This issue features:
Need help for poor bladder control? Dr. Deshpande discusses non-surgical techniques for treating female incontinence.
Bob Franklin found inspiration for a career in family medicine from his childhood doctor. Read more about CPC’s newest physician.
Are you sure what you know about the flu is accurate? Check out flu fallacies and facts from the Centers for Disease Control and Prevention.
Note: This article is the second half of a two-part feature on female incontinence.
Poor bladder control is a fairly common problem among women, but it is rarely one they are willing to live with. Fortunately, there are numerous treatment options available, including many that do not involve medications or surgery. The best treatment, however, depends on the cause of the problem.
According to Priya S. Deshpande, M.D., of CPC-Central, The type of problem a woman has is the key to directing treatment, so the decision about who should get what type of treatment comes down to a good medical evaluation. Usually the most effective treatment plan is one using a combination of treatments rather than a single approach.
Incontinence medications work in various ways, such as reducing contractions of an overactive bladder, relaxing muscles to improve bladder emptying, and tightening muscles at the bladder neck and urethra to prevent leakage. In hormone-deficient women, estrogen replacement is often prescribed to help the restore normal function to the muscles used in urination. Women should discuss the potential for side effects with their doctor prior to treatment.
Exercises help women control their bladder function by strengthening bladder and urethral muscles, Dr. Deshpande says, but learning how to target these muscles can be difficult because theyre inside the body. Biofeedback helps women learn how to isolate and effectively exercise the muscle groups that control urinary flow by providing visual and auditory feedback.
Bladder retraining uses biofeedback and scheduled voiding to treat retention incontinence and overactive bladder. Sometimes with retention incontinence, a woman does not sense when her bladder is full, while an overactive bladder signals the need to void before the bladder is actually full. Retraining is simply a matter of adjusting the bladder’s pattern of storing and emptying urine to be more in line with the physical need to void. For retention incontinence, retraining increases voiding frequency, Dr. Deshpande says, while overactive bladders are retrained to delay voiding until the bladder is full.
A pessary, a stiff ring designed to be inserted into the vagina, can be used to treat bladder control problems related to muscle laxity or prolapse in the vaginal area or a improperly angled urethra. When inserted, a pessary presses against the wall of the vagina and urethra, helping to reposition the urethra and lessen stress leakage. Pessaries support the bladder to help relieve retention and assist in voiding, Dr. Deshpande says.
Pelvic floor stimulation is used to treat both overactive bladder and retention incontinence through electrical stimulation of the nerves that supply the muscles regulating urinary flow. It works in the same way exercises do, by either relaxing or strengthening the muscles to achieve better control.
Changing dietary habits can also improve bladder control. The amount of fluids a woman drinks and her intake of bladder irritants can increase urinary frequency to a point where she needs to go all the time, Dr. Deshpande explains. Simply being more cautious about the amount and type of foods and liquids ingested can make a big difference. Common irritants include carbonated, caffeinated, and some uncaffeinated beverages; highly acidic, sugary, and spicy foods; artificial sweeteners, some herbal teas, alcohol, and chocolate.
Silicone injections treat stress incontinence by adding bulk and helping to narrow the urethra, Dr. Deshpande says. One potential problem with this approach is an allergic reaction to silicone, but the potential for allergic reactions can be easily determined prior to the procedure by a skin test.
Retention incontinence is the most difficult type of bladder control problem to treat. Self-catheterization, which uses a tube inserted through the urethra to drain urine from the bladder, is one method of treating retention caused by poor muscle tone, previous surgery, spinal cord injury, or chronic illness. According to Dr. Deshpande, however, it is less acceptable but can be used if a woman is willing to learn to self-catheterize to avoid wearing pads.
Surgery is an option for treating stress incontinence, but Dr. Deshpande does not consider it a good first-line therapy. She suggests trying other approaches first. “If the surgery is unsuccessful, other treatments may not work as well,” Dr. Deshpande says, often because of scar tissue. Another problem that can occur is overcorrection, in which the surgery eliminates stress incontinence but creates a retention problem, which is even harder to treat.
Dr. Deshpande stresses that one of the most important things a woman can do to keep incontinence from compromising her quality of life is to seek evaluation and treatment as soon as possible after a bladder control problem develops. The longer you wait, the harder it is to fix, she says.
To schedule an appointment with Dr. Deshpande for a thorough medical evaluation for incontinence, call CPC-Central at 868-7380.
Source: Urinary Incontinence in Women, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, US Department of Health and Human Services, Washington, DC, Publication No. 02-432, May 2002; patient education materials from the National Association for Continence, Spartanburg, SC, 2002.
