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009: Do you HAVE to see a specialist to treat your incontinence? A talk with Dr. Colin Goudelocke

Do you have to see a specialist if you have symptoms of incontinence? What can you do to get the most out of your appointment? Is it helpful or harmful to do your own research online? Today we talk with Dr. Colin Goudelocke, a board-certified urologist who specializes in female urology. He shares helpful insights for those who are just starting to seek care for their bladder issues and for those who may have been looking for support but who haven’t found satisfactory solutions yet. Listen to this episode of The Life Without Leaks podcast using the player below or check it out on Apple Podcastsiheart Radio, or Spotify.

Resources:

How To Talk To Your Doctor
NAFC’s Find A Doctor Tool
NAFC’s Overactive Bladder Resource Center

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

Welcome back to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today is Dr. Colin Goudelocke, who’s a urologist who specializes in female urology and he’s with Ochsner health center’s main campus in New Orleans. Welcome Dr. Goudelocke, how are you today? 

Dr. Goudelocke: I’m wonderful, Bruce, how are you doing?

Bruce Kassover: I am doing well also. And thank you for joining us. We really appreciate hearing the perspective of practicing physicians and specialists, and we’re looking forward to hearing what you have to say about the field of urology, particularly women’s urology and OAB. So maybe you could start off by telling us how did you get into urology in the first place?

Dr. Goudelocke: Well, I think probably a lot of that comes from the mentorship that I had through medical school. I had some really wonderful mentors who just happened to be urologists in terms of getting into female urology specifically, though, again, I think it was from the influence of mentors.

My area of urology combines a lot of areas that still, we still have a lot of unknowns. There’s a lot that we don’t know about. And so I had a natural curiosity about that area of medicine, and there’s still a lot of territory to be discovered. We’re also helping patients with disorders that are often ignored.

And I think that was something that was very attractive to me is that these patients oftentimes have disorders that we don’t talk about and don’t make it into conversation, and sometimes their providers don’t address them. And so being able to address some of those underserved needs, I think had a lot to do with it.

And then it’s challenging, and female urology, what we’re typically doing is restoring function. We’re not taking things out. We’re sort of building things back and that can be very challenging, but there’s a lot of reward in that challenges. So I think if you put all that together and then looking around with some of the other really wonderful people that we have in urology, you can imagine how that was just a really very attractive specialty.

Bruce Kassover: I can. And you already hinted on one of the things that I think we hear as a recurring theme when we speak to physicians is that it isn’t always easy to get patients to talk about a lot of the issues that they’re facing, that there’s a stigma associated with, it there’s a sense of embarrassment or just misunderstanding, people are often misinformed about urological issues. What is your sense of the general tenor of patients you see today, is there still a lot of that embarrassment in those, the reluctance to actually, come forward with what their problems are?

Dr. Goudelocke: I think you do see that there’s certainly changes. Sometimes it’s a generational change. Sometimes it’s a cultural change. But you know, I see patients that almost can’t even bring themselves to talk about these issues. It’s not something that they’re used to talking about, particularly in patients of an older generation. Maybe it was something they were raised that we really didn’t talk about.

So that’s a real challenge. Sometimes even when patients are in the office, they’re not necessarily comfortable talking about, frankly, some very intimate and very personal and very vulnerable issues. I do find some patients are more open and eventually even in those patients who are really reserved, it doesn’t really take long for them to open up.

And I think part of that is that when they come to see someone who really specializes in this area and really cares about issues of pelvic health, incontinence, we’re more than just listening to them, I think we’re really hearing them and for sometimes for these patients, sometimes this is the first time that they really do feel heard.

They know that I and my staff and everyone I work with, I mean, we generally care about these issues would kind of devote our lives to them. And they’re very important to us. And I hope that’s sort of conveyed to patients. I think they also see hope. As I’m sure you know, a lot of patients with pelvic health issues will sort of bounce around from provider to provider and never really get the advice that they’re seeking or sometimes don’t even get the diagnosis of what’s going on.

