photo credit: bella_domanie

Botox Treatments for Urinary Incontinence in Seniors

The United States Food and Drug Administration approved Botox for use in treating urinary incontinence among elderly patients in August of 2011. Primarily conceived as a wrinkle-reducing alternative to plastic surgery, Botox has eluded many medical authorities with its growing applications in treating the symptoms of many conditions and diseases. So what is urinary incontinence, how does the use of Botox in New York and the rest of the country treat it, and what else can this drug do?

What is Urinary Incontinence?

Urinary incontinence refers to uncontrollable urination. Episodes of incontinence are reportedly sporadic, varying in frequency and volume, but almost always create social anxiety in the patient. Urinary incontinence is almost always a symptom rather than a disorder in itself. As such, physical examinations and urinalysis tests should be conducted to reveal the cause of the problem.

Acute urinary incontinence can be caused by excessive consumption of water, alcohol, coffee, or a pre-existing condition such as a urinary tract infection. More chronic cases are associated with various surgical operations, aging, childbirth, prostate cancer, or bladder issues.

The most prevalent symptom of urinary incontinence is uncontrollable urination, which can be excited by stress, involuntary bladder contractions, or the bladder’s inability to empty itself. Related conditions, whether they are causal, resultant, or incidental, include urinary tract infections, bladder and prostate cancer, atrophic urethritis, endocrine disorders, and psychiatric disorders.

Why Botox?

Botox or botulinum toxin is a diluted neurotoxin, similar to the venom that snakes and other predators use to paralyze their prey. When safely administered, Botox acts as a long-term muscle relaxer. When used to treat urinary incontinence, Botox is directly injected to an overactive bladder. After an incontinent person is injected with Botox, they have much more control of the contractions involved with urination. No other medications or plastic surgery procedures have deterred urinary incontinence for as long as a single Botox injection, which the FDA says can relieve incontinence for as long as ten months.

Additional Uses

In addition to treating urinary incontinence, the use of Botox in New York and several other states has been FDA-approved to treat several other symptoms and disorders. Its primary use was to relieve muscle spasms of the eye. Since then, it has been cited to relieve hyperhidrosis, migraines, and even cerebral palsy. Hyperhidrosis, or excessive sweating, is inhibited by the gland-blocking effects of Botox injections. Similarly, research initiatives by the Baylor College of Medicine have suggested that Botox cures migraines by cutting off “pain pathways” in the nervous system. Finally, Botox allows young adults and children with cerebral palsy to better control their otherwise severe and unpredictable muscular contractions.

Botox Statistics

When compared to a placebo group, patients in an FDA clinical trial of almost 700 urinary incontinence sufferers said that they experienced fewer episodes of incontinence. The American Society for Aesthetic Plastic Surgery recently released the number of procedures that have been conducted across the country, which is now more than 2,437,165. Roughly 17 percent of those procedures addressed urinary continence and related conditions. As it concerns the use of Botox in New York, the state’s 12 percent of elderly residents has undergone more than 100,000 botox injections since 2003.

Editor’s note: The above information was provided by PlasticSurgeryGuide.com. Please do not consider this as a recommendation.  It is simply presented for your information.  Check with your physician to decide whether this would be an appropriate treatment or to discuss other options for treatment of urinary incontinence.

By Guest Writer: Ruth Rogers

Every year, many senior citizens have a fall.  Not all of the falls are devastating, but many of them are. Falls can cause broken or fractured bones, loss of motor function and independence, and even death. Unfortunately, many people just accept this as a normal aspect of aging. Fortunately, there are many ways to prevent senior citizens from falling so they can maintain their independence.

There are many reasons that falls increase with age. To begin with, failing eyesight can cause a person to misjudge stairs and curbs, even when they are in a familiar location. Regular eye checks and screenings will alert you to issues with your loved one’s eyesight and help to keep them safe. Wearing  glasses is another way to prevent falls from poor eyesight. Even though your loved one might only be walking from their bed to the bathroom in the middle of the night, make sure to remind them to turn on the lights and put on their glasses.

Another way to prevent falls from vision problems is to remove trip hazards throughout the house. When caregiving, remember to check the home thoroughly for dangling cords or clutter that might be dangerous.

Even small changes like eating a better diet can help eyesight. Dark leafy veggies, fish oil, and vitamins E, A, and C are perfect for protecting  eye health.

Exercise is another way to reduce eye problems. Hardening of the arteries can lead to high blood pressure which can affect eyesight. Diabetes is another risk factor for reduced eyesight. Exercise can help with heart disease risks as well as circulation problems, which can greatly reduce the associated risk of sight loss.

