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Growing Concerns about Complications from Robotic Prostate Surgery

  
  
  

We’ve shared a good bit on here about treatment and complications for Prostate Cancer. One of the most interesting/frustrating things about medicine today is that so much can change so quickly. There are a lot of different opinions out there and it’s hard to know who’s right and wrong at any given moment. Personally, that makes me crazy.

So, in the interest of fairness, we wanted to share some different perspectives on robotic prostate cancer surgery. A few weeks ago we featured the pro-robot argument from Dr. Charles Chabert of Laparoscopic Urology Australia. Check it out here.

For the anti-robot argument we turn to a recent CNBC News article. Check out the relevant excerpts below.

When Intuitive Surgicalwent public 13 years ago at $9, it dazzled Wall Street with its sizzling story of something that would revolutionize medicine: a surgical robot called the da Vinci.

da Vinci robot surgeryBorn in Silicon Valley, the da Vinci was steeped in technology so advanced that it "overcomes many of the shortcomings" of traditional open surgery, notably less blood loss and a faster recovery, Intuitive boasted in its IPO filing.

Since then, da Vinci hospital robot placements and procedures have skyrocketed. Last year alone, installations rose by 21 percent to 2,585 units worldwide at a cost of more than $1.5 million each. And robotic surgical procedures leaped by 25 percent to 450,000.

While one of the downsides of robotic surgery is a lack of tactile feel, surgeons who sit at a console a few feet from the patients raved about its 3-D vision. "The vision compensated for everything," world-renowned prostate specialist Dr. Ash Tewari of New York Presbyterian Hospital said in a recent interview. He performs as many as four of the two-to-three hour procedures a day, four times a week. "If you look at it from a surgical standpoint, every surgeon's dream is to get to see exactly what he or she is doing and get to do it in a field (of vision) which is not pooled with a lot of blood."

Such testimonials have helped propel Intuitive into what Northland Capital analyst Suraj Kalia calls "the 'Apple' of the medtech sector."

Intuitive, which builds and sells the machines, also collects more than $100,000 in service maintenance agreements for each machine and sells the disposable instruments used by the machines for surgical procedures.

In recent years, as the da Vinci's popularity has grown, so have questions and concerns about its safety, training and the aggressiveness of its marketing.

However, a CNBC Investigations Inc. review, which included numerous interviews with surgeons, lawyers, ex-employees and patients and an extensive review of internal documents, multiple studies, lawsuits and depositions of current employees, shows:

  • A sharp rise in lawsuits and complaints about injuries, complications and even deaths following da Vinci procedures. At least 10 have been filed over the past two years, most of them in 2012; many more complaints, plaintiffs, attorneys says, are headed toward mediation.
  • Surgeons can use the robot to operate on patients after several steps, including at least an hour of online training, four hours watching two full-length procedures online, seven hours operating on a pig and as few as two surgeries, overseen by a more seasoned robotic surgeon. The number of supervised cases can vary by hospital.
  • A high-pressure sales culture driven by quarterly "quotas" on surgical procedures has led sales people to lean on surgeons to do more robotic surgeries, according to interviews with former salespeople and internal emails.

In some procedures, such as hysterectomies, robotic surgery is being promoted and used as an alternative to laparoscopic surgery, another so-called "minimally invasive" surgical technique. In prostatectomies, while robotic surgery is likely to result in less blood loss and faster recovery than traditional open surgery, the most feared side-effects of all—incontinence and sexual impotence—"are high after both," according to a study released last year by the Journal of Clinical Oncology.

Injury Complaints

"The robot has a place in surgery," said Dr. Francois Blaudeau, a practicing Alabama gynecologist who also is lead plaintiffs, attorney focused on da Vinci-related injuries. Blaudeau, who has been trained on the da Vinci, also cautions that "it is a sophisticated piece of equipment that has its own set of issues." One, he said, is that it can inadvertently cause serious injury.

Male Urinary SystemAccording to lawsuits, complaints, interviews with alleged victims, plaintiff attorneys and an FDA's database, many of the reported injuries during robotic surgery appear to be burns and other heat-related damage to intestines, ureter, bowels and other organs. Blaudeau and several surgeons interviewed for this story said the injuries can occur beyond the surgeon's range of vision and without the surgeon's knowledge and may only show days after the surgery. This, plaintiff lawyers say, has meant that many of the injuries and complications in the complaints have not been reported to the Food & Drug Administration as a da Vinci issue, resulting in an under-reporting of "adverse events" related to the machine.

