“Don’t make me laugh!” “I’m afraid to sneeze or cough.” “I can’t lift anything heavy.”
If you have urinary stress incontinence (loss of bladder control), you’ve either made
these statements or thought them, and you are NOT alone! Urinary incontinence is very
common – it actually affects 1 in 2 women – and it is a sensitive subject we’re not
prone to talk about because it can be embarrassing. But it shouldn’t be.
Urinary incontinence isn’t a disease, it’s a symptom that actually affects more women than high blood pressure (1 in 3), diabetes (1 in 10), or depression (1 in 20). And urinary incontinence affects women of all ages (even women in their 30s and 40s) because it is caused by a variety of conditions that stretch or weaken the pelvic floor muscles: pregnancy, childbirth, menopause, hysterectomies, lifting heavy objects, even having a job that requires standing for long periods of time.
Urinary stress incontinence occurs when the pelvic floor muscles weaken so they cannot support your bladder or control the release of urine, especially when certain types of physical activity (sneezing, coughing, bending, etc.) put extra pressure on your bladder.
Problems with loss of bladder control can often be relieved simply by making a few behavioral and physical changes. It does not mean that surgery is going to be required. According to Victor Grigoriev, M.D., board-certified urogynecologist (certified in both urology and in female pelvic medicine and reconstructive surgery), many noninvasive treatment options are available.
Urogynecologists diagnose and treat pelvic floor disorders (a wide range of problems, including urinary incontinence, that occur when the pelvic floor muscles are weak), and pelvic organ prolapse, when organs such as the bladder, uterus, or rectum drop from their normal locations.
Dr. Grigoriev says those with overactive bladders can often find relief just by changing their diets. “Dietary changes can make a tremendous difference,” he says. “Avoiding things that irritate the bladder, regulating your amount of fluid intake, and increasing your dietary fiber are just a few ways you can help your overactive bladder.”
Strengthening the pelvic muscles can also help those who leak just a few drops of urine while sneezing, laughing, or coughing, or who have a strong, sudden urge to urinate or leak stool. Kegel exercises are the most commonly used. Learn more about Kegel exercises at lasvegasurogynecology.com.
Depending on what is causing the urinary incontinence, conservative measures such as behavioral or physical therapy may not work, so surgery can also be an option. While every woman’s problems differ and require individualized treatment approaches, many minimally invasive techniques are available today.
At St. Rose Dominican, Dr. Grigoriev, who began using the daVinci® Surgical System for other procedures approximately five years ago, is now using the system to correct pelvic floor disorders. The minimally invasive procedure is done using small incisions in the abdomen. “This robotically controlled procedure decreases the risk of infection and allows me to put the pelvic organs back into a more correct anatomical position while avoiding the use of vaginal mesh,” says Dr. Grigoriev. “Repositioning the organs takes the pressure off of the muscles, which relieves symptoms, and women typically recover within 1-2 weeks depending on the degree of their prolapse.”
How to train your bladder
- Keep a diary of fluid intake and urination – just the simple act of keeping a diary has been shown to decrease urinary frequency and incontinence by 40 percent
- Timed voiding – Use the restroom on a schedule (e.g., every two hours) before the urge occurs; this trains the bladder and decreases episodes of leakage
- Drink fluids in moderate amounts and slowly over the course of the day. Your bladder can accommodate more volume if it is filled slowly
- Work on constipation and regular bowel movements
Incontinence: Foods to avoid
Doctors have identified a number of foods and drinks that can worsen overactive bladders as they contain irritants that, when collected in the bladder, can cause the bladder muscles to spasm. Those spasms can create the sudden urge to urinate and increase your frequency of urination.
- Tomato-based products
- Coffee and tea
- Citrus fruits
- Carbonated drinks
- Artificial sweeteners
- Spicy foods
- Raw onions
Incontinence: Foods to eat
Make your diet as simple as possible, says Dr. Grigoriev. “Very often, I have my patients start off with cream of wheat and baby food and then add foods back little by little to see what causes problems.” Constipation can cause or exacerbate an overactive bladder, so eat plenty of
Juices that won’t irritate your bladder include apple, grape, cherry, and cranberry juices. They also help by making urine more acidic, preventing the spread of bacteria and controlling urine odor. Drink plenty of water to hydrate your body.