And so I think a lot of times for someone to come in and sit down in the office, Have someone that really wants to hear what they have to say, someone that generally cares about their issues and now has ideas about how we can take some steps forward. That hope, I think provides a lot of, a lot of the strength that they need to open up.

I can imagine one of the most frustrating things for someone must be to sort of finally get the courage to come into someone’s office and really open up and talk about these very intimate issues, but then not really have any solutions provided. And so we try to provide those solutions. We try to provide that hope. And I think that really does help patients to be able to open up in the office and talk about some very difficult issues. 

Bruce Kassover: And most of your patients are women?

Dr. Goudelocke: Not necessarily. I, certainly the majority of my patients are women. I am a, a female urologist, so the majority of patients are, but we have to remember that a lot of pelvic health issues are male issues as well.

So men have overactive bladder and as men age, their rates of overactive bladder approach, the same rates as women with overactive bladder; they never quite reach the same prevalence of overactive bladder, but certainly the numbers do come up. Men can have issues with incontinence, particularly after surgery, such as prostate cancer surgery.

So I see a lot of men with incontinence after prostatectomies, we call them, removal of the prostate, so I see a lot of post prostatectomy incontinence. So probably about 80% of all of the patients that I see are female, but about 20% of the patients that I see are male as well. 

Bruce Kassover: Do you find that women tend to be, or some women tend to be surprised that a urologist is the right specialist for them? Is there a sense that urology is typically a specialty that’s focused on men and women don’t necessarily realize that urologists have solutions for them also? 

Dr. Goudelocke: That’s such a common misconception, right? And I think, the population at large, we normally do think about, what does a urologist do? He sees men, he does exams on men. He treats the prostate, and notice I’m using the word, “He,” because historically many urologists were men. Thankfully that is starting to change. And then we see growing number of women who are urologists and who oftentimes are treating men as well. We do struggle sometimes I think to explain the role of female urology. I think there’s some advantages to having a urologist treat these disorders. Oftentimes, we can see things from a slightly different perspective, but it’s certainly a challenge to explain to patients about what is the role of urology in female pelvic dysfunction, and specifically, what is the role of a female urologist in pelvic female pelvic floor dysfunction. 

Bruce Kassover: So now with that in mind, what should a patient do before coming to see you so that they can on their end, make sure that they get the most out of their appointment?

Dr. Goudelocke: Probably the most valuable thing a patient can do is to educate themselves. So I have a website where we’ll, I will send my patients, both the ones that I have already seen and the ones we’re getting ready to see, to be educated about overactive bladder and urinary incontinence. And so a patient who’s been directed there and reads through that or watches videos, or does his or own her own research comes into that office visit in a really very different place. And I honestly say the differences between those patients who come in sort-of educated about what’s going on with them and those patients who maybe don’t have as much information about what’s going on, it’s night and day. And the ability of that patient to make decisions for herself and allow me to certainly, you know, express my opinion, express what I might do in the same situation, but, you know, “here are your options,” the ability for that patient to distinguish among the options that are best for her, all of that comes from patient education. And so one of the things that we try to do is before you even get there, we want you to know as much about the process, as much about the care pathway, as much about the disease, as much about the treatment options before you even make it into the door.

Bruce Kassover: Now, I know that getting information from a site like yours or the NAFC’s website, at NAFC.org, where they have an enormous amount of information that’s also up-to-date and science- and evidence-based, would have to be helpful. But do you also have issues with people who go and find all sorts of misinformation online and, you know, they’re educated by Dr. Google and don’t necessarily come with the, a good sense of what may be in store for them from a treatment perspective?

Dr. Goudelocke: It can certainly be a challenge. I never like to, sort of, discourage patient information. And oftentimes patients will come in and say, “you know, I’m really, I’m really sorry. I Googled this ahead of time.”

And I say, “that’s, that’s fantastic, that’s wonderful!” You know, I want you to be as involved in this process as I am. I need for you to be as involved in this process. But it is a challenge, and you’re right, thankfully we do have, you know, really reliable information, but directing those patients, that information can sometimes be a challenge.