Since 2000, the database shows reports of at least 85 deaths and 245 da Vinci-related injuries. (A complete spreadsheet of 4,600 adverse events, including machine malfunction, filed with the FDA is included in this Intuitive report by Citron Research, which does investment research.)

During the same period, roughly 1.5 million robotic procedures have been performed, suggesting reported problems are statistically insignificant.

But critics like Dr. Marty Makary of Johns Hopkins University Hospital believe the number of injuries and complications are under-reported. A study he co-authored, which is under review by the Journal for Healthcare Quality, cross-referenced the FDA's database with press reports and lawsuits and found eight cases that were either incorrectly or never filed with the FDA.

While that may be a "fraction of procedures that are done," said Makary, the industry has done "a poor job of monitoring the safety profile of certain new technologies, and this is a classic example."

Blaudeau and other surgeons we spoke with say they believe one reason for the injuries is the da Vinci's use of "monopolar" energy for cauterizing and cutting, which can create excessive heat. If there is a failure in insulation on the instruments, they said, it can cause what is known as a "stray current" or arching—when sparks from an instrument leap elsewhere.

Stray currents can occur in regular laparoscopy as well. However, a 2011 study published in the American Journal of Obstetrics & Gynecology said, "robotic instruments have a significantly higher incidence and prevalence of [insulation failure] compared with laparoscopic instruments."

Training on a Pig

Surgeons, plaintiffs lawyers and at least one lawsuit cite training as a concern. Typically it involves seven hours of training over a weekend, usually operating on a pig.

Then, based on the hospital's criteria, the surgeon is required to conduct two to five surgeries supervised or "proctored" by an experienced robotic surgeon before doing their first unsupervised operation. The more practice, in general, the better, but that also adds to the cost of training.

"Many surgeons are trained the same way, with no differences made as to their prior knowledge or prior ability prior to entering the robotic training," Bladeau said. "It's not reasonable to believe that every surgeon across the country can be adequately trained with one pig lab and two proctored cases."

The Marketing Drive

Underlying all of this, according to former salespeople and internal emails, is a company culture steeped in aggressive marketing techniques, that includes high-pressure sales efforts by Intuitive to hospitals and doctors.

"Our extensive field checks highlighted a story where aggressive marketing drives the message and true clinical utility seems secondary in nature," wrote Kalia, the Northland Capital analyst.

His comments are supported by our interviews with former Intuitive salespeople and internal documents, including those filed with the Taylor lawsuit. One common theme is an effort to prod surgeons to "convert" previously scheduled non-robotic surgeries to robotic surgeries to meet quarterly sales quotas.

Other emails show sales reps trying to persuade hospitals to lower the amount of supervised surgeries required before surgeons can operate solo.

Orange Line

As CNBC notes, not every hospital or surgeon is experiencing the same problems. Some hospitals that have the robot, have kept it low key. Massachusetts General, for example, has one robot, has never actively promoted it and has capped the doctors who can use it. "We have had a very conservative, cautious and skeptical approach to the use of it," said anesthesiologist Dr. Peter Dunn, who also oversees the hospital's new surgical technology as head of its perioperative operations.

Dunn said that after five years, Mass General, which prides itself on being on the cutting edge of new medical technologies, has determined the robot has not proven to be the best solution for all patients.

And while the hospital continues to consider new uses for the robot, Dunn said, "more important than the device, is the quality of the surgeon."

Check out the full article over at CNBC: http://www.cnbc.com/id/100564517

 

Surgical Urinary Management: Eliminate Condom Catheters!

  
  
  

Nurse HospitalWhile most doctors will tell you there are some serious drawbacks to condom catheters, there’s nothing that quite captures it for me than the story this guy, we’ll call him Bob, told about his surgery at a New York hospital in 2010.

We’ve redacted the identifying bits but here’s the bit I found most interesting… his experience of bladder management during and after surgery. We’re sharing that portion of his story below.

Orange Line

I went in for surgery at one of the best hospitals in New York. When I arrive, I’m immediately met; given a changing room, told were to go etc, very orderly…they put in an IV, and led to a waiting room, where I stayed for about an hour. Very well appointed, it was like the Ritz-Carlton lobby.

Finally, I’m escorted to the operating room, this turns out to be a five minute walk around hospital with my ass hanging out the back side of my “robe.” As we reach the operating room, my escort looks at me as we arrive in front of the open operating room doors; and my goodness, the look he gives me; it’s like meeting the hang man.