If you are having problems with urinary incontinence, know that you’re not alone and that there are things you can do to relieve your symptoms. Talk with your doctor to learn about your options or find a St. Rose physician who treats urinary incontinence by calling 702.616.4900.
The demand for women’s and children’s health care services in southern Nevada continues to grow. So much so that Dignity Health – St. Rose Dominican has opened a third WomensCare Center of Excellence to meet that demand.
The WomensCare Centers of Excellence have embraced women, men, and children of all ages by providing no or low-cost health, support, and fitness services since 1998, when the first Center opened. The second WomensCare Center opened near the San Martín Campus in 2007 to expand services into the southwest part of Las Vegas, and a third WomensCare Center has now opened on the Rose de Lima Campus at 98 E. Lake Mead Pkwy., Suite 301, in Henderson.
“We’ve wanted to open a WomensCare Center near the Rose de Lima Campus for several years,” says Holly Lyman, Director of WomensCare and Community Outreach. “We’re thrilled that we will now be able to offer our services at a more convenient location for those who live in this part of Henderson.”
Helping Hands will have an office at the Rose de Lima location, and programs and services will be similar to those offered at the other two Centers:
- Breastfeeding support and pump rentals
- Chronic disease management
- Diabetes education and management
- Exercise and fitness programs
- Family to Family Connection services
- Health screenings
- Parenting classes
- Physician lectures
- Prenatal education
- Safety and injury prevention
- Support groups
- WIC (Women, Infants & Children) Programs
“The staff and volunteers at our WomensCare Centers – many of whom used our services before joining us – share in the commitment to delivering high quality, compassionate health services,” says Holly. “We truly bond with the women we assist and consider it a privilege to be of service.”
For information on our WomensCare Centers and the services they offer, please call 702.616.4901.
When you are recovering from an injury, surgery or illness and need continued care, there’s no place you’d rather receive that care than in the comfort of your own home. And your recovery can be much smoother when you’re supported by the exceptional health care team at St. Rose Home Health Services.
The three St. Rose Dominican hospitals in Henderson and Las Vegas are here to serve our community by providing a full spectrum of services that treat and help you recover from illnesses, injuries, surgeries, and more. In some cases, when patients are ready to be discharged from the hospital, they may still need continued care or treatment to complete their recovery. With St. Rose Home Health Services, that care can be provided at home.
If your doctor or a referring health care provider decides you or a loved one needs home health care, St. Rose Home Health Services is here to help. “Our experienced, highly skilled staff includes registered nurses, physical, occupational and speech therapists, and social workers, who all thrive on providing exceptional care filled with compassion and kindness,” says Sharon Kelley, Sr. Director of Home Health Services. “In fact, two of our nurses were named nurses of the year in 2014: Bonnie Schmidt, RN, by the National Association for Home Care & Hospice, and Terry Yates, RN, by March of Dimes Nevada. Our entire team of caregivers is exceptional.”
St. Rose Home Health Services is the only not-for-profit, faith-based, Joint Commission accredited, state licensed and Medicare certified home health agency in southern Nevada. “As part of the St. Rose Dominican system, we are passionate about providing caring service to those in our community,” says Sharon. “I’m proud to say that the care provided by our Home Health team exceeds the national average in all patient satisfaction surveys conducted by the Centers for Medicare & Medicaid Services (CMS).”
St. Rose Dominican’s team was named a top home health agency in the U.S. numerous times by Homecare Elite and is a frequent recipient of HealthInsight’s Home Health Quality Award. The Home Health team keeps patients on the road to recovery by providing assistance with services such as IV management, skilled nursing care, physical, speech and occupational therapies, wound care, medication management, and family/caregiver education.
Ask your doctor if you would benefit from home health services. To learn more about St. Rose Home Health Services, please call 702.616.4476 or visit strosehospitals.org/homehealth.
Dignity Health – St. Rose Dominican’s WomensCare Center, Labor & Delivery, and lactation counselors and consultants (photo below) hosted an event Wednesday, February 18, to announce that the Siena Campus received prestigious international recognition as an official Baby-Friendly Designated birth facility.
