| Call it a shining example of a patient’s appreciation for her health care provider: After learning that years of suffering from a common and often misunderstood medical condition were about to end, an elderly woman presented nurse practitioner Helen Carcio with a diamond ring, and adamantly refused to take it back.“I’ve put it safely aside, because I expect this woman’s family might like it back at some point,” Carcio said, laughing. “But the gesture speaks volumes, don’t you think?”
Carcio had addressed and subsequently treated the woman’s problem with incontinence, an issue the patient had lived with for years, believing there was little she could do to alleviate her symptoms or the feeling of embarrassment and even shame that accompanied them.
Carcio said her generous patient is a good representation of most women suffering from varying degrees of incontinence; they feel there is nothing that can be done, they are too embarrassed to talk to their doctors about the problem, and often, they live with the condition far too long, becoming progressively more socially isolated.
Incontinence affects an estimated 17 million people nationwide, and, according to Carcio, that figure could be conservative. It remains one of the most vastly under-reported medical conditions in America today, and those variables, coupled with the various ways that incontinence can be treated, led Carcio and her business partner, fellow nurse practitioner Shali Sanders, to open the Health & Continence Institute in South Deerfield.
HCI is a health care facility devoted solely to treating patients experiencing incontinence, and to educating the health care community and the public at large on the subject, in hopes of mitigating the many stigmas associated with the problem.
Primarily a women’s health center (men with continence problems are typically referred to a urologist, although HCI will treat men as well), the facility is the only continence center of its kind in the area, filling a void locally that Carcio and Sanders say is only now being addressed on a national level.
HCI opened its doors in November, 2004, with Carcio and Sanders seeing patients two full days a week. Carcio said the center has already treated more than 600 women with various bladder conditions, employing largely conservative methods – only about 12 patients have been referred to surgery.
She said in most cases the center will exhaust natural methods, such as strengthening the muscles of the pelvic floor and making dietary adjustments, before suggesting medication or corrective procedures. That policy is in line with the center’s approach to its patients and their individual needs: addressing the whole issue of incontinence and only that issue, which Carcio and Sanders said allows them to provide focused, comprehensive care.
In addition, they stage regular seminars for the public to better educate them on the scope of the issue, and are also working to create a cohesive network between their center and the physician’s community of Western Mass., in order to accrue a greater number of referrals, but also to underscore the importance of sensitivity to incontinence, which, Carcio said, creates a major impact on quality of life.
“Women need to know that this is not just part of getting old, and they don’t have to ‘just live with it,’” she said.
Safe Harbor
Carcio and Sanders said that, as their careers progressed, they each found a professional niche in addressing incontinence in women. Sanders has worked extensively in OB/GYN, while Carcio works frequently with the elderly. Incontinence is largely exacerbated by pregnancy and age, however as Sanders and Carcio became more educated on the subject, they said they began to realize how pervasive the problem actually is.
“People talk about everything with their doctors, but they won’t talk about leaking,” Carcio said. “Women especially won’t seek help, because they think it must be a normal part of life that they have to deal with, or because they’re ashamed. Now, with the Baby Boomers aging and approaching the time in their lives when incontinence could be more of an issue, it’s more important than ever to get people talking about this.”
She added that there are a number of other reasons why incontinence goes unreported, and therefore untreated, for such a large number of women; they often feel they can handle the problem themselves, for instance, with incontinence products or by limiting their fluid intake. Others are afraid surgery is the only option, or that their incontinence is the result of cancer. Still others are fearful that they will be institutionalized.
“And a lot of doctors aren’t asking their patients if they are having problems with incontinence,” said Sanders, noting that raising awareness of the social impact of the issue among patients and physicians has become the hub of the HCI practice.
“We’re really trying to open this up,” she said. “And once you do, you see that incontinence is a Pandora’s Box, filled with physical, emotional, and social problems that need to be addressed. Doctors don’t always have the time to address all of those issues, but we have devoted our careers as NPs to doing just that. All we want is for doctors to ask: ‘Is this a problem for you?’ and then send them to us. We are a resource that can help people with all aspects of the issue.”