Incontinent ManIt’s now time to prep me…The head resident/fellow picks an intern we’ll call John.  “Lucky John” the intern gets to shave me. He doesn’t look too happy. In the process he asked me, what would turn out to be, the most important question of the entire affair: what kind of catheter would I like? Would I like a standard catheter (one that is inserted into the hole of your penis), or would I like a condom catheter (one that slides over your penis)? Now I don’t know about you, but I’m thinking nothing inserted into your penis can be good! So, I go for option number two, the condom catheter. “Lucky John” finishes shaving me, puts on the condom catheter and three hours later, the surgery done, I’m rolled into the recovery room.

Exhausted, but somewhat alert, I’m told I need to lie flat for six hours and not move. This is after the above three hours and three bags of IV fluid…I really have to piss now, but I can’t move, and I can’t piss with this catheter laying flat on my back. My bladder is talking to me at this point, it’s getting painful.

Nine hours later and now 4 bags of IV fluid in me, they help stand to take the piss of life, but first we have to remove the condom catheter. Whoever invented this should be shot. Not only is it uncomfortable, it is covered with a crazy glue substance that is impossible to remove without pulling the skin off of your Johnson, it is truly, incredibly painful, I had tears in my eyes, but that wasn’t the worst part, the worst part is when you realize that “Lucky John” the intern that shaved you, didn’t do such a good job. You realize that as the pubic hair attached to your scrotum and at the bottom of your shaft is being ripped out by the roots. I no longer needed to piss, I was somewhere between wanting to eviscerate the intern, and shooting myself, it was that bad. Two days later, and one shower, the glue still has my Johnston sticking to my leg, although there’s no pain involved, I flinch every time I adjust.

Orange Line

I don’t know about you but that story made me cringe in sympathy.  Condom catheters utilize a strong acrylic adhesive similar to what you find on duct tape or mild superglue. Now imagine ripping that off your skin 4-5 times a day, then putting a new one back on. For men who need to intermittent cath, that’s a regular occurrence. Is it any wonder doctors and patients are flocking to abandon condom catheters for a healthier, painless alternative?

Personally, for any man in his situation, I’d recommend a hydrocolloid external like Men’s Liberty that doesn’t have quite the barbaric side effects that Bob described above. Which would you choose?

 

Bladder Adjectives from Men's Liberty

  
  
  

Your bladder can be a lot of things - flaccid, neurogenic, neurotic, incompetent, incomplete, reflexive, spastic… the list just goes on and on. So which one of the list above doesn’t belong, which one isn’t like the rest?

I’ll give you a minute to think about that. No Googling the answer.

So did you guess incompetent? I did (and I was wrong). It’s a trick question. They’re actually all possible adjectives for your bladder’s behavior. So in the interests of a little public education, I’ve pulled together the definition of each of these common bladder adjectives for your reference.

  • Male Urinary SystemFlaccid - a bladder that is unable to contract sufficiently to empty. It may be secondary to neural deficiencies or chronic obstruction. The bladder can be emptied by pressure applied to the area or via catheterization. Also called atonic bladder, autonomous bladder, nonreflex bladder.
  • Neurogenic - Neurogenic bladder is a dysfunction that results from interference with the normal nerve pathways associated with urination. There are two categories of neurogenic bladder dysfunction: overactive (spastic or hyper-reflexive) and underactive (flaccid or hypotonic). An overactive neurogenic bladder is characterized by uncontrolled, frequent expulsion of urine from the bladder. There is reduced bladder capacity and incomplete emptying of urine. An underactive neurogenic bladder has a capacity that is extremely large (up to 2000 ml). Due to a loss of the sensation of bladder filling, the bladder does not contract forcefully, and small amounts of urine dribble from the urethra as the bladder pressure reaches a breakthrough point.
  • Reflexive - Reflex bladder is also known as spastic bladder. It occurs when the stretch receptors in the bladder wall are triggered from a full or filling bladder sending signals to the brain and spinal cord to relax the sphincter muscles. This is an automatic involuntary action, and the person has no control over when the bladder will empty. Sometimes the sphincter muscles will not relax properly when the bladder contracts, and this can lead to a condition called Dyssynergia. One danger of dyssynergia is that it can lead to an overfull bladder, which could damage the kidneys from a reflux of urine.
  • Neurotic BladderNeurotic – an outdated term for patients with a history of neurosis that center on the bladder. It can also be called irritable bladder. Key symptoms include: worry and anxiety focused on bladder activity, pain while urinating, nervous spasms of the urethra and bladder neck, persistent feeling of weight over the pubic region.
  • Incompetent – A disorder of the sphincter muscles that restricts the functionality of the muscles that contract and release to control urination. Predominantly found in women who have had multiple vaginal births and men with enlarged prostates.
  • Incomplete – A function of Underactive Bladder Syndrome (UAB). UAB is a urological condition characterized by bladder underactivity causing difficulty in voiding, resulting in incomplete bladder emptying. The International Continence Society (ICS) refers to the condition of detrusor underactivity, defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a usual time span. Bladder underactivity may cause overdistention of the bladder, resulting in overflow incontinence.
  • Spastic - a form of neurogenic bladder caused by a lesion of the spinal cord above the voiding reflex center. It is marked by loss of bladder control and bladder sensation; incontinence; and automatic, interrupted, incomplete voiding. It is most often caused by trauma but may result from a tumor or multiple sclerosis. Also called automatic bladder, reflex bladder.