Hospitals with the Baby-Friendly designation have a demonstrably higher level of expertise in support and education of mothers interested in breastfeeding their newborns. Siena is only one of two hospitals in southern Nevada with this distinction; the first was St. Rose’s San Martín campus, which received the designation in May 2014.
As Madeleine Sigman-Grant, past president of the Southern Nevada Breastfeeding Coalition, stated at the event, “One of the mainstays of Baby-Friendly is the focus on the first 60 minutes of a baby’s life … 60 minutes of skin-to-skin contact. We carve out 60 minutes of our day for a variety of things: we unwind with our favorite TV show or video game, we work out, we take a class, we have lunch with friends or dinner with family. Baby-Friendly commits to making the most of baby’s first 60 minutes of life because it can influence his or her health and wellness throughout a lifetime.”
Emily Jackson, wife of Jackie Jackson (the oldest member of the Jackson 5) and new mother of twins (at right), agreed when she spoke. She praised the staff at St. Rose for helping her bond and breastfeed her boys.
The designation is conferred by the Baby-Friendly Hospital Initiative (“BFHI”), a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), and implemented in the United States by Baby-Friendly USA. This initiative encourages and recognizes hospitals and birthing centers which offer an optimal level of care for breastfeeding mothers and their babies.
Based on the Ten Steps to Successful Breastfeeding, this prestigious international award recognizes birth facilities which offer breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies.
Becoming a Baby-Friendly facility is a comprehensive, detailed and thorough journey toward excellence in providing evidence-based maternity care, with the goal of achieving optimal infant feeding outcomes and mother/baby bonding. It compels facilities to examine, challenge, and modify longstanding policies and procedures. It requires training and skill building among all levels of staff. It entails implementing audit processes to assure quality in all aspects of maternity care operations, enhances patient satisfaction, and improves health outcomes.
“We are extremely proud of being named as a Baby-Friendly hospital,” said Brian Brannman, senior vice president of operations, Dignity Health Nevada and president/CEO of Dignity Health-St. Rose Dominican, Siena Campus, at the event. “The practice of breastfeeding has always been an important part of what we do here at Siena and this designation is significant to the community.”
Southern Nevada residents who need emergency medical care for a stroke may benefit from the Mayo Clinic “telestroke” program that is now available at all three Dignity Health – St. Rose Dominican campuses. A recent agreement between St. Rose and Mayo Clinic in Arizona means the service featuring a portable, self-propelled robot has begun in southern Nevada. St. Rose Dominican is the first system in Nevada to partner with Mayo Clinic, and the service compliments and augments the already robust certified stroke centers at all three campuses.
In telestroke care, a telestroke robot located in a hospital lets a stroke patient be seen in real time by a neurology specialist at Mayo Clinic located in Phoenix. The Mayo stroke neurologist, whose face appears on the screen of the robot, consults with emergency room physicians and evaluates the patient.
Patients showing signs of stroke can be examined by the neurologist via computer, smart phone technology, portable tablets or laptops. In addition to assessing the patient, the neurologist can view scans of the patient’s brain to detect possible damage from a hemorrhage or blocked artery.
“The excellent, capable emergency physicians at Dignity Health – St. Rose Dominican can ring the telestroke hotline and be instantly connected with Mayo Clinic’s stroke experts,” said Bart Demaerschalk, M.D., Professor of Neurology, and medical director of Mayo Clinic Telestroke. “Urgent and immediate virtual care can be provided to patients – collaboration between stroke neurologists and physicians at the remote sites has resulted in 96 percent accuracy in diagnosing stroke.”
Brian Brannman, senior vice president of operations at Dignity Health Nevada, stated, “Our mission is to provide quality health and wellness services where the patient, family, and community come first. This newly formed partnership with the Mayo Clinic is another step toward achieving that mission. In collaboration with the stroke neurologists and our Emergency Room physicians, immediate, life-saving interventions can begin shortly after the patient enters the ER. This new service provides possible stroke patients care in a collaborative setting and will ultimately save lives. We are very excited to be able to offer this service to the communities we serve.”