We solve it in our case by, you know, we have little, little cards that we can give to patients that direct them to resources that we think are very responsible and are both science-based but also very patient-centered and patient-oriented and have good patient representation. As you’ve mentioned, the NAFC website is a phenomenal example of that, but it is a real challenge.

And I do spend a little bit of my time sometimes dispelling myths that patients may have may have encountered on the internet, but I think that’s a fair trade off. I’m willing to spend an extra few minutes to sort of explain to a patient why a myth they may have seen on a website may not exactly be true simply because I never want to discourage patients from educating themselves and just to play devil’s advocate.

Listen, I’ve had patients come in and, and tell me things that they read about or things that they saw online or something like that, that sounded completely off the wall to me. But I went and did my own research and found out, you know, what, there’s actually some new study or new paper or a new finding that supports that.

So really sometimes those patients come in with things that, to me might sound a little out there or a little, a little misguided, but when I actually go and look, it turns out the patient has educated me, and I’m really appreciative of that. So sometimes it’s not such a bad thing. 

Bruce Kassover: I suppose the openness to new information is always a sign of a good physician. You know, you’re, you’re not going to be stuck in your ways. Do you happen to have a greatest hits of some of the biggest myths that you, that you tend to hear? 

Dr. Goudelocke: Wow. I think probably the biggest myth or the biggest problem that we run into, and it’s probably not so much put out there by the internet and by website, it’s actually something that that’s probably spread mostly by providers. And it’s this idea that overactive bladder or frequent urination or urinary incontinence is just a normal part of getting older. Right? So if I’m a woman and I just turned 60 or just turned 70 or just pick whatever age that you want, well, this is just a normal part of that.

That’s a real dangerous myth for a couple of reasons. Number one, it shuts patients down. You can imagine, if I feel very vulnerable about talking about this or, or again, it’s sort of an intimate subject and I actually get the courage to bring it up to a provider and I’m sort of shut down by saying, oh, that’s just part of being a woman.

It’s part of being older. You know, imagine what that says to you and, and imagine how unlikely I am to bring it up in the future or to another provider or how unlikely I am to to seek additional care. I’m always, you know, there are a lot of things that become more common as we get older. Heart attacks are more common as we get older, but you can’t imagine going into your provider’s office and saying, “oh, I think I might be having a heart attack,” and they’d say that’s just a normal part of getting older. Because something is more common doesn’t mean that it’s normal or that we don’t do something about it. So that I think that’s a myth is that these problems are, open quote, normal, close quote. And they’re just something that people have to deal with and that’s not true.

And I think it’s a big obstacle for a lot of people to seeking the care that could actually make them better. 

Bruce Kassover: You know, one of the things we’re seeing a lot of are patients who seem to be stuck at primary care and fewer of them are going to specialists, but there’s a concern that primary care may not always be equipped to deal with these issues. Is that something you’re seeing? And if so, how do we address that? 

Dr. Goudelocke: That’s a fantastic question, and I think the question itself actually speaks to what I think is one of the greatest challenges that we have in pelvic health. And it’s the idea that someone would need to get to a specialist like me or any of the wonderful colleagues I have across the country, that someone would need to get to a specialist in order to have their incontinence addressed.

I think that may be the greatest challenge that we have in pelvic health. And, and let me give you the reason I think why. I don’t know how many, the exact number of people that I would consider pelvic health experts around the country, but I know at most it’s in the low thousands. So if we just look at a disease like overactive bladder, there are about, depends on the, on the statistic, depends on the paper that you look at, but somewhere in the range of about 37 to 48 million adults in this country who have overactive bladder, that’s just in the United States. So just some quick math would tell you that 48 million divided by a couple of thousand is a really, really big number.

Just another example: I can count on two hands the number of female, pelvic medicine certified urologists in Louisiana, the whole state of Louisiana, two hands. And so the issue becomes if we’re relying on someone like me to treat all of these patients, we are never really going to make a dent in the problem.

