Guest Post: Why Peeing Our Pants Should be Looked at Like a Sprained Ankle

AmandaGuest post by Amanda Fisher, DPT, Owner/ Physical Therapist at Empower Your Pelvis.

Up until I had children, peeing my pants was something I was fearful of doing. I did not want to be the kid in P.E. at school who peed her pants when hitting the volleyball, I did not want to wet the bed at my besties sleepover and especially did not want to pee my pants while running or being tickled. But I did.

I remember peeing my pants when I was 21 (in physical therapy school) while running. At the time, I was learning how the musculoskeletal system works and the fact that strong individuals were peeing their pants did not make sense to me. So I began specializing in pelvic floor physical therapy to learn more about what was going on.

After I graduated, I was working with teenage girls who were competing in gymnastics, cheerleading or playing other sports who were also peeing their pants and they had not had children yet. It started making sense to me, that something was going on with the pelvic floor muscles and the rest of the body, and it did not always happen after childbirth.

Pelvic Floor Muscles

Our pelvic floor muscles are our muscles inside the pelvis and they are a part of our “core”. When they work properly, we are able to stop the flow of urine, hold back gas, keep fluids in and let fluids out when we tell them it’s time, have orgasms, pain free intercourse, and our organs are supported by the muscles and not falling into our vaginal canal (pelvic organ prolapse).

Pelvic Floor MusclesWhen dysfunction begins happening, some part of the system is not working well. It could be the pelvic floor muscles (their strength, endurance, how they contract and relax or range of motion) how they connect with your breath, or compensations that are made with poor body mechanics. For instance, our pelvic floor lengthens when we squat down to the floor or to sit in a chair and then it contracts as you move from sitting to standing. If we spend a lot of our time bending at the waist to pick things up off the ground instead of squatting down to get it, our pelvic floor starts to not work the way we need it to. We may begin compensating with our back muscles instead.

The pelvic floor muscles stay tight when we bend at the waist and if we do this often, it can learn to be in a shortened range of motion. Then when you need it to fire so you don’t pee your pants with coughing/ sneezing/ exercising, it is not moving well and will most likely cause you to wet your pants.

Getting Treatment

Just like any other injury or dysfunction (sprained ankle, low back pain, etc.) you would most likely see a physical therapist to help you restore your function.

If you are noticing you are peeing your pants, even once a month, you should see a pelvic floor physical therapist to help assess your dysfunction and get you on the road to recovery. We are specialized in this area and love helping men and women restore their function and get them back to doing what they love.

We look at how your body is moving through activities, look at the strength, endurance and range of motion of the pelvic floor muscles and see how it is all coordinating with movement. Our goal is to get you back to doing what you love or functioning well while keeping your pants dry. Listen to your body this year, and know that peeing your pants is NOT normal.. but it is common.

Morgan and I at Empower Your Pelvis, pelvic floor physical therapy, want to help you keep your pants dry this year! Please feel free to email us if you have any questions: amanda@empoweryourpelvis.com.

Amanda and Morgan

 

Blood donation. You can save a life!

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group.

Donating blood is something that my family has always done and felt was important. I grew up with my parents working in EMS and helping out in the school health room. I’ve been around healthcare literally my entire life.

As soon as I was old enough to donate blood, I knew it was something that I wanted to do REGULARLY. I hate needles, but one little stick is all I have to endure to literally help save a patient’s life. I decided that was the least I can do to help my community. I pray that someone would donate for me if I needed it at some point, therefore I should help others.

Blood Donation - Cindy and Carol

Let me introduce you to my mother, Carol.

Carol's Blood Donation Milestone PinsCarol is a patient here at LSPG, and with her permission, I would like to brag on her. She has donated 12 gallons of blood over her lifetime and is currently working on #13. That means she has donated blood at least 96 times! She has gone to every traveling community blood bank collection that has ever come to our hometown and now regularly goes to a donation center to give as often as they allow her to.