Any adjectives I’m missing? Put your entries (and their definitions) in the comments section!

 

Reducing the Stigma of Incontinence

  
  
  

Cheryl GartleyWe’ve talked quite a bit about how to talk about incontinence and the importance of addressing the stigma of incontinence in society. Incontinence is a symptom of a medical issue, not a standard part of life, no matter your age. So we’re thrilled to share the article below from the Mundelein Review!

They interviewed our pal, Cheryl Gartley, CEO of the Simon Foundation for Continence! See full article here: http://mundelein.suntimes.com/opinions/17855744-598/taking-stigma-off-incontinence.html

Orange Line

Watching daytime TV, and all of the commercials for incontinence products, one might think that incontinence is a normal part of life and aging.

While television commercials do help in decreasing the stigma attached to incontinence, it is still a very sensitive subject and experts say that is not something that individuals should just live with.

Incontinence Hot Line“Incontinence is a symptom of something else happening in the body,” says Cheryle Gartley, CEO of The Simon Foundation for Continence, based in Wilmette. “As we age there are changes in the body. That very fact can make [seniors] more susceptible to incontinence.”

Gartley says that talking about incontinence can be challenging for many people, but she believes that it is so important for seniors, and others, who experience symptoms of incontinence, to talk with their physicians so that the underlying reasons can be explored.

“Incontinence is a generic term for the way that the bladder is misbehaving,” Gartley said. “Specifically say what is going on to your doctor. Do you leak urine when you lift your grandchild or when you sneeze or laugh? That is one set of circumstances that indicates stress urinary incontinence.

“Do you have a sudden urge to urinate and it may or may not be associated with leakage? That’s overactive bladder and that’s caused by something different in the body.”

She also says that there is a lot of misunderstanding about issues relating to incontinence and the bladder. “Most people do not understand that the bladder is a muscle. They think of it as a vessel. That misperception leads to some things that aren’t good for the bladder.” Gartley said that when someone stops to use the bathroom when they do not have the urge, but are going “just in case,” it can actually create problems, rather than helping. “If the bladder never gets the chance to fill to its full capacity, like any other muscle that isn’t used, it doesn’t get the chance to do the job it was designed to do and you increase the chance of a misbehaving bladder.”

Gartley also understands that people may be embarrassed to talk about incontinence problems. She says although it may be difficult, it’s important to remember that physicians and nurses are used to these issues and they are trained to help.

Simon Foundation Logo“We’ve done work on stigma a lot in health care.” said Gartley, who started the Simon Foundation 30 years ago because of a personal experience with incontinence. She started to look for help herself, and couldn’t locate any support. Shortly after starting the organization they were featured in an Ann Landers column. A few days later they received a call from the post office: 30,000 pieces of mail from people impacted by incontinence had arrived. “The need was unbelievable,” she recalls.

The Simon Foundation just published a new book, “Managing Life with Incontinence,” to support families and individuals. Gartley says the book is unique because in addition to providing information about how to talk to doctors, family and friends and what resources are available, there are stories of individuals who actually are affected by incontinence. The Simon Foundation can be contacted online at www.simonfoundation.org or (800) 23-SIMON.

 

So What is Robotic Laparoscopic Radical Prostatectomy Exactly?

