasons why they’re leaking so that they understand why we’re doing all these steps. Otherwise it just feels like this endless ride and there’s no logic to the next step.

Steve Gregg: One of the areas that we have been successful is educating people in bathroom habits. So two examples, one is when somebody contacts us around nocturia, nighttime voiding, and you ask them to record what they drink after five o’clock, you get to oftentimes, well, you know, three martinis at 10 o’clock are probably not helpful if you’re going to the bathroom a lot, you know, so that’s one place.

The other place that I was surprised to learn when I started at NAFC is trying to educate people how to actually void so that you sit on the toilet. Whether you’re a man or a woman, you void. When you’re finished, you count to three, you stand up, you sit down and you do it again. And if I think back to my advertising career, there were so many people who are so busy going from meeting to meeting to meeting.

And surely at the end of every day somebody would say, could we finish this meeting? Cause I haven’t peed since nine o’clock. You go, that’s not really a good idea. And it’s starting to learn what the pelvic floor does and proper pelvic health. And we’re seeing a lot of, a lot of encouragement in that space, particularly across the life cycle of a woman from pre childbirth, postpartum, midlife.

And then our now favorite topic, perimenopause and menopause, right? Are those issues that you sort of see as potential opportunities?

Dr. Kobashi: Yes. And I do see that’s, that’s a great point. I think what’s important is that we’re becoming a lot more, you know, attentive to these things, these behavioral habits and things that we do that we didn’t use to really pay attention to it.

I think with the work that’s being done, really looking at what the patient perception is, we’re really looking into more of these, the patient contribution to things, you know, like you’re talking about their voiding habits or, on the flip side, going just in case all the time, “I see a bathroom, I’m going to go just in case because I don’t want to get caught somewhere.”

And that’s not good either, because then the bladder is like a kid, right? It starts to get conditioned to go more than it needs to go. And so then I think if you could get into the habit of having your bladder feel like it’s always something that you’re paying attention to too much. So I think all of these things are ripe for more research and development to see what we can do, what, how we can utilize this new knowledge or this new sort of yet untapped field to contribute to our success in treating patients with bladder control issues.

Bruce Kassover: Excellent. So let’s end it on an optimistic note then rather than talking about what people can do and what people might do. Can you tell us a little bit about what people who follow their treatment plan can expect to see in terms of outcomes? What are we seeing today based on, you know, the current standard of care?

Dr. Kobashi: Well, I think we are really looking a lot more at what it is that results in patient success and patient satisfaction at patient perceived success.

So it’s really much more qualitative and much more subjective. Well, we would like to see a hundred percent dry. I mean, the reality is it may just be significantly improved and not a hundred percent dry that we, that we should be aiming for. But I think it’s making sure that we as the clinicians are on the same page as the patients. In other words, knowing what their goals are when we step off, right? Because if their goals are not aligned with what we can achieve with the treatment options we have available today, and we don’t square that away from the very beginning, we’re never really going to be successful, right? Because they’re reaching for a goal that may or may not be possible.

That being said, if we’re talking about stress incontinence, you know, success rates are upwards of 80% and pretty durable. We’ve also learned over the years that things are not going to last forever for everybody, but that it’s okay for us to top things off or to retreat.

And so that’s something we didn’t know several decades ago because we didn’t know if retreatment was going to be successful. And there just wasn’t enough of the work being done. From an overactive bladder standpoint, success rates, depending on what you, what you choose to do, as far as third line therapies are concerned, are going to be in the, you know, 70 to 90% success rate.

I mean, I think it’s very important for us to make sure our patients’ goals are aligned with what we can achieve with the technologies we have today, but what’s really encouraging is that we’ve come such a long way.

Bruce Kassover: That’s, that’s genuinely remarkable. I mean, when you consider the range of chronic conditions that are out there, if you’re talking about 70 to 90% relief rate, that’s got to be as good as people can expect in almost anything. I mean, it’s got to be exciting.

Dr. Kobashi: It’s almost too good to be true. It feels like, but I think, you know, just to be fair and transparent though, a lot of that comes down to how we define success, right? And we defined it differently before now. We really, we really lean on the patient. That’s the whole reason why we’re doing it is patient satisfaction and patient perception, so we’re paying more attention to that. And I think we’re doing better by the patient because of that these days.

Bruce Kassover: Outstanding. Well, thank you again, Dr. Kobashi, for joining us today. I really appreciate your insights and hope that patients can take them to heart and have the best possible experience when they next visit their urologist, so thank you.

Dr. Kobashi: Thank you so much for having me. It’s been a real delight. Thank you.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. This podcast was supported by our sponsor partner, Medtronic, makers of the InterStim systems for bladder and bowel control. To learn more about the InterStiim systems, visit controlleaks.com.

Our music is Rainbows by Kevin McLeod and can be found online at incompetech.com.

For more information about the National Association for Continence,  visit us at www.NAFC.org.

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Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
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