When I asked her how she got started donating blood, she said, “The first time I gave blood was at Western Electric where I was working. I was around 20. Then I was a health room volunteer at school and we helped on the blood drives here in town. This is what started me giving a semi-regular basis.”

Then I asked her why she donates and she said, “I knew there was a need and I wanted to help. It doesn’t bother me at all to give, and I get to help someone else. I’ve also given double reds and plasma a few times.”

Donating blood is voluntary and it helps people in local hospitals and trauma facilities.

You can donate blood every 8 weeks. You must be 17 (or 16 with parent consent) and weigh at least 110 lbs. You must be feeling well. Make sure you drink plenty/extra non-caffeinated drinks 24 hours prior to donation or at least the morning before donation. And bring your photo ID with you.

The process of donating blood is pretty simple. You can walk in or schedule an apt. They ask you a series of personal health questions and ask about any foreign travel, then do a quick vital sign assessment and prick your finger to make sure you are eligible to donate. After that, you lay back and relax on a bed while they prep your arm then collect the blood. Afterward you get a snack! (that’s my favorite part – Nutter Butters!)

They run tests on every pint of blood that is donated and notify you if they detect a concern like hepatitis or HIV. Sometimes they run promotions that they do free cholesterol screens on your blood as well, so you get a benefit of not having to pay for that at the doctor’s office on your annual physical. Sometimes organizations like the Royals give free tickets or discounts for donating blood as a thank you for supporting our community.

I can’t think of a better gift than the gift of life. Please consider donating to help others and potentially someone you love!

For more information, check out your community blood center or the American Red Cross.

Risk of falling increases as we get older. Prepare yourself and your loved ones.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group.

Falling risks increase as we get olderWinter is upon us, and the ER nurse in me thinks of all the falls and how busy the ortho offices are during this season of the year.

Falls are the leading cause of trauma and poor health outcomes in older age. Falls have potential to cause large bone breaks like hip/thigh and complicated fractures in the spine. There are two areas that need to be addressed when discussing this topic.

1. How to prevent falls
2. How to prevent bone thinning (osteopenia or osteoporosis) that increase risks of fractures/breaks.

Lets talk about how to prevent falls first.

Falls can be from tripping over objects or from being unsteady on your feet. Tripping over throw rugs, small animals, and shoes that had been taken off and not placed out of the way are among the most common causes of falls/tripping.

Medicare recommends that all areas of the house need to be well lit, no throw rugs to get shoes or toes caught on and grab bars in the bathroom to help prevent falls. Being unsteady on your feet can be prevented by changing positions slowly and waiting after changing position before taking a first step.

Hydrating well is important also to prevent falls from dehydration and to keep organs functioning well. This means limiting or avoiding caffeine to stay well hydrated. Caffeine actually pulls water from your body and dehydrates you.

Having strong muscles because of daily physical activity or exercise is important to prevent falls and to help maintain balance. Yoga is an excellent way to strengthen muscles and to help with balance and stretching. See my previous blog on daily activity for further info on this topic.

If you have a fall, talk with your healthcare provider. Some medications can increase fall risk. Sometimes medication choices can be changed and minimize the chance of falls in future.

Prevent bone thinning

Falling risks increase as we get olderOsteoporosis, the thinning of bones, and osteopenia (pre-osteoporosis) can be prevented by weight bearing exercises regularly. Running, aerobics, walking briskly, jumping jacks, and fast pace dancing are good examples of helpful exercise. Also, getting enough calcium and vitamin D3 is important. UpToDate resources says that 1,200 mg of calcium and 800 IU of vitamin D3 is needed daily to help prevent osteoporosis. This can be through food intake, supplements, or a combination of both. Smoking cessation and avoidance of heavy alcohol use is important to prevent bone loss as well.

To determine if you have osteoporosis or osteopenia, you will need a bone density scan ordered by your provider. The prevention of bone loss can be implemented on your own without a provider’s order however… Talk with your provider if you have risk factors such as a broken bone as an adult, long term steroid use, long term smoker, low body weight less than 127 lbs, or excessive alcohol consumption. Being Caucasian/white puts you at higher risk for this disease than being black/African American, Hispanic or Asian.

Additional Resources:

UpToDate: screening for osteoporosis

UpToDate: management of osteoporosis in post-menopausal women

Turning 50 is a Big Thing. Like a 100,000 Mile Tune Up!

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group.

Did you know there is preventive care for your body, just like preventive care for a vehicle or anything that has constantly moving parts?

Turning 50 is a milestone in healthcare.

Tune UpTurning 50 is when we start thinking about screening for disease processes that typically happen in a more “mature” adult rather than in younger adults.

For men, prostate screening through blood work starts at 50 for average risk patients (sooner for increased risk patients and African Americans). Some providers will also screen a manual (finger) prostate exam if the patient is symptomatic for enlarged prostate as well as the blood work for cancer screening.

For women at age 50, breast cancer screening via mammogram for standard risk patients or MRI for higher risk or genetically positive patients becomes a very important ANNUAL exam. Current recommendations at age 40 for women is either yearly or every other year screening, but 50 it is definitely annually.

For both men and women routine screening for colon cancer is done at age 50 by a colonoscopy, the preferred method, or other screening tools like Cologuard or a hemoccult card. Colon cancer can be prevented by including a high fiber diet in your meal plan. Talk with your healthcare provider about getting this scheduled.

Shingrix, the current shingles vaccine, is now also recommended at age 50 (Zostavax use to be 60).  Even if you’ve had shingles in the past or the old shingles vaccine Zostavax, you should still get the two dose series of Shingrix as it is much more effective at preventing the chicken pox virus from causing a shingles rash and shingles pain in your body.

Working on HeartCholesterol screening, immunizations, skin checks and other screening tools are key in keeping up your preventive maintenance. There are other screens that happen at your annual physical depending on your risks, history, family history etc.

Make sure you’re eating healthy and getting physical activity daily to help keep your body strong and healthy.

If any of this applies to you, and you haven’t been doing preventative maintenance, go and schedule your annual physical today!

Here are some great tips to get you prepared for seasonal allergies.

By Cindy Aldrige, F.N.P., Provider for Lee’s Summit Physicians Group

Seasonal AllergiesAllergy season is upon us. Do you know what the symptoms are? Of course sneezing, runny nose, watery eyes are the first symptoms we think of, but clearing the throat frequently, coughing and head pressure or headaches are other more subtle signs that some don’t think about.

There are different ways to treat allergies and specialist recommendations start with some of these basic non-medication steps.

  • Did you think about how much dust and particles are in carpets? Vacuuming doesn’t get rid of anything down deep or tiny particles. Also there are special filters on HVAC units that can greatly reduce symptoms of those in the building.
  • Changing your pillowcase regularly because your face rubbing in it overnight can make allergy symptoms start or worsen depending on what the individual is sensitive to.
  • How about avoiding smoke/pollutants as a treatment? Not many remember that step!
  • OK, here is one that I can attest to the most… KEEP THE WINDOWS CLOSED in your home. For those that suffer from pollen and mold allergies, this is one of the best things that you can do to keep symptoms controlled. I requested windows that don’t open in most of my house because that drives my allergies CRAZY!
  • Another one that is less popular these days is hanging clothes/linens out on the line… a bad mistake for allergy sufferers.
  • Using a sinus irrigation system that you can get at your local drug store is one of the best preventive and treatment measures. Using distilled water only, not bottled or tap, you can actually rinse out the tiny particles that cause your body to react with tons of mucus and tears!

Okay, what about over the counter allergy medications? How do I choose?

Over the counter products use to be prescription only. They can actually be used effectively and are main line treatment. Allergy specialists are now using nasal steroids like name brand Flonase/Nasacort/Rhinacort for baseline therapy once daily. Be sure to follow the package instructions on administration because often they are not administered correctly. And ideal results are not achieved. (So reading the package insert is really helpful.)

If that alone is not enough to control your allergies, then consider Claritin/Allegra/Zyrtec/Xyzal or a generic equivalent. They work well at stopping the mucus production to help control symptoms.

As we always recommend, please talk to your health care provider about these specific recommendations and what might be right for you and your health. Have a great and active spring /summer 2019!

Do I really have to get a mammogram?

MammogramBy Molly Lewindowski M.D.

Screening mammograms are the most important tool to diagnose early breast cancer. About 1 in 8 women will be diagnosed with breast cancer. While there’s no one answer why the rate has increased in the past 25 years, there are known risk factors. Some risk factors we don’t have any control over- getting older, family history, prior history of breast cancer. Another common issue is high breast density, which can complicate the reading of the mammogram. But others risks we can change: smoking, drinking alcohol, avoiding weight gain, lack of exercise, use of hormone replacement therapy.

There are several types of mammograms.  The screening starts for most women at age 40.

  • The digital  mammogram is the standard screening test. If you are told you have dense breasts, this is normal. About 50% of women have a larger proportion of fibrous and glandular tissue than fat. The only reason this is important to know is that it does make the images harder to interpret, and you may be called back for more testing.
    *Getting called back after the mammogram does not mean you have breast cancer.
  • The 3D mammogram is another type of x-ray that will allow the radiologist to look at the tissue in greater detail. Many times this type of mammogram gives the best detail in dense breast tissue. However, insurance frequently will not cover it 100%. Check with your insurance, as each one is different.
  • Breast ultrasound is usually ordered when trying to determine if an area is a cyst or a solid mass. It may be used during pregnancy as there is no x-ray exposure.
  • Breast MRI can provide other information when diagnosing and treating breast cancer.  This type is usually ordered in women who are at high risk for breast cancer, when there is a close family member diagnosed before age 50.

Two local sites for mammograms are the Breast Center at St Luke’s and The Diagnostic Imaging Center. You do not need an order, but we do ask that they send the report to us for your health record.

Even though mammograms and breast imaging have greatly advanced in recent years, it’s important to notify your primary care office of any breast lumps or skin changes. Checking your own breasts monthly is a healthy habit, and may save your life. We can provide instructions during your annual physical visit.

The apple doesn’t fall far from the tree.

By Dr. William Barnard

Dr. Barnard and his son Luke BarnardI was raised a Kansas boy in a small town in southeast Kansas, I attended the University of Kansas for my undergrad and was performing well in math and the sciences, but didn’t like engineering. After much thought and discussion with friends and my college mates, I decided to give medical school a try. I was accepted to KUMC in 1975 and my new career was born. I came out to Lee’s Summit in 1981 after finishing my residency in internal medicine at St. Luke’s Hospital in Kansas City, Missouri and 37 years later, the rest is history!

My son Luke grew up in Lee’s Summit, but he caught the KU fever from me! Naturally when it came time for him to pick a college, he only wanted to go to KU. He graduated with his Bachelor’s degree, but wasn’t yet ready to commit to more schooling, deciding instead to take a year off and do some traveling. He even traveled to China where he taught English for four months.

Apple Doesn't Fall From the TreeIt also turns out the apple doesn’t fall far from the tree and since Luke excelled in math and the sciences as well, off to the University of Kansas Medical School. He currently has two years left before he will graduate and pursue a career in ophthalmology.

Dr. Barnard is a long-time resident of Lee’s Summit and has been with LSPG since 1981. He graduated medical school from the University of Kansas in 1978 and completed his residency in Internal Medicine at St. Luke’s Hospital in 1981. Dr. Barnard is board certified by the American Board of Internal Medicine. He enjoys caring for adults of all ages. He lives in Lee’s Summit with his wife and three children.

A Personal Story about Meningitis and Life Saving Vaccines

Emily Robb, M.D.By Emily G. Robb, M.D.

It was the summer of 1992. I’d just arrived home after finishing my freshman year at college. Although I was exhausted from finals and the end of the year celebrations, I immediately returned to my summer job working full-time at the hospital as an EKG tech. Unfortunately, I only made it part way through my first eight-hour shift when I developed a fever of 101 degrees and was sent home.

That evening I had all the symptoms of a classic stomach flu – vomiting, fever and chills.

Things got significantly worse by 2 am.

I woke up with a strange rash and was very confused. My parents discussed what to do for a few hours. They called a nurse line and got conflicting suggestions of waiting it out or taking me to the ER. I continued to get even more confused and lethargic and the rash was spreading fast, so they decided to take me to the ER at about 5 am. By that time, I was unable to walk, barely conscious and near death. The doctor in the ER immediately recognized that I might have bacterial meningitis and started me on IV antibiotics even before proceeding with the lumbar puncture and blood cultures.

Lee's Summit Physicians Group: MeningitisIt turns out I did have bacterial meningitis, caused by Neisseria Meningitis, and spent the next week in the ICU in a state of delirium and on the edge of death. My liver and kidney’s failed and I had double pneumonia. But after six days, I woke up and wondered what the heck I was doing in the ICU. I barely remembered any of it. My hands and feet were numb and my whole body was covered with large black spots where the skin had died.

I was transferred to another floor where I spent two weeks recovering and having all the dead tissue removed by the wound care team. This left me with very large, open wounds all over my body. I was so weak. I went home with a walker to keep from falling because all my muscles had atrophied while I was lying in bed for 3 weeks.

In 1992, schools did not require meningitis vaccines to go to college.

Not many people had even heard of bacterial meningitis despite college kids dying from it every year. Education about bacterial meningitis and mandatory vaccinations for college kids didn’t begin until after the year 2000. Recommendations for routine vaccination of 11-12 year-old kids began in 2010.

Today, most high schools and colleges require proof of meningitis vaccination. Because of this, the infection rate for meningitis has dropped significantly – saving thousands of lives.

Bacterial meningitis is a life threatening disease that strikes quickly and can kill within 24 hours. It is difficult to recognize in its early stages, and by the time bacterial meningitis is diagnosed, it is often too late for treatment. That’s why vaccination against bacterial meningitis is the most effective way to protect yourself. I was very lucky to only have scars from my infection. Those that survive bacterial meningitis often lose arms and legs, go deaf, lose kidneys or end up with brain damage.

Information about Neisseria meningitis from the CDC website

Neisseria meningitides is one type bacteria that causes bacterial meningitis. Meningitis is a contagious infection spread by close contact, such as living with or kissing an infected person. Quick medical attention is extremely important if meningococcal disease is suspected.

The symptoms of meningococcal disease can vary based on the type of illness that develops. Common symptoms of meningococcal meningitis include sudden fever, headache, and stiff neck. Other symptoms can include nausea, vomiting, increased sensitivity to light, and confusion. Children and infants may show different signs, such as inactivity, irritability, vomiting, or poor reflexes.

Meningococcal bacteria can also infect the blood which can lead to tiredness, vomiting, cold hands and feet, chills, severe aches and pain, fast breathing, diarrhea, and a dark purple rash. Meningococcal disease is very serious and can be fatal. When fatal, death can occur in as little as a few hours.

Vaccinations

Knowing my story, it’s not surprising that I’m an avid advocate for all vaccinations. I believe that prevention is the key. When the benefit is so great, and the risk so small, it only makes sense to immunize against all preventable diseases. Vaccines save more lives each year than seat belts and car seats combined.

Neisseria Meningitis is the leading cause of bacterial meningitis in adolescents and teens.

There are five different sub-types of this bacteria. There are two different types of vaccines which prevent Meningitis caused by Neisseria Meningitis that are recommended for adolescents and teens: the quadrivalent (Menveo and Menactra) which protects against 4 groups (A, C, W and Y) and group B (Trumenba and Bexsero). The CDC recommends initial vaccination for all adolescents and teens with a quadrivalent at 11/12 and booster at 16/17 years old. The group B vaccination is given sometime between 16-18 years old. Common side effects include redness/warmth at the injection site and fever lasting less than 2 days.

For more information, here is a link to the CDC page on meningitis vaccination.