  
  
  
Quite a few of our customers are dealing with incontinence as a result of prostate cancer treatment, so we’re thrilled to be able to share the guest post below from Dr Charles Chabert of Laparoscopic Urology Australia. He specializes in laparoscopic surgery which may reduce post-surgical complications like incontinence. Not to cannibalize our own customer base or anything but, lifelong incontinence is something we wouldn’t wish on anyone. So here’s a little info to whet your appetite!

Prostate CancerRobotic laparoscopic radical prostatectomy is performed on male patients with prostate cancer. Laparoscopic surgery is less invasive than open prostate surgery. The removal of the prostate gland is called a prostatectomy. Prostatectomy is the removal of all cancerous cells. Keyhole surgery is also known as laparoscopic surgery, which aims to be minimally invasive with the use of tiny surgical cameras. The cameras are placed in the body through small incisions. Laparoscopic instruments can be hand held by surgeons or a computer can control them. Advanced computer systems that are highly advanced will control robotic arms to perform the prostate surgery.

Prostate cancer or Adencarcinoma grows from the glands and is a group of cells. The cells produce and give off fluids and the cancer comes from these fluids. Cancer can also take on the form like a gland in structure. When cancer is detected in the early stages, most surgeons will perform the open prostate surgery. The problems patients face with the open prostate surgery are urinary incontinence and erectile problems. Almost 20 percent of men develop urinary problems and 70 percent of men have erectile problems that keep them from having an erection strong enough for intercourse five years after the surgery.

With the advancement of robotic laparoscopic surgery, patients will have fewer problems in these areas, because the surgery is less invasive and easier on the more susceptible areas of the body to heal.

Surgeons need to be highly skilled in order to do laparoscopic prostate surgery while holding the instruments. Some parts of the surgery are extremely difficult and delicate to perform. When performing robotic prostate surgery the robot does all the necessary cutting while the surgeon controls the robot through a computer. The robot does all the surgery but the surgeon does all the thinking and directs the robot for the operation. The surgeon directs the arm and wrist movements of the robot while seeing the images that are in three-dimensional form on the computer. This way the surgeon gets a very natural feel while directing the robot.

Prostatectomy Incision ComparisonRobotic prostate surgery involves the insertion of six laparoscopic ports into the body. These small holes go through the body wall so the instruments can be placed safely. One of the ports is used for the insertion of a small camera for the surgeon to see what is going on with the surgery. Two more ports are used for the arms of the robot that will be doing the cutting and holding of body tissues. All three of these ports are then hooked up to the prostate surgery machine. The other three ports that were opened up are for any other laparoscopic pieces of equipment or for the surgeon to use if human hands are needed to work on the patient.

An extremely specialized computer is used that will control all the motions of the camera and the working arms of the robot, by the surgeon who sits at the console. The nurse and assistants that are right at the side of the patient on the operating table change the instruments that are used by the robot. The surgeon controls all the movements of the robot that is inside of the patient. The nurses and attendants will do all the other tasks that the robot cannot do on its own. The surgeon will control the robot using his thumb and forefinger on the controls and watching the images in three-dimension on the computer screen.

Laparoscopic Radical Prostatectomy DoctorThe robotic instruments allow for more movement, which gives the surgeon a better chance to do work that is more detailed during the surgery. The cameras take in depth images that are high quality three-dimensional so the surgeon can see everything clearly. The images can be enlarged up to ten times on the computer giving the surgeon precise control over all aspects of the surgery. With the magnified images, the surgeon will have precise movements with the robotic arms and nerve damage can be avoided.

Patients will have a reduced blood loss and transfusions are unusual for patients that have robotic prostate surgery. Patients will also have a shorter hospital stay and less discomfort after the surgery. Patients can return to their daily routines faster than with open radical prostatectomy surgery.

For more information on laparoscopic radical prostatectomies and other forms of prostate cancer treatments, visit http://www.prostates.com.au/.

 

Senator Paul - Extend Your Next Filibuster with Men's Liberty!

  
  
  

An impromptu filibuster is an unusual event. And while we wish to remain entirely apolitical, I can’t help the spark that occurred when I read this morning that Senator Rand Paul’s impromptu filibuster was brought down in the wee hours of the morning by the persistent demands of his bladder. After 12 hours and 52 minutes, nature was calling and he simply had to answer!

Rand Paul FilibusterWhen Strom Thurmond set the record for a one man filibuster (24 hours, 18 minutes) in 1957, he prepared well in advance. He intentionally dehydrated himself in the steam room to reduce the pressing need to visit the little boy’s room. He also had a little help from his colleague Barry Goldwater who took the floor briefly for a entry into the Congressional Record and allowed the Senator a brief respite.