Mayo Clinic was the first medical center in Arizona to do pioneering clinical research to study telemedicine as a means of serving patients with a stroke and today serves as the “hub” in a network of 16 other “spoke” centers, with most in Arizona. To date, more than 1,500 emergency consultations for stroke have taken place between Mayo Clinic stroke neurologists and physicians at these spoke centers.
Melanie Baldwin considers herself a “walking, talking research and development project 50 years in the making.” Born with a congenital heart defect – still the leading cause of death in children – Melanie says she is “a product of determination, good fortune, and amazing technology.”
“I was born with a hole in my heart and a defective aortic valve, and I have had five open heart surgeries through the years,” says Melanie. “I am currently on my fourth pacemaker.”
Melanie had two surgeries while she was still a young child then another when she turned 19 to replace a defective aortic valve with a mechanical one. The new valve was meant to last 15 years, but in exchange, she would have to take Coumadin to keep her blood thin. This arrangement worked well until she married and decided her life was not really complete without a child.
Almost 25 years ago, Melanie became pregnant, and after moving to San Diego, she went to check in with her new doctor. That doctor’s appointment turned into a month long hospital stay because she had developed a blood clot just outside of her heart; if it moved, both she and the baby were at risk of dying.
Although Melanie knew her pregnancy was considered high risk, she did not expect to be told that she would have to terminate her pregnancy in order to have surgery to remove the clot. While she was on complete bed rest, doctors spent a month trying to convince her that was the best option. She adamantly refused and insisted they do the surgery while she was pregnant, which they did, reluctantly. At 26 weeks pregnant, Melanie’s clot was removed and her mechanical valve was
replaced with a pig valve.
“Not only did I survive, so did my daughter,” says Melanie. “I gave birth to her in July 1990, and I have never regretted my decision. Cardiovascular disease is a family affair. It affects everyone you know and love.”
Melanie’s mom, Carol Payne, agrees. “Ours has been a normal life for the most part, interspersed with moments of horror, heart-wrenching sorrow, and desperation,” says Carol. “But there were also euphoric moments when Melanie’s amazing positive spirit and tenacity helped overcome what should have been life-ending events.”
Melanie suffered cardiac arrest in June 2013 and spent 10 days in the hospital. She walked out of the hospital, but the incident put her in line for an AICD (automatic implanted cardioverter-defibrillator) to replace her third pacemaker. An AICD differs from a pacemaker in that its defibrillator has the ability to shock the heart out of a life-threatening heart rhythm abnormality. “Luckily, Melanie was resuscitated by her husband when she had her cardiac arrest,” says Dhiraj Narula, M.D., FACC, a board certified cardiac electrophysiologist. “We changed her pacemaker to a pacemaker-AICD combination to protect her in the event she had another cardiac arrest.” The procedure was done at the end of August 2013, and she spent another five days at Dignity Health – St. Rose Dominican’s Siena Campus.
February is American Heart Month, a nationwide initiative to raise awareness in the effort to combat heart disease and educate communities on prevention and treatment options.
Melanie, her mom, and her daughter are sharing their stories at the American Heart Association’s Go Red Luncheon on Friday, Feb. 27. “Our family has obviously learned a lot about cardiovascular disease over the years,” says Melanie. “My mom is my hero. She’s been right beside me every step of the way, as has my daughter who has accompanied me through my cardiac ‘journey’ and is now a registered diagnostic cardiac sonographer.”
“You can’t control what challenges life throws your way, but you can control how you choose to deal with those challenges,” says the upbeat, ever joyful, Melanie.
A Mother’s View
“My daughter is the hero,” says Carol. “When Melanie was born, my doctor told me there was a problem, so I was amazed that there was nothing visibly wrong, and this has really been true all of her life. Melanie has never looked sick, and she has always had a happy, positive disposition.
When Melanie was 3 years old, we went to the hospital for her first surgery. It was supposed to be the only surgery she would need … the one that would fix whatever was wrong, but after the surgery, we learned that doctors had found other problems with her heart.”
At 7, while living in San Diego, further surgery was recommended to open Melanie’s aortic valve. “She was comforting me as she went into surgery,” says Carol, “telling me that she would be fine and I wasn’t to cry.” At 19, Melanie was told she needed further surgery, this time to replace the aortic valve. She was told the night before surgery that the surgeon would be using a mechanical valve, so she would need to take blood thinners, which meant having children was not an option. “We had always felt tremendous gratitude that technology and medicine could save Melanie’s life,” says Carol, “but now the quality of her life would change. She was devastated.”