There are issues with access. There are issues with geography. So of those nine or 10 female urologists in the state of Louisiana, you can imagine they’re also all concentrated in population centers. So someone in a rural part of Louisiana is going to have a lot of trouble driving three or four hours to see that specialist.

I would argue that what we really need to do is more effectively empower and more effectively enlist these frontline providers, our primary care physicians, our OB GYNs, so that they’re actually able to provide the care. I’m of the opinion that overactive bladder is a primary care disease, meaning the vast majority of patients can be very effectively treated by a primary care physician that would be close to home, and that would be easily accessible that they’re probably already seeing on a regular basis to treat high blood pressure diabetes and those sorts of things. 

So I think we need to look at what are the obstacles and what are the barriers that primary care physicians and OB GYNs, what are the barriers that they have to effectively treating overactive bladder so that we can make sure we can start to address these problems in millions of people and then sort of sort out those people that really do need to see a specialist in order to get, you know, an advanced therapy, as we might call it, for overactive bladder. 

Bruce Kassover: You know, one thing related to this, you’ve also mentioned a little bit earlier about the care continuum. Maybe you want to tell us what that care continuum is and what it looks like to a patient. 

Dr. Goudelocke: Sure, so in general, I think a care continuum refers to the fact that there are a lot of different options for treatments of overactive bladder. Some of them are very what, we would say, noninvasive. So a behavioral therapy like avoiding bladder irritants, caffeine, alcohol, acidic foods and beverages, that sort of thing. There’s not a lot of cost from that. And I don’t mean necessarily just a financial cost, but there’re not a lot of side effects, there’s really no risk, and those sorts of things are known as behavioral therapies. 

We have some other types of therapies if you want to look at the other, into the spectrum where we’re implanting devices into patients or injecting medications into a patient’s bladder. Those are obviously associated with greater costs again, to some degree financial costs, but also costs to the patient in terms of risk and side effects and those sorts of things.

So that all, all of these therapy options exist on sort of a care continuum where some therapies are going to be more appropriate for some patients and some therapies are going to be more appropriate for other patients. Generally we approach these therapies in kind of a step-wise fashion. So those therapies that are less invasive, less costly, have fewer side effects. We’re going to try those first. And those therapies that have greater, cause greater side effects, greater risks, we’re going to approach those later on as second line or third line therapies is what we actually call them. That care continuum is sometimes represented as something called a “care pathway.”

And so care pathway is sort of the steps that patients take among those different treatment options. And a lot of times we like to represent that care pathway as a roadmap. And I’ve done illustrations for my patients where it literally looks like a roadmap where there’s a road and sort of step one is behavioral therapy, and step two are medications that they might take by mouth, and step three are devices that we might implant our medications that we might inject into the bladder. I actually think it’s really helpful and really useful for patients to understand the big picture, for patients to know what the care continuum is, for patients to know what their roadmap looks like.

I think it reduces the frustration levels of patients. If someone is not improving with one of the early therapies, They know that there are other therapies out there that are available to them. It also makes sense when you understand that the third line therapies are more invasive and they have more side effects, it makes sense why you might stick with some of the early therapies first.

And so I think it improves patients’ adherence to therapy. And then finally, I think one of the most important things is coming back to that idea about respect for patients. It seems preposterous to me to imagine asking a patient to sort of blindly following my direction, “I want you to take this medication because I’m the doctor and I said so.” That’s just not a very responsible approach to patient care. I think if patients sort of understand where medications fit in that continuum, they’re much more likely to follow those directions because they understand the reasoning behind it. And then quite simply, it’s just more respectful of the patient and their autonomy.

Bruce Kassover: You find that patients are surprised by how many different treatment options that are available to them? 