As part of their independent practice, Sanders and Carcio are currently involved in the creation of similar continence centers in the Northeast, and offer support and information for other NPs hoping to enter the field. HCI also hosts continence seminars on-site, but one of the most successful educational aspects of the center has been Carcio and Sanders’ visits to senior centers across the region to talk about incontinence and the options available for treatment, using a good balance of information and humor to broach a sensitive subject and bring information to a wider population.
“For a lot of people we meet, that is their first time talking about it – ever,” said Carcio. “We give them a safe space where asking questions is OK, and slowly, the hands start going up.”
Options, Options Everywhere …
She added that the educational component of HCI’s practice continues into a patient’s visit.
“A patient typically leaves the office much more aware of her own anatomy,” she said. “And as far as all of the non-invasive, conservative treatments we can try … most patients don’t know anything about those until they come in, and they’re surprised and happy.”
Carcio explained that there are two types of incontinence – stress incontinence and urgency incontinence – that sometimes occur simultaneously and in varying degrees of severity depending on the patient.
In short, every patient is different, she said, and requires a tailored treatment approach. To that end, women who are referred to HCI for treatment of incontinence are given an initial consultation that often lasts an hour or more – much longer than a standard visit to the doctor. The lengthy visit is meant to provide that education to the patient, but also to form a clear picture of the patient’s daily routines, habits, and to what extent incontinence has already affected her life. Carcio and Sanders will then determine what the best approach for treatment will be.
Once infection or cancer has been ruled out, nutritional adjustments are suggested – there are a number of foods and drinks that can irritate the bladder, such as coffee, tea, and caffeinated sodas, chocolate, alcohol, artificial sweeteners, and citrus. Often, patients will be asked to keep a ‘bladder diary’ for a few days.
“That tracks everything they eat and drink, when they go to the bathroom, and when they leak,” said Carcio.
Exercises such as Kegels to strengthen the muscles of the pelvic floor are also suggested, and Carcio and Sanders are careful to teach the appropriate way to perform the simple movement. To monitor a patient’s progress, HCI employs a sophisticated biofeedback system, which uses sensors to gauge the strength of those muscles, and also to record a patient’s progress over time.
“The goal is to bring awareness to that group of muscles,” said Carcio. “Anyone can strengthen them and improve. It may take four to six months, but there is usually a consistent improvement, and women realize that they’re getting better and better.”
In many cases, those nutritional adjustments and exercises to strengthen the pelvic floor are enough to substantially alleviate a patient’s problem with incontinence.
“We like to give every patient as many tools as possible to manage her problem,” Sanders said, adding that 85{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women with bladder problems will see their conditions improve or even disappear after the implementation of conservative methods. Even if the issue is more severe or advanced, there are still options before surgery becomes necessary, including the use of pessaries – small, flexible discs that, essentially, support the bladder.
About one in 12 women who visit HCI end up using a pessary; it was just such a device that prompted the unlikely gift of a diamond ring from one of Carcio’s patients. Others still may benefit from one of the many new drugs on the market geared toward incontinence.
“Big pharmaceutical companies are working feverishly on new meds,” Carcio said. “There are quite a few new ones, with fewer side-effects and better resolve. We do use them when we have to; they’re another spoke in the wheel.”
She added that the recent advertising campaigns of some of those companies are also drawing further attention to the problem.
“I think it’s becoming a more recognized thing now, and creating more awareness of the problem can only be a benefit,”
She noted that as awareness grows, referrals to HCI are slowly climbing, and a good level of respect is developing for the center among the Western Mass. health care community. “I think we are well thought of in the area. Two NPs on their own … that’s unheard of, but we’re plowing through, because people are forever in need of new avenues for help.”
A Decent Proposal
Operating their own business was, indeed, uncharted territory for Carcio and Sanders, but a move they say was the next logical step in their careers as incontinence awareness becomes more prevalent.
With all of the clinical and business terms these two entrepreneurs exchange these days, though, they always revert to success stories about their own patients: a woman who gleefully announced that she practices her Kegel exercises during church meetings, and no one is the wiser. Another who tearfully thanked Sanders and Carcio for allowing her the luxury of accepting an invitation for a square-dancing date; and, of course, the woman so happy with her results she took a diamond ring right off her finger and left it in the hands of someone she felt was most deserving.
“Now, women look for help with this problem and they find us,” said Carcio, the faithful keeper of that diamond heirloom. “We’re very proud of that.” |