Smoking is the second largest reason for the development of macular degeneration, so quitting smoking now will not only do wonders for the heart and blood flow, the skin tone and a lessened risk of cancer, but will also lower their risk of damage to your eyesight.

Balance exercises are also encouraged to lessen the risk of a fall. Have your loved one try balancing on one foot and then the other for a few moments.  Make sure that there is a table or chair nearby in case they are a bit wobbly, but you will find that just a little bit of practice will help to restore their balance and to safeguard you from a dangerous fall.

The process of aging is already tough on the eyes as they are less able to produce tears and the lenses are not as clear as they once were. Focusing can become difficult and sensitivity to glare increases. All of these factors add up to the increased risk of a fall and it is vital that your loved one does all that they can to preserve their eyesight so that they can avoid a fall.

There is a wonderful video called “Care home turns back the clock on dementia”.  You
can find it at  www.bbc.uk and search under “health” .  I highly suggest seeking it
out.  It talks about using the past to calm dementia patients in the present.  How
often have any of us, as caregivers, been frustrated or even frightened by our
inability to reach our loved ones when they seem lost in the fog of forgetfulness?

In my own experience as a care giver, it was recalling the past that best engaged my
93 year old mother in articulate conversation, when she would ask a question about
her current state, such as “where is the dog” every 2 minutes, even when answered
every time.  It was not out of spite that she would repeat and repeat these kinds of
questions, she simply could not retain the information.    But when she spoke of her
youth, when asked about her job at Lord and Taylor’s in NYC when she was in her
20′s, she could describe the exact dress she bought with a matching coat and hat
when dating my father, and how much he liked that particular ensemble….and could
carry on that conversation in a linear way for MUCH longer than she could remember
the answer to “where is the dog” – even when the dog was sitting at her feet!  Or,
when played a song from 1930′s, could tell you exactly where she was when she first
heard that song, and perhaps, how she and her sisters would dance together to the
music on Saturday morning, when helping in the housekeeping with her own mother,
Mama….

When ArtsCare (www.artscareus.org) visits a facility, we use the arts as a vehicle
to engage the elderly in activities that can increase their motor and social skills,
or reduce their level of anxiety.  Music is a great resource -  William Congreve is
credited with having said “Music hath charms to soothe a savage breast, to soften
rocks, or bend a knotted oak.”   We need to be credited with USING this blessed
tool…

Maryellen Kernaghan
Director
ArtsCare
www.artscareus.org521 E. 6th Street #2
New York, NY 10009

Art is the only way to run away without leaving home.
-Twyla Tharp

First of all, falls happen. They don’t just happen in nursing homes (in fact, only 10% of falls happen in a nursing home). My father fell all the time. He would fall when I was 3 steps away from him. He kept telling me “don’t worry; I know how to fall” and he must have because he was never seriously injured from a fall later in life. The reason I say “later in life” is because a fall on a boom of logs was what broke his back, causing the doctors to perform a bone graft from his leg (OLD medicine) which made his one leg VERY weak.

Anyway, back to the matter at hand. Statistics show that 69% of elders over the age of 70 WILL fall. That’s a HUGE number. Falls do not happen in convenient locations (i.e. in places where telephones just happen to be present).

There are things that we can do to prevent falls:

Environmental:

• eliminate throw rugs
• make sure that electrical cords are secured against walls
• provide for adequate lighting in walk-ways and all areas (remember to install night lights in hallways)
• avoid clutter
• make sure that all needed items are within reach so there is no temptation to use a stool or chair
• grab bars in bathrooms and sturdy handrails in places with steps are necessary

Health:

• medical conditons can make falls more likely, so be aware of those
• recent hospitalizations may have debilitated the elder
• keep the elder hydrated and consuming adequate nutrients
• be aware that vision and gait problems can also cause falls
• persons with dementia may forget that they cannot do a specific dangerous task

Falls occur most often in bathrooms and on stairways.  There are usually no telephones in those areas.

Here were the facts that I found most alarming:

If a senior fell and the response time for help was less than 3 hours, they had an 88.5% chance of returning home from the hospital if they needed to be brought there.  If the response time was longer than 12 hours, there was only a 2.7% chance that the elder would be able to return home!  But guess what???  The median response time for an elder who falls is…………17 hours!

This is why a Personal Emergency Response System (PERS) is so important.  One example of this is a button that is worn by the elder.  If there is a fall, the elder can push the button which then sends a signal to an operator. This operator has information about the wearer, such as name, address, age, medications, allergies,  personal physician, and location of a lock box where a spare key is hidden.  The operator will immediately send a medical response team.

There are many PERS suppliers and it’s important to find a good one, of course.  Check with both AARP.org and Alz.org for their recommendations.  Also here is a good article on making sure that you are choosing an appropriate one. 