Dr. Goudelocke: Yes. I think it’s exhausting to them. Actually, I think it’s exhausting to me when I sit down and explain it to them. That’s why, that’s why I created a patient education website because I found we were spending sometimes 30 and 40 minutes just, just explaining the options to patient. But it’s good and bad, right? As a, as a care provider, I want as many tools in the toolbox as possible. I want to have as many different options for you. I’m sure you’ve heard the saying, “if, if all you have is a hammer, everything looks like a nail.” Well, I want a hammer and I want a screwdriver. I want a wrench. I want all these things so that I can tailor the treatment to the patient rather than tailoring the patient to the treatment. But it can be really exhausting. It can be really daunting to understand where all of these treatment options fit in. And that’s where I think education becomes so important.

That’s why I want patients to kind of know what all, a little bit about all of the treatment options are before they even come in to talk with me, because then rather than me sitting down and sort of explaining everything from scratch, it’s them asking me questions. “Hey, I read a little bit about this injection therapy, but I have some concerns about that. Can you tell me a little bit more?” And that’s why that educated patient comes in and has a much more beneficial visit, a much more efficient visit for them, and they’re better able to navigate those choices. 

Bruce Kassover: Do you find that there’s some resistance to choosing things like the injection therapy or some of the implants and things of that nature?

Dr. Goudelocke: I find that it depends. And if you’re asking, is, are, do patients have resistance to moving on to those more invasive therapies? You definitely, you definitely see that, you know, overactive bladder, urinary incontinence, pelvic health disorders, they’re very interesting in that, ultimately, what matters is the patient’s bother.

If I was treating bladder cancer or prostate cancer or something like that, I mean, the patient’s opinion certainly matters in what treatment options they want. You know, what side effects they’re willing to tolerate, all those sorts of things. But when you’re dealing with something like bladder cancer or prostate cancer, ultimately the cancer doesn’t care about your opinion.

It’s going to grow or not grow. It’s going to be cured or not cured, and how we feel about it doesn’t really alter that. When you’re talking about pelvic health and pelvic dysfunction, it’s really the opposite. The only thing that matters is the patient’s bother. So if you have a patient who comes in with relatively low bother, she might be willing to make some lifestyle changes.

She may be willing to cut down from three cups of coffee a day to one cup of coffee a day. She may be willing to do some pelvic floor exercises. She may be willing to do timed voiding. She might even be willing to take a medication, but maybe she isn’t willing to move on to an advanced therapy that might require a trip to the operating room.

And that’s okay. That’s fine. That’s actually how it should be. Our treatment and what treatments we offer, what treatments we pursue, should always be centered on that patient bother. And sometimes with a low bother patient, they’re not going to want to go down that kind of a path. However, I see patients every day and it may be because of what I do and because I’m a specialist in this area, I tend to see the worst of the worst of the worst. But my patients who come in and they’re leaking into 10 pads per day, they have a high, high degree of bother, right? These are not just life altering, but really debilitating disorders that patients have. And they feel like they can’t leave the house and, and really, it just changes their lives and oftentimes takes away the things that, really, we enjoy most in life.

So for those patients with a high degree of bother, they really are willing to do more invasive therapies if they need to. The good news is that a lot of the innovations that we’re making today, a lot of the innovations that I work on in in my research and in clinical trials that we run, are actually toward some of these, what we now call advanced therapies, actually making them a lot easier on patients, making them less invasive, making them office-based instead of operating room-based or sometimes even home-based instead of operating room-based. So as we innovate, as we evolve, I think we’re evolving to therapies that patients are going to find much more tolerable.

Bruce Kassover: I suppose a natural extension of what you’re talking about is to ask outcomes. So with all of these different choices and with new innovations coming on, when a patient comes to see you, how do you talk with them about outcomes and what sort of outcomes can patients realistically expect to see with the standard of care today?

Dr. Goudelocke: What do patients really mean when we talk about better? So it, it always starts from that patient centric, patient dependent area, right? Your bother is all that matters. And we are done treating you when you think we’re done treating you. So once we start from that premise, I do think that it, it becomes important to give patients realistic expectations in a couple of areas.

Number one is that in, in my experience, it’s rare that a single modality of therapy is all that it takes, whether it’s a pill, whether it’s an injection, whether it’s a device that we’re using or device that we’re implanting, it’s typically more effective for us to use multiple treatments. Now that treatment might be a medication that you take by mouth and some pelvic floor exercises that you do at home.