Senator Paul did not plan quite so far in advance. Fortunately, there is no need for Senator Paul or any other gentleman to dehydrate himself in order to avoid the bathroom or to rely on the kindness of his colleagues. Instead he can use Men’s Liberty and attach it to a leg or bedside bag. With a wear time of 24+ hours, you too can have that competitive edge to beat the filibuster record.

In this spirit, today, we’ve sent a pre-filibuster care package to Senator Paul for the next time he takes the stage. We included 3 Men’s Liberty devices, a leg bag and FreeDerm remover wipes. Men's Liberty is a revolutionary new device for managing men's urinary incontinence that should easily allow him to beat Strom Thurmond’s record and set a new bar for Senators talking at length without actually saying anything. Senator Paul’s filibuster was the 9th longest in Senate history, but he’s a young man, with many more potential filibusters to come!

Senate Majority Leader Harry Reid, D-Nev., may not have agreed with the substance of Paul's remarks but, according to USA Today, he saluted the GOP senator for exercising his right to speak at length.

"One thing I learned from my own experience with talking filibusters: To succeed, you need strong convictions but also a strong bladder," Reid said. "Senator Paul has both." May neither of these gentlemen need to exercise their bladder to this extent in the future.

And for any other Senators out there, if you’re contemplating a filibuster, let us know!


Wee Answer Wednesday with Men’s Liberty

  
  
  

You’d think we’d run out of questions after a while, especially since we do this every week. In actuality, not really. With a growing base of new customers and healthcare professionals joining the Men’s Liberty family, there’s always someone new with questions I’ve never heard before. So I have to tip my hat to our Customer Care Reps and our Customers who so consistently think outside the box in ways I’d never expect. I salute you!

 

1. Why doesn't the small pouch drain into the bed bag? I have to almost lay the bag on the floor to get it to drain.

    Doctor Bed BagThe Men's Liberty utilizes gravity drainage, meaning the bag must be below your bladder in order to drain. From your question, it sounds as though urine is draining into the small bag but not into the bed bag, which can indicate that there is an issue with the bed bag or tubing. I suggest trying a different bed bag and seeing if the same issue occurs. I would also recommend checking all your tubing to ensure that it is not twisted or kinked. If none of these resolves the issue, please call our Customer Care team and we will work with you to troubleshoot the issue and make sure we get it resolved for you!

    2. You say do not remove plug on bottom. How do I empty the urine from the bag if I don't pull the plug? The bag does not hold very much fluid. My first day I had to empty the bag every two hours.

      If you are regularly producing more urine than the small pouch can handle, we recommend attaching the drain plug to any standard leg or bedside bag to ensure sufficient drainage. However, if you just dribble and leak, the small pouch may be enough.

      So unless it is connected to another large drainage bag, it is important to keep the plug closed in order to prevent leakage.

      3. You said that it is covered by Medicare and insurance. Are all supplies needed in the future also covered and how do you receive supplies?

        Yes. Once we get a letter of medical necessity and progress note from your physician, our distributors can ensure reimbursement from Medicare and/or your insurance provider. Additional documentation for future orders is obtained annually in order to ensure continued reimbursement. Our Customer Care team will take care of all this paperwork for you so that you get your supplies when you need them.

        4. You asked my doctor to sign a letter of medical necessity. What is that? Is it like a prescription?

          It’s similar. A Letter of Medical Necessity (LMN) is slightly different from a prescription and it is not necessary to purchase the product. If you wish to pay cash, you can do that, unlike prescription items like Viagra. However, a LMN is required in order to secure coverage for the product under Medicare or your insurance plan.

          5. I’m just getting out of the hospital and will have a home health nurse helping me for the next 6 weeks. I’d like to resume using Men’s Liberty but the home health agency doesn’t want to buy the product, what can I do?

            Caregiver and ManFirst, glad to hear you are on the mend! Second, due to Medicare regulations, only one entity can bill Medicare at a time. During a home health episode that means that they are the only ones who can bill your Medicare so they have to purchase all products you will be using, including Men’s Liberty. Unfortunately, sometimes that means they want to use products they are more familiar with, such as diapers or condom catheters. If your home health agency is reluctant, feel free to connect them to our Customer Care Team. We are happy to inform them about the product, why people use it and the benefits they can see. Once they’re bought in, it’s a lot easier to get them to supply your choice of product.

