Take it all off

 What ever happened to Patient modesty?

Take it all off?  Why?

 This phrase is said to patients in medical facilities all over.  In many (perhaps most) cases it isn't even necessary.  But somehow the medical "professionals" have forgotten that stressed and uncomfortable patients do not heal as fast as ones that aren't stressed.  And stressed patients say and and do stupid things.  It's not in the patients' best interest.  And this is another thing doctors won't generally tell you.

Here is a nice article "Keep Your Pants, and Your Dignity, at the Hospital" Seems like something a service industry (medical) should strive for.

"Dr. Harlan Krumholz, a professor of medicine and public health at Yale School of Medicine, has suggested patients may suffer from a period of vulnerability, which he called the "post-hospital syndrome." The combination of a recovering body and a stressful hospital experience could make people less able to fend off new diseases,"

And beyond contracting new diseases it can make patients not seek medical treatment. And once sedated most hospitals treat every person like a piece of meat and do nothing to protect their dignity.  They do not ask the patient if it ok to expose their privates or remove their gown prior to sedating them and doing just that.  They don't because they don't have to.  Sedated and anesthetized patients aren't able to speak for themselves.  And if the hospital doesn't tell the patient details of what they did to them in surgery how will they will ever know.  The hospitals ensure that no family or advocate is around to know either.  And what the patient doesn't know won't hurt them, right?  So the medical staff can do as they please.

Much of this nudity is totally unnecessary.  I can hear you now.  What's the big deal.  They are "out" so it's not hurting the patient.  They can't be embarrassed.  Well some people have religious beliefs that go beyond if they are embarrassed or not.  And some have personal beliefs.  Is it ok for a hospital to give a sedated vegetarian meat?  They won't know they ate it.  Or a Jew pork?  But somehow it's ok to strip them of their clothes and dignity regardless of what the patient believes and regardless of their desires. There are also people who have had terrifying sexual assaults in their past.

So many times "take it all off" is said when it is completely unnecessary.  Remember the anesthesiologist that got a big fine for making fun of a patients genitals while getting a colonoscopy? Article  Should have never happened.  But you say you have to be naked for a colonoscopy.  Um... no.  Ever hear of Colonoscopy pants? See some here Your doctor didn't mention that?  Yes they only need access to the anus.  Not the genitals.  The rest of you could still be covered and the pants allow access to the part that is needed.  I am betting that anesthesiologist, Tiffany M. Ingham, is wishing now that her hospital had used colonoscopy pants.  If the hospital had used them they would have avoided traumatizing a patient, a lawsuit, bad press, loss of a employee, etc.  All for a few $ in clothing?  Was that bad situation caused by the negligence of the hospital?  Hummm...

Another good article  "The dreaded hospital gown, described as health care's prison jumpsuit, often imposed on patients needlessly"

"Researchers in Montreal and Toronto surveyed patients at five hospitals, finding that almost 60% could have worn clothes that covered their whole bodies, but that barely one in 10 had on more than a gown."

So many surgeries are done where they remove part or all of the patient's gown and leave them totally naked.  A helpless, unconscious person laying totally naked in a room full of people.  What does this sound like?  And there are so many times when this is not necessary.  Heck many states require strippers to cover their nipples.  Patients don't even get as much dignity as a stripper

Here is another time that "take it all off" really hurt the hospital.  In trying to catch an employee stealing drugs, the hospital videotaped the operating