That treatment might be a medication that I inject into your bladder, but we’re also going to moderate the amount of caffeine or moderate the amount of alcohol or moderate the acidic foods and beverages that we’re taking. Sometimes we’re combining behavioral therapies with other either medication therapies or more invasive therapies.

So I think it’s really important that patients understand you might call it a “multimodal approach,” that we wanna bring more than one treatment to bear on this problem. So often what happens is we talked about that care continuum. I talked a little bit about this pathway, this sort of step-by-step, step one we do behavioral therapies. Step two, we take medication. Step three, we do surgical therapy. And oftentimes when we move on to those steps, we forget about what we did in step one. So maybe I moderated my caffeine intake and I went from urinating 20 times a day to 12 times a day. Well, a lot of people aren’t going to be satisfied with that and they may want to move on and take a medication, and that’s great. But don’t forget that the moderation of that caffeine decreased the number of times you went to the bathroom by eight times a day. So we don’t start to take the pill and go back to drinking six cups of coffee a day. We want to build on that, right? So we made some progress with behavioral therapy, and now we’re going to make some progress with medication. Or we made some, some progress with behavioral therapy, and now we may do an injection into the bladder or we may treat you with a device, and we’re gonna build on that and bring those two therapies together. So I think that’s a really important expectation for patients. 

And lastly, and the thing that I struggle with most is that there are a lot of patients that we make much, much better, but they still have some frequency, some urgency, or even some, some urinary incontinence. And that can be a real struggle. It’s a struggle for me. I’m, I’m a perfectionist. I think a lot of the best healthcare providers maybe are perfectionists, and we want everything to be perfect, and sometimes we don’t quite get there and, and I think that’s a real frustration for me, it’s a frustration for patients, and I try to address that early on if we can. 

Bruce Kassover: I did want to ask you about one other big barrier, potential barrier to successful treatment and that’s insurance. Do you have any sense of whether insurance represents a barrier for some of the people that you either see or don’t see, because there’s an insurance issue?

Dr. Goudelocke: It can be, it’s certainly something, the more you do this, the more that you learn to negotiate some of those obstacles, you learn, particularly when we move on to some of the surgical therapies, listen, a lot of times insurance companies are just trying to make sure that we’re using an effective therapy in the right patient. They want to make sure that we’re doing the right surgery in the right patient. They might have a selfish motive to do so, but ultimately the goal is still the same: To get the right effective therapy to the patient. And so knowing how to communicate that to a patient, so if I’m doing. there’s a type of therapy that we do where we essentially do a test first, so it’s really important that we establish the baseline symptoms of that patient. So maybe she’s urinating 20 times a day. Maybe she’s leaking five times a day. It’s really important that we establish that baseline so that we can do this test and show that she has the requisite improvement, right?

Because if she’s not improved by that test, we don’t wantto go on with the therapy. The insurance company doesn’t want to pay for it. The patient certainly doesn’t want to do a therapy that’s not helping her. She wants to move on to something that’s going to be more effective. I also find that sometimes we as providers can introduce some of these obstacles and medication therapy, I think, is a perfect example of that.

We have lots and lots of overactive bladder medications and they all, they have their pluses and they have their minuses, but we don’t have a lot of sense of one medication being particularly better than the other. And most patients have what’s called an “insurance formulary,” a list of medications that your insurance company prefers, that you use. And of course they show that preference by making the medication less expensive, by making your copay less expensive. And it’s usually going to be just some of those medications. Well, if I, as a provider, just sort of blindly write a prescription, someone comes in, so I write medication A because I always write medication A, but medication B is on the patient’s formulary, that’s going to be incredibly frustrating to the patient. That’s not really the insurance company’s fault. It’s kind of my fault for not checking that ahead of time. One of the advantages, we have an overactive bladder navigator, and this is someone whose job, her sole job is to sort of help patients navigate these obstacles.