I also want to give a shout out to Bay Alarm Medical as they are allowing a special price to our readers which can be taken advantage of until April 30th.  They are offering a free 30 day trial with no shipping or handling charges for the equipment and no activiation fee.  For anyone who contiues using the system, their monthly charge is $34.95. The PERS can be worn around the neck or wrist and is waterproof.  Their phone number is 1-877-522-9633. Mention the word “webinar” for the free trial.  (I have no affiliation with this company, nor do I receive a commission.  Please do your research to make sure that your personal needs will be met before purchasing ANY product.)

Also, if you have a father like mine (slightly stubborn, shall we say) who did not wish to wear any sort of alarm, a couple of things that you might say to convince them are “this is to make ME feel better, Dad…….do it for me” .  Or you might compare the system to the Triple A card that many of us carry around “just in case” and also that many of our parents gave to US when we first learned to drive.   One other item you might try is to reinforce to them that wearing this device will actually help them to maintain their independence in the long run and isn’t that what they really want?

The son and daughter-in-law became irritated with the mess.  “We must do something about Grandfather,” said the son.  “I’ve had enough of his spilled milk, noisy eating and food on the floor.”  So the husband and wife set a small table in the corner.  There, Grandfather ate alone while the rest of the family enjoyed dinner. Since Grandfather had broken a dish or two, his food was served in a wooden bowl. When the family glanced in Grandfather’s direction, sometimes he had a tear in his eye as he sat alone. Still, the only words the couple had for him were sharp admonitions when he dropped a fork or spilled food.

The four-year-old watched it all in silence. One evening before supper, the father noticed his son playing with wood scraps on the floor.  He asked the child sweetly, “What are you making?”  Just as sweetly, the boy responded, “Oh I am making a little bowl for you and Mama to eat your food from when I grow up.”  The four year-old smiled and went back to work.

The words so struck the parents that they were speechless.  Then tears started to stream down their cheeks. Though no word was spoken, both knew what must be done.  That evening the husband took Grandfather’s hand and gently led him back to the family table. For the remainder of his days he ate every meal with the family. And for some reason, neither husband nor wife seemed to care any longer when a fork was dropped, milk spilled, or the tablecloth soiled.
 
[Children are remarkably perceptive. Their eyes ever observe, their ears ever listen, and their minds ever process the messages they absorb.  If they see us patiently provide a happy home atmosphere for family members, they will imitate that attitude for the rest of their lives.  The wise parent realizes that every day the building blocks are being laid for the child's future.  Let's be wise builders and role models. 
 

The author of this story is unknown but it was retold on http://story-lovers.com. 

Here’s what happened:

My Mom, who is 86, and somewhat hard of hearing as many elders are,  lives in Canada in a senior apartment complex.  She received a call from a man who stated that her grandson was in jail for drunk driving (he had been at a wedding, had a couple beers and was caught driving the wrong way up a one way street) and needed money to bail him out immediately.  He mumbled the name a couple of times, and my Mom, being the helpful person she is, volunteered my son’s name.  “Yes, Tyler!” said the man.  “We need the money within 15 minutes and then he’ll go before the judge in an hour.”  So my Mom immediately called my sister to come get her and help her wire money to “him”.  She had all the details written down.

Praise the Lord that it just so happened that my sister and I were texting back and forth about some other banking business.  I had texted “You should go out to dinner tonight.”  About 2 minutes later, she texted back “No..no dinner celebration yet…gotta pick up Mom so she can wire $ to Tyler.  I just heard. Om goodness.”  I texted back “whaaat?  I don’t think I know about this.”

Apparently the man who had spoken to my Mom had said not to notify her grandson’s parents as he didn’t want them to know about the incident. 

So that was about the time I became frantic.  I called Tyler….NO ANSWER!  I called his Dad…..NO ANSWER!  NO ANSWER from his sister either.  Meanwhile Mom is on the way with my sister to wire the money.  I finally was able to talk to Tyler’s Dad who said he had spoken to him just a couple hours earlier and he wasn’t at a wedding; he was at school.  I texted my sister “Are you SURE we’re talking about Tyler?”  “Yup”, she responded.

You might wonder why I just didn’t dial my sister’s phone and talk to her.  Well, she was on her cell phone and not supposed to receive calls from the US because it’s about $3.00 a minute.  I texted her again “Ask Mom if she actually talked to Tyler.”  No response.

It was time for a voice to voice phone chat!  I dialed several times before she finally picked up and she told me they were just about to send the money through.  I heard the clerk in the background.  I asked where it was being sent….Montreal, I heard my Mom say.  MONTREAL????  My son lives in California. 

I told my sister to stop, don’t send the money; it sounds like a scam.  So they called the police and sure enough, that’s what it was.