When Bob Franklin was just a boy growing up in rural North Carolina, he learned early and first-hand the true measure of a dedicated family doctor.
The only child of Ray and Louise Franklin, Bob became very ill one evening with severe abdominal pain, a fever of 105-106, and shaking chills, but the family had no means of transportation to the hospital. On learning of his illness, their family doctor, Heywood Smith, M.D., came to their home at 11 p.m. to see what he could do for Bob. Fearing the child might have appendicitis, Dr. Smith drove him to the nearest hospital emergency room.
Bob recovered from this episode but was left with a lasting impression of his family doctor, who became a model and inspiration for Bob. After that, I thought it would be good to go into medicine, Dr. Franklin explains. It was inspiring to have a doctor who cared so much about my family.
Bob never wavered in his early decision to become a family doctor. The first step on this path was to pursue an undergraduate degree in chemistry at the University of North Carolina at Chapel Hill. Bob’s first priority was always education, but he also found time for diversions: intramural football and basketball, religious organizations such as Navigators and Intervarsity, and church activities, which he says have always been an important part of his life.
After college, Bob was offered one of only 15 scholarships from the North Carolina Board of Governors for students who wanted to become family physicians and work in North Carolina. The scholarship seemed tailor-made for Bob. I already wanted to be a family doctor like Dr. Smith, he says, and I had always intended to practice in North Carolina. So without a second thought, he accepted the scholarship and headed for Wake Forest University School of Medicine in Winston-Salem, N.C.
In early 1979 while in medical school, Bob met Mary Ellen, a physical therapist, at the hospital where she worked. When it came time for Bob to choose where he would like to do his internship and residency, Mary Ellen was a major consideration. In the matching process, during which a medical students preferred location for internship and residency is matched with available programs, Bob listed the University of Kentucky in Lexington because it is situated roughly halfway between her hometown in Indiana and his in North Carolina. I thought we would eventually marry, so my first choice was UK because I thought it would be more enticing for her to make that move, he explains. Fortunately, he matched with UK, and when the couple married in December of 1980, they settled in Lexington, where Bob would finish his medical education.
When Dr. Franklin finished his residency in 1983, Mary Ellen was working on her doctorate in exercise physiology. For the next two years, while she completed the program, Dr. Franklin was medical director of an urgent care and family practice center in Fort Wright, Ky., and as an emergency room physician at area hospitals. In 1985, Mary Ellen was offered a job in Greenville, N.C. While there, Dr. Franklin practiced with and eventually became a partner in Greenville Family Doctors. At the same time, he also was medical director of Stantonsburg Medical Clinic in Stantonsburg, N.C. During their 13 years in Greenville, the couple celebrated the birth of a daughter, Meryl, in 1986, and a son, Eric, four years later.
When the family had an opportunity to move to Augusta, where Mary Ellen would be an associate professor in the physical therapy department at the Medical College of Georgia, they were conflicted. We had strong feelings about moving because we liked Greenville and our work there, Dr. Franklin says. Leaving was one of the most difficult decisions weve ever made. When they did make the move to Augusta and settled in Columbia County, however, they found their new community much to their liking. The people here are nice, friendly, and easy to talk with, he explains. Theres a lot to do here and its a good place to raise children.
From the start, Dr. Franklin was interested in joining the Center for Primary Care, but since there was no opportunity available at the time, he worked in an urgent care and family practice at Medical Park in Sumter, S.C. During that time, he also worked part time on Saturdays for CPC, and later was offered a full-time position. In October 2002, Dr. Franklin joined the CPC medical staff as the fifth doctor at CPC-South.
Aside from the influence of his childhood family physician, Dr. Franklin has always been attracted to family medicine because of its variety, and he has found CPC to be a good fit for his medical philosophy. He enjoys caring for patients of all ages and meeting the full spectrum of their health care needs. I especially like caring for whole families and getting to know my patients, he says. Although he finds almost every aspect of family medicine intriguing, preventive health is one of Dr. Franklins primary interests. I like helping my patients understand what they can do to stay healthy because their well-being is very important to me, he says. My philosophy includes treating each one of my patients as I would my own mother. Cardiovascular health and occupational medicine are other aspects of family medicine Dr. Franklin particularly likes.
On a personal level, Dr. Franklin enjoys being a good family man more than anything. I spend lots of time with my children just being a dad, he says. He and his family also like traveling to beaches, cities, and the countryside, and engaging in cultural activities, such as visiting art museums. The main family-focused goal that he and Mary Ellen share, though, is raising their children and helping them become happy, successful adults.