But one of the things that she does is, is before the patient even comes to see me, when, when I bring that patient up on my computer screen, right before I go to see her, I have a list of her medications and, of overactive bladder medications, and what her copay is going to be, or at least what we estimate her copay is going to be for each of those medications.

So my goal is not to write the medication. That’s going to be $347, but to write the medication, that’s going to be $35 as long as it’s appropriate for that patient. So sometimes these insurance obstacles, we can provide the insurance companies what they’re actually wanting, the information that they want in a timely manner.

And sometimes we can sort of navigate this system ourselves, or at least help our patients to navigate this system by working within the confines of their, of their insurance plan.

Bruce Kassover: On the whole it sounds really encouraging. I’m wondering, is there anything else – we’ve covered a lot of ground now – is there anything else that we, that you’d like patients to know that we might not have discussed? 

Dr. Goudelocke: You know, I think that what really gets to me, tugs at my heartstrings, what, whatever you might say, is when someone comes to see me and we start talking about what’s going on with her incontinence, what’s going on with her overactive bladder, how it has dramatically shrunk her world down, right, so she doesn’t feel like she can leave the house. And then I’ll always ask the question, it’s important, is “so how long has this been going on?” And she’ll reply, “three years, five years, seven years.” And you know, what have, what’s been done? What have you had done? To help with this over those three or five or seven years.

And a lot of times the question is nothing and it, it really gets to me because those are lost years. There’s a lot of times a lot that we can do for these men and women, and I just feel like we are not doing a good enough job communicating. I think. Resources like this, like this podcast. That’s why I was so excited to participate in this because I think this is a wonderful resource to get out there.

It always reminds me, Fred Rogers, Mr. Rogers, from public television, he once said a quote, always sticks with me. He says, “Anything that is human is mentionable, and anything that is mentionable is more manageable.” And that quote always sticks with me. When I think about how we approach patients and how we approach education and how we approach community outreach, is that we need to make these problems more mentionable because when they’re more mentionable patients are able to manage them.

Bruce Kassover: Well, I would imagine that the biggest reward is when you actually see patients have meaningful improvements that take them from having something that truly is debilitating to, you know, giving them their lives back. 

Dr. Goudelocke: I think you’re right. It, for me, the, the ultimate reward with this, for this is, and for my profession is the patients that I see every day, the patients that I saw a few minutes before we started this and the patients I’ll see a few minutes after, and there’s a huge reward in that people come into my office and they talk to me about the most intimate details of their lives. They make themselves incredibly vulnerable. I think that’s an amazing privilege that I’m given.

And to be able to have that positive effect, as I said, sometimes we, sometimes patients are made whole, sometimes we’re able to really get patients back to where they’re able to live their lives as if they have no problems. Other times we’re able to make significant improvement. And I think we have to celebrate those improvements. But when a patient comes back and they’re able to tell me the things that they do, I get a little teary every time I think about it, but, I have a, I had a lady that came to see me and we started talking about what are her goals? What does she want to do? What, why is treating her incontinence so important to her? And she simply said, I want to go to my granddaughter’s high school graduation. Right? So the idea of her being able to sit in an auditorium and watch her granddaughter walk across that stage, it’s just not something she could conceive of with her current condition. And by treating her overactive bladder, by treating her incontinence, we were able to give her that gift. And for me, I don’t think there’s anything I could do that would be more rewarding. 

Bruce Kassover: Well, Dr. Goudelocke, I really want to thank you for taking the time to speak with us today. We really appreciate all of the efforts that you’ve been putting with your patients and definitely appreciate your taking the time to share your perspective with us, so thank you. 

Dr. Goudelocke: Well, thank you so much for the opportunity and please continue the wonderful work that all of you at NAFC have been doing for many years. 

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 intersystem systems for bladder and bowel control. To learn more about the intersystem systems, visit controlleaks.com. Our music is rainbows by Kevin McLeod and can be found online at incompetech.com.

Music: Rainbows Kevin MacLeod (incompetech.com)
 Licensed under Creative Commons: By Attribution 3.0 License
 http://creativecommons.org/licenses/by/3.0/

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