Seconds away from losing $4400.00. 

If you are a caregiver for a family member who is under constant surveillance, this is less likely to happen, but for those of us with elders living elsewhere, it’s a absolute possibility, especially if they are living in a senior apartment complex or a community of “55 plus” residents.  Please advise all of your aging relatives or friends to NEVER send money by wire OR by mail  without first speaking to another family member.  Never follow anyone’s advice who tells them not to “trouble anyone else” with the information.  Tell them that if a family member is unavailable, to call their minister, rabbi or even their family physician for advice before acting on requests for money, no matter how urgent the matter might seem. 

Incidentally, Tyler was very glad to hear that he was NOT under arrest, as was his girlfriend, sister and father.

Look for a family practitioner or general practice physician to be the primary care physician for your loved one. General and family practitioners are trained to treat all aspects of a person’s health and well-being even though they have not specialized in a specific field. They treat the elderly as well as newborns, children and adults for everything from a splinter to a more serious illness.

Health Insurance Coverage

Choosing a doctor can be based upon several factors. One of the first aspects to look at is whether or not the patient’s health coverage is accepted by the physician being considered.  Most physicians will accept Medicare but it’s important to determine whether or not they will accept Medicaid and/or the supplemental policy if one is available.  If the doctor will accept the health coverage, the next thing to look at is accessibility.

Location and Accessibility

It is important to choose a doctor whose office is located close enough to be easily accessed for routine care and emergencies. If the elderly loved one is homebound, a physician who understands this and is willing to work around this detail to provide care is ideal.

Physicians can order home health nurses to draw blood, administer injections, take vitals signs and other basic medical procedures then report to the doctor. These procedures would normally be done at the doctor’s office, but when dealing with a homebound patient, getting them into the office may be a problem.

In addition, when transporting an elderly homebound loved one, distance to the doctor’s office can play a part in the convenience of the location. Determine if the time spent driving and the distance to and from a doctor’s office makes the doctor in question an acceptable choice for your loved one’s needs. If the doctor requires that your loved one must been seen at the office frequently, then distance can be an important factor when choosing the physician.

Office Hours

When choosing a doctor there are a few important questions about the doctor’s schedule that you should ask. What kind of office hours does the doctor hold? Do they have evening or weekend hours? How can you get in touch with them when the office is closed? Are the physicians who cover the “on-call” hours acceptible to you?

Hospital Choices

Most doctors have privileges at specific hospitals. When choosing a doctor, it is important to find out which hospital or hospitals the doctor has privileges at. This is the same hospital the patient would go to for emergency care, tests and surgeries in most cases. The size, location and reputation of the hospital may play a large role in your decision to choose or not choose a specific doctor.  Some towns and cities have specialty hospitals for certain conditions.  If your loved one has a condition that is treated by one of these specialty hospitals, it is important to determine if the primary physician has priviledges there.

Personality

Even the most qualified and credentialed doctor may not be the best choice for your loved one’s personal physician if their personality clashes with yours. You’ll probably want to choose a doctor that you genuinely like and feel comfortable with. Remember that you will need to be working closely with this person to advocate for the best health care for your loved one.  Imagine my surprise when I asked my father’s physician if he might be discharged in the afternoon only to hear him say “What part of HE WILL BE DISCHARGED TOMORROW MORNING did you not understand?”  However, there are also surgeons that I have worked with in the past who had terrible bed-side manners yet they are the ones with whom I would have trusted my life.

Choose a doctor who will take the time to speak with you as you advocate for your loved one’s health care. The doctor should be willing to listen to your concerns and answer your questions to your satisfaction. Remember, you are hiring them and paying them for their time.  The days of the primadonna physician OUGHT to be over.

Another consideration is the physician’s staff.

Do you like the physician’s staff? Are the doctor’s employees personable, respectful and pleasant? If you find receptionists, nurses and other staff members to be rude, then perhaps you should consider other physicians. These are the people you will be working with to schedule appointments, update prescriptions and access patient information. If you find them difficult to work with initially, it might improve over time but don’t expect it to automatically occur.

Ask the doctor if they have a Family Nurse Practitioner or a Physician’s Assistant in practice with them. These medical professionals assist doctors in caring for patients in many private practices. Decide if this is acceptable to you for your loved one’s care. If not, then you may need to continue looking or specify in the patient records that care must be provided by the doctor.  Keep in mind though that Nurse Practitioners and Physician’s Assistants generally have more time to spend with the patient and are trained to be patient advocates.  They are also often more accessible.

Making the Choice

After taking all of these factors into consideration, decide which physician you would like to care for your loved one. Schedule a new patient appointment and commit to making the new relationship work.