            And last, but certainly not least, you can always look for a different home health service. Although sometimes it’s hard to remember, you are the customer here and you have the power to hire and fire. If your current provider isn’t providing the level and quality of service that you need, look for someone else who will!

             

            Men’s Liberty Announces New Partnership with Eloquest Healthcare!

              
              
              

            Courtney BurgeWell, we’re just back from Detroit and let me tell you, brrrrrr. For us Florida types, that was just NOT okay! But snow aside, it was a great trip and we’re thrilled to be able to announce that we are kicking off a new partnership with Eloquest Healthcare®, Inc.!

            Eloquest will be promoting our new urinary management device in hospitals all over the US! So our CSO Wendy, and Head of Sales, Courtney, raced to Detroit for an in-depth training with Eloquest’s head honchos and sales gurus.Wendy Snow Angel

            It was great to get to share some of the oodles of info we have about incontinence with a really compassionate, engaged audience. They really got it!

            The gentleman below is Terp, the head of National Sales and as you can see, he looks very pleased with himself after he successfully applied the Men’s Liberty to an anatomical model. Terp was one of about a dozen trainers who learned how to apply the device and how Men’s Liberty can change lives.Eloquest Terp

            So while we won’t be officially launching until July, we’re thrilled to be getting started! And, no kidding, there’s quite the mountain to climb. In 2009, there were an estimated 38 million hospital admissions, of which 25% received indwelling Foley catheters. An estimated 38% of those catheters were NOT medically necessary. So what does that mean in practice? It means that in 2009, roughly 3.6 million people were catheterized in hospitals for NO reason! Patients were put at risk for avoidable infections, endured extended hospital stays and thousands of dollars in added bills accumulated, without any medical justification. Add into that the number of patients utilizing adult diapers, bed pads and condom catheters and the costs just keep rising. Does that sound okay to you?

            So that’s the challenge. And we’re looking forward to working with Eloquest to promote discreet, dignified, dependable urinary management in acute care! We’ll keep you all updated as we get closer to that July launch!Eloquest Logo CMYK NoBackround 200x73pixels

            Eloquest Healthcare®, Inc. launched as a Ferndale Pharma Group company in February 2008. Eloquest Healthcare provides solutions that drive positive outcomes for patients, caregivers and hospitals while complementing existing treatment protocols. You can find more info here:  http://www.eloquesthealthcare.com/

             

             

             

             


            "I can do that!" Adaptive Athlete Profiles from ABC Medical

              
              
              

            “Adaptive Sports! It felt like I was reborn. It was a new life.It is like day and night. When I saw wheelchair softball on the TV, I said 'I can do that!'. I felt the sun shine in my life again." Hector Bruno, Chicago, IL 

            Hector Bruno 150pxWhere were you born and raised?
            I was born in Manati, Puerto Rico. My family moved to Chicago when I was 5 years old. I’ve lived in Chicago ever since.

            Are you involved with adaptive sports?
            Yes a lot! First, I started playing wheelchair softball. Then, I got involved with wheelchair basketball, hand cycling, and sled hockey.

            How did you become involved with adaptive sports?
            I have a spinal cord injury due to a gun shooting in 1980 in Chicago. For 7 years, I did not know about wheelchair sports and was having a really hard time with life. Then, one day I was watching tv and saw a commercial with Keith Wallace, the coach of a Chicago wheelchair softball team.

            What has adaptive sports done for you?
            Adaptive Sports! It felt like I was reborn. It was a new life. It is like day and night. When I didn’t know about adaptive sports, I did nothing for years and years. Then all of a sudden, I saw wheelchair softball on the TV and I said “I can do that”.  When you try it, you get hooked. It‘s the best thing that’s happened to me.

            What are your long term aspirations?
            I want to spread the word about adaptive sports and ABC Medical.  I want to get as many people involved in adaptive sports - the sooner the better. As soon as someone gets out of the hospital, they need to start getting involved. They should not have time to think about their situation and be devastated. 

            You recently started coaching children? How do you like it?
            Yes, I coach the RIC Cubs team. It’s the junior team. I love to see the look on their faces when they catch the ball.  The children are between seven to fifteen years old.

            So they are either newly injured or just starting to play wheelchair sports?
            Yes to both. The look on their faces is great. I regularly tell them “good, you’re doing a great job,” because it encourages them.  They like playing a lot and are extremely happy. They are like little angels.

            What is one thing that you wish people knew more about adaptive sports?
            Adaptive sports provide great options for people. It helps you get to know people who are involved in sports. It gives you confidence and inspires you. It makes you the best person you can be and helps you move on.