Dr. Franklin brings to CPC breadth of experience as well as personal commitment to providing the best care for his patients. His gentle manner and his love of people and the privilege of caring for them is evident in all that he does, and he will surely be an asset to CPC
Make the most of your purchasing power this season by taking advantage of CPCs two-for-one special on microdermabrasion. From now until December 31, you can get two treatments for $100. Gift certificates, available at all 3 CPC offices, make wonderful holiday gifts. For more information, call CPC-Central at 868-7380, or read about microdermabrasion.
South Office Addition Completed
The South office of the Center for Primary Care has grown! Construction to add approximately 1200 square feet to the office on Windsor Spring Road began this summer and was completed this fall. According to Jim Larson, CPCs Vice President for Operations, the expansion is a response to the growing patient population, increased technology, and the addition of a fifth doctor, Robert C. Franklin, M.D., who joined the CPC-South medical staff in early October.
Supervised by construction manager Mickey Barefield, the addition includes two patient examination rooms, new office space for Dr. Edwin Scott and Dr. Keith Harden, two additional storage closets, and expansions to one of the nurses stations, the staff break room, the pharmaceutical sample storage area, and the technology room.
The expansion created an opportunity for cosmetic improvements as well. The windows in the waiting room were tripled in size to bring in more natural light, and new carpet and a copper roof were installed. The craftsman who installed the copper roof is one of very few in the Augusta area qualified to do the job. Some of the tools he used in the installation are over 100 years old, Mickey explains.
The physicians, staff, and patients of CPC-South carried on with their normal routine as much as possible during the construction, even though it was sometimes a challenge to work around the progress in progress. They had to put up with a lot of inconveniences during the construction but everyone was very cooperative and helpful, Mickey says.
Fallacies & facts
How much do you know about influenza and the vaccine that protects you against it? Are you sure everything you know is really true? According to the Centers for Disease Control and Prevention (CDC), some commonly accepted facts about influenza and the flu vaccine are really myths that might keep you from doing all you can to protect yourself and your loved ones from this potentially dangerous illness. Here are the most common:
Myth: The flu is nothing more than a bad cold.. Fact: Influenza is much more serious than a cold. It is a viral infection of the lungs that can lead to pneumonia and poses the greatest health threat to children under age 2 and adults over age 65. Over 114,000 people are hospitalized each year for complications of the flu, and over 20,000 die.
Myth: The shot can give you the flu. Fact: Because the influenza vaccine is made of dead viruses, it cannot cause you to have the flu.
Myth: The shot wont keep me from getting the flu. Fact: It is unlikely that a person who has had the vaccine will get the flu. However, the vaccine does not prevent you from getting other viral infections that have similar symptoms and make you feel like you have the flu.
Myth: Since the vaccine isnt 100% effective, theres no reason to take it. Fact: No vaccine is 100% effective, but if you do get the flu after taking the vaccine, you will probably be far less sick than you would have been without it.
Myth: Everyone should take the flu shot. Fact: The flu shot is recommended for most people, but anyone who is allergic to eggs (which are used in the vaccine), who has a very high fever, or who has previously had a serious reaction to the vaccine should not get a flu shot.
Myth: The side effects of the vaccine are worse than the flu itself. Fact: A sore arm is probably the worst side effect you will get from the flu vaccine Your risk of having a rare allergic reaction to the vaccine is much less than your risk of developing severe complications from the flu.
Myth: Only old, sick people need a flu shot. Fact: Most children and adults, even those in good health who are not at high risk for complications of the flu, should get the shot to help them stay healthy and to protect the people they live and work with.
Myth: December is too late to get a flu shot. Fact: You can get a flu shot either before or during flu season, which generally peaks between December and March. Although the best time is as early as possible between September and November, a flu shot in December will still protect you against this illness.
Myth: If I get the flu, theres nothing I can do about it. Fact: New prescription antiviral medications, such as Tamiflu and Relenza, can lessen the severity of influenza if taken within 48 hours of the first symptoms, and over-the-counter pain relief medications, such as Tylenol and Advil, will reduce muscles aches and fever associated with the flu.
The flu shot offers your best protection against this viral infection. Flu shots are available at all three CPC offices for $15. No appointment is necessary. If you have any concerns about whether the flu vaccine is right for you, talk with your family physician. Otherwise, dont delay. The earlier you get your flu shot, the longer you will be protected this season.
Source: Flu Season 2002-03: Flu Facts for Everyone. Department of Health and Human Services, Centers for Disease Control and Prevention, National Immunization Program, 2002: (website: http://www.cdc.gov/nip/Flu/).