Melanie later married, and Carol was not surprised when she decided to have a child against all odds. “She had survived a ruptured appendix and cardiac arrest shortly after her surgery at 19, so when she said she could handle pregnancy while taking blood thinners, I believed her. The result is our beautiful Kate.”
A Daughter’s Perspective
As an ultrasound technician, Kate Eggington works with people who have heart problems every day. “I chose this career partially because of my mother,” says Kate and Melanie, with friend Ronrico Hawkins, at the AHA’s annual Heart Walk in 2014. Kate. “But it wasn’t until I completed my schooling that I realized how serious her condition is. I almost wish I could go back to my days of ignorance because knowing the full depth and consequences of what she was born with is scary.”
Even knowing about her mother’s heart condition, it wasn’t until June 15, 2013, that Kate was forced to accept that “my mother wasn’t as invincible as she seemed and that I could lose her at any point without any notice.”
Kate’s parents were having a normal day at home. “Luckily, my stepfather happened to be home for one of the 10 weeks of the year he doesn’t travel,” she says. That afternoon, Kate’s mother’s heart stopped without any warning. She collapsed and went into cardiac arrest. For the next two days, she was put into a coma and therapeutic hypothermia was used (her body temperature was lowered) to slow her metabolism, decrease the amount of oxygen she needed, and prevent brain damage.
“None of us could function. I couldn’t eat, I could barely sleep, I was inconsolable,” says Kate. “During the times I could actually bring myself to sit by her bed, I couldn’t call her mom because the sound of my voice made her reach out, trying to pull at the IV and breathing tube she had in. On the third day, they slowly warmed her back up, and when they took her out of sedation and she spoke, my stepfather broke down. We hadn’t lost her. After 10 days in the hospital she finally came home to us.”
“Although that was the most terrifying experience of my life,” says Kate. “I now cherish my mother … every lunch with her, every hug, every time she says I love you.” Heart disease kills more women each year and is more deadly than all forms of cancer. Melanie is a true advocate for raising awareness of the threat of heart disease – she’s been actively involved with the American Heart Association for 15 years. Arm yourself with information. To learn the facts about heart disease and what you can do to prevent it, visit goredforwomen.org. For more information about cardiac services provided at St. Rose Dominican or to find a St. Rose cardiologist, visit strosehospitals.org/heart.
When Josh woke at his home in Henderson in the middle of the night unable to walk, paramedics rushed him to St. Rose Dominican’s Rose de Lima Campus. After spending two weeks in the hospital getting his health stabilized, the Inpatient Rehabilitation Facility (IRF) staff took over and helped Josh walk out the front doors.
Josh was diagnosed with Guillain-Barre (pronounced Gē-yän Bä Rā) Syndrome, a rare, serious autoimmune disorder that damages the nerves, causing muscle weakness and paralysis. The Centers for Disease Control and Prevention (CDC) says the syndrome affects one out of every 100,000 people.
“Doctors think I had a virus that locked on to my nerve endings,” says Josh. “So after fighting off the virus, my body thought the nerve endings were still part of it, and it just kept attacking.” With Josh bedridden, doctors turned to the hospital’s IRF and its new robotic technology for answers.
Fortunately for Josh, the IRF had recently received three new robotic rehabilitation therapy machines made by Hocoma® Products: the Erigo®, Lokomat Pro®, and Armeo®Power and Hand Therapy robot. According to Dr. Tony Chin, Medical Director of the IRF, the hospital is the first in the southwest United States to receive the equipment.
Erigo® – The Erigo® (shown right) is a robotic mobilization and electrical stimulation support system that helps patients stand again after long periods of lying down. Named Apollo Zen by the IRF (“Apollo” for god of the sky and “Zen” for health), it gradually moves the patient into an upright position, allowing them to gain the strength to stand. Robotic foot pedals help patients improve their blood circulation while doing passive, active or resisted exercise. The system also uses functional electrical stimulation to assist in muscle contraction, which speeds strengthening.