            How did you deal with the challenge of being in a wheelchair?
            I love challenges. I moved forward. You see the challenge, move forward and get ready for a new challenge.

            What would people be surprised to hear about you?

            I am stubborn. I am very stubborn. I hate when people say “no” or “you can’t”. The more you say “no” to me, the more I’ll say “yes”; the more you say “you can’t” , the more I’ll say “I can”.

            Do you have anything else you’d like to share with us?

            My only message is to always think positively, never take bad advice. Listen to those who give good advice.

            Can you explain what you mean by “bad advice”?
            People say “you can’t do this,” “you can’t do that because you are in wheelchair.”

            Are there people out there who give bad advice?
            Yes, a lot of people give bad advice!  People who are ignorant about people in wheelchairs always give bad advice. They make you feel more crippled than you really are. That’s unnecessary. Unless I ask your opinion, do not approach me and try to tell me what to do. I appreciate it, but no thanks.

            For more information or the full interview, visit ABC Medical's blog!

             

            Four Tips for Talking to Your Patients about Incontinence

              
              
              
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            A man walks into a doctor’s office for his monthly check up with his daughter. During the examination, the doctor asks how his nightly incontinence is.

            "Its fine," says the old man. "I just get up and go to the bathroom, and God turns on the light for me."

            The doctor finishes up the examination, and then calls in the daughter to tell her about the God-light thing.

            "Oh, my God!" says the daughter. "He's been using the fridge again!"

             Pee Stamp

            I burst out laughing when I heard that joke. In our office you learn to be a connoisseur of incontinence and diaper jokes. It’s just how we cope. The truth is we talk about incontinence all day, so sometimes our sense of normal conversational boundaries gets a bit skewed.

            I guess that’s why I sometimes still get surprised by healthcare professionals who don’t talk about incontinence with their patients. I always figured they spent their lives mired in blood work, strange abscesses and bladder problems, they had to be used to it by now!

            Turns out, I was wrong. Most doctors don’t talk to their patients about incontinence. Whether it’s because of shame, embarrassment or obliviousness, it doesn’t happen nearly as often as it should. According to the National Association for Continence there are 25 million incontinent adults in America today – the notion that only a fraction of those people ever talk to their doctor about a treatable health issue is, frankly, kind of scary.

            So, with those thoughts in mind, we’ve pulled together our top four tips for doctors when they need to ask their patients about the bladder.

            #1: Incontinence doesn’t mean they have a problem with their bladder.

            There are lots of medical and congenital conditions which can impair the physical function of a person’s urinary system. But most people’s incontinence isn’t caused by a physical impairment. Many older gentlemen simply can’t reach the bathroom in time or are losing the muscle strength to hold it. So change your expectations and understand that you aren’t limited to discussing incontinence only when its associated with another diagnosis.

            #2: If there is a caregiver involved, ask them too!

            CaregiverAs family members age, they may increasingly have a partner or caregiver go to the doctor’s office with them. They may also employ part-time care assistants to help with household chores. These caregivers are a resource for patients but also for their healthcare professionals. They can provide an objective response that may be more informed and may be able to recall events in greater detail.  Additionally, if they are cleaning up after an incontinent person, they have a strong incentive to look for options without the embarrassment.

            #3: If you see something, say something.

            If you notice a patient is wearing a diaper or pad, say something! If you noticed dried urine stains on their pants, say something. If you smell ammonia or urine when you’re near him, say something.

            Sensing a theme here? I know you may be uncomfortable, but I swear, it gets easier with time. And just know that your patient is probably even more embarrassed than you are. But that doesn’t make the conversation less necessary.

            #4: Get informed on the options!

            Great, you’ve started that conversation; your patient has a problem, now what?

            It’s important to know what options are available for managing incontinence. It’s not just diapers and pads any more. There are healthier options that are covered by most private insurance plans and by Medicare. I won’t bore you with all the options here but I would recommend checking out the article below on incontinence management options.

             

             

            And since you sat through all that, here is another incontinence joke:

            Two elderly gentlemen from a retirement center were sitting on a bench under a tree when one turned to the other and said:

            “Slim, I'm 83 years old now and I'm just full of aches and pains. I know you're about my age. How do you feel?”

            Slim said, “I feel just like a newborn baby.”

            “Really? Like a newborn baby?”

            “Yep. No hair, no teeth, and I think I just wet my pants.”

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