Aging Dads: Incontinence Issues–Part 1 Older Men

incontinence-condition

Wanting to be inclusive, this follows last Saturday’s post about women’s incontinence and the New Guidelines for dealing with it. Interestingly, a current TV ad features a group of women mapping out where bathrooms are located, before presumably going out shopping–or for lunch. Then of course we hear about the product that will make that kind of planning unnecessary.

But what about men?

Although the high rise of incontinence is in women 75 and over, and the rise is less dramatic in men, incontinence–usually temporary (3-6 months)–is common following prostate surgery. Also as men age the sphincter muscle that controls urine outflow can weaken due to more and more years of use. Doctors recommend Kegel exercises for men (with varying degrees of success depending on different factors). I’ve selected informational links from what I consider reputable sources like Mayo Clinic, as this post is intended to provide some background information before speaking with a doctor if there are issues. It should not be construed as giving medical advice, however.

Links:
—Mayo Clinic has instructions for doing Kegel exercises: http://www.mayoclinic.org/healthy-living/mens-health/in-depth/kegel-exercises-for-men/art-20045074
—Webmd weighs in: http://www.webmd.com/urinary-incontinence-oab/kegel-exercises-treating-male-urinary-incontinence
—The NY Times blog also (July 2014)–Here it’s necessary to read to the end of the article to avoid missing important information: http://well.blogs.nytimes.com/2014/07/14/ pelvic-exercises-for-men-too/?_php=true&_type=blogs&_r=0

As we get older and dine out with friends, it’s not unusual to have men get up from the table to use the bathroom. It’s a part of aging. Enlarged prostate as well as prostate cancer become problematic for many older men. That’s why PSA monitoring is important– may be the equivalent of mammograms for women.

Everyone of a certain age (boomers and older) must know men who have had surgery for prostate cancer. Whether using the DaVinci method or the traditional method, there will be some degree of incontinence for a limited time. An acquaintance is living with the same incontinence situation (following successful prostate surgery for cancer) as the person in Harvard’s Health publication–Prostate Knowledge. He is currently debating the surgery, as was the man in this very good article http://www.harvardprostateknowledge.org/a-patients-story-overcoming-incontinence#an important read for any man contemplating prostate surgery or dealing with incontinence.

Included–as always–in the current US News‘ 2014-2015 survey are the best urology departments in the US. The top 4 (all scoring at least 91.2 to /100) are: Cleveland Clinic, Mayo Clinic-Rochester, Johns Hopkins and UCLA Medical Center respectively. This does not mean they have the best urologists for men’s incontinence; but it does mean these hospitals have excellent departments, if needed. Click for the list

We try to help parents age well. While incontinence is bothersome and embarrassing and isn’t usually an ordinary topic of conversation, understandings about it may prove helpful for many.

Related: Johns Hopkins yearly “Prostate Cancer “Discovery” 2015 issue, plus site with yearly back issues.

Note: “Newsworthy” (right sidebar). Links to timely information from outstanding research institutions–and some fun stuff–to help parents age well.

 

Aging Parents: Making Major Decisions–Think: Doctors, Life-saving/changing Surgery

How Do We Make the Best Choice?

We make many choices throughout our lives, granted some much more important than others. But how do we know we’re making a really good choice–or the best choice–when major health matters are involved?

I posted a few years ago a relative’s stage 3-4 colon cancer and efforts to get him to leave the comfort of his home town and go to Sloan-Kettering in NYC, where the country’s leading colon cancer surgeon was at the time. His heart (and wife) were urging stay home for the surgery. But a science researcher relative demanded he go to NY–regardless of disruption to his and his family’s routine and any other inconvenience.  Bottom line: Head ruled heart. His surgery at Sloan-Kettering was much lengthier–more complicated–than first imagined, but the team there was well equipped to handle it.  He lived to see his daughter married, the birth of his first grandchild–and he’s still alive today. A good choice. And his insurance took care of almost everything.

I think about the countless choices teenagers need to make during that period of their lives. As counselors we try to instill good decision-making skills so they know how to make good choices, and think twice when a strong pull towards “heart over head,” “a friend said…,” “everyone’s doing it,” I just don’t know how to decide” etc. become a reason or default reason for their choice.

Identifying then prioritizing options, along with the rationale for those options, is productive and instructive.  And when time is involved (ie. for surgery, rehabilitation, recuperation), doesn’t it make sense to get the most out of that time….meaning using the best health professional–because the “cure” involves the same amount of time–more or less– whether its results are very productive or barely productive. (Next finding out what medical insurance qualifies no doubt gets added to the  priorities/options mix.)

Choice of a surgeon after Sr. Advisor R broke her hip at age 97, was left up to her doctor. He selected one who had “good hands,” “could get in and out quickly” thereby reducing trauma and blood loss in an elderly person, which he thought extremely important. This meant “very experienced” which was a requirement for the surgeon and the physical therapists in the rehab center she was transferred to. (Result: she did great as you know from reading the broken hip posts.)

“Very experienced” and “an excellent success rate,” were the criteria when Dad underwent 5 bypasses many year ago. Bypass surgery was relatively new at the time and we learned (upon questioning) it was important that the surgeon did what amounted to a bypass a day (not counting weekends)–in other words, was doing this almost daily (at a time when only a small number of heart surgeons could make that claim).

The internet makes it possible to locate “the best.” And at leading medical centers (although probably not as warm and cozy as the hometown hospital) there may be residences provided for families while a loved one is having a procedure. (MD Anderson and Sloan-Kettering, for example, provide this.) Also check the US News Top Hospitals 2012-2013 in the Blogs and Sites I Like tab above.

How to find top hospitals? Using prostate cancer for the model, I googled:
1. “best prostate cancer hospital;” this site looked interesting: http://prostatecancerinfolink.net/2011/07/22/top-hospitals-for-cancer-and-for-urology/.
2.  I decided to follow Johns Hopkins: http://urology.jhu.edu and clicking “About Us” learned it was the #1 Cancer Center from 1991-2011
3.  I clicked this Johns Hopkins site, wanting more information: http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/prostate_cancer/prostate_multi_d_clinic.html.
4. And I remembered something about a Charlie Rose interview on prostate cancer so googled that and found this excellent, informative video of Charlie Rose interviewing a renowned Johns Hopkins surgeon: http://urology.jhu.edu/prostate/videoWalsh.php

While it takes time, feeling I had some command of what was involved by seeking “the best” was the best. I was no longer basically clueless and dependent on others because I wouldn’t even know the questions to ask. And asking the right questions can lead us to the best answers as we continue to help parents age well.

Related:
A long post (concerns various cancers), disconcerting at times, but very informative and worthwhile about “the best”– how to select them, when one definitely needs them, with statistical comparisons. http://www.thedailybeast.com/newsweek/2009/10/16/what-you-don-t-know-might-kill-you.htm