“The whole idea is to get the muscles to contract so we get blood flow back to the heart,” says Dr. Chin. “With good blood flow, the heart starts to pump, and we can slowly tilt the patient upright while maintaining their blood pressure. If they’re able to maintain blood pressure, they’re able to do therapy.”
A few days after Josh was admitted to Rose de Lima, the Erigo® arrived. He was the first patient to test out the new technology. “The Erigo® was amazing,” says Josh. “It got me moving again. I’ve been on my feet ever since.”
Lokomat Pro® – The IRF’s Lokomat Pro®, a customizable robotic gait training system that helps patients walk again, has been nicknamed “Optimus Yung” (Optimus, a robot character in the movie “Transformers” that helps humans, and Yung, the Chinese word for “courageous”). The name is fitting because it takes a lot of courage for a patient to get on the machine and try to walk again after a stroke or traumatic injury.
The machine (shown left) hoists patients upright using a harness that moves up and down and side to side to simulate the natural “bob” of a walking person. Robotic legs attach to the patient’s hips, knees, and ankles to guide them as they move forward on a treadmill, and a hip attachment feature allows natural hip movement. A video screen facing the patient offers games that encourage and provide instant feedback.
The Lokomat Pro® has both automatic and manual settings. New patients are typically placed on an automatic setting so they can experience concise and repetitive movements to form new muscle memory. The settings are gradually moved to manual as the patient improves. “The movement has to be precise and accurate,” says Dr. Chin. “If not, they will learn a bad pathway.”
After stabilizing his blood pressure using the Erigo®, Josh used the Lokomat Pro® to regain his ability to walk. “The machine got me started,” says Josh. “I went from not being able to walk to moving my legs to being able to hold my weight to walking all over again. Now, I feel like I can almost jump again.”
“It’s like the old expression, ‘You never forget how to ride a bike,’” says Josh. “Well, you never forget how to walk either. Sometimes it just takes a while to get it down the way you did before, but the amazing staff here at the IRF helps you do it.”
Armeo®Power – The Armeo®Power (shown right) is an upper body robot that helps patients regain the use of their arms. Dr. Chin says the machine focuses on repetition to increase strength and improve mobility of the shoulder, elbow, and wrist. Like the Lokomat Pro®, it uses video games to encourage patients and give them instant feedback.
“Our Armeo®Power is named Rosie Chern,” says Dr. Chin. “’Rosie’ after Rosie the Riveter (an American icon during World War II representing women who worked in factories), and Chern, the Chinese word for being successful.”
Former patient Lana Million experienced the machine’s success after suffering from a debilitating stroke in July 2014 that caused her entire left side to become numb. After spending two weeks recovering at St. Rose Dominican’s Siena Campus, Lana was transferred to the Rose de Lima IRF to rehabilitate using the Armeo®Power. “My fingers and arm would move, but I couldn’t control them,” Lana says. “The Armeo helped me learn how to squeeze things, and it gave me the whole range of movement back in my arm. I can’t imagine having better therapy.”
“Our emergency rooms save lives,” says Teressa Conley, President/CEO of the Rose de Lima Campus, “but life-saving
technology is just part of the picture. After trauma, accident, or stroke, it is only through rehabilitative services that patients really get their lives back. Regaining the ability to do something as simple as combing your hair or brushing your teeth or something incredibly difficult, such as learning to walk and be independent again, is truly life-saving.”
In the past, residents had to travel out of state for care beyond traditional therapy. Now that Rose de Lima has the Hocoma® technology, residents can recover in their own community.
The robotic technology offered at the IRF now allows patients to have the best of both worlds: the most current technology
and the support of friends and family. For Josh, staying close to home was important because it allowed him to visit with his two small children every other day. “If I was out of state, that wouldn’t have been an option,” Josh says. “It was hard not being able to hold my kids when they were sitting right next to me, but having them visit was motivation. It kept me pushing, and it kept me moving forward. I did it for them.”
At a recent unveiling of the new equipment, Conley agreed. “We are proud to be the leader in rehabilitative services for our region,” she says. “Residents of southern Nevada should not need to leave the community to get the best medical care available.” To learn more, visit StRoseHospitals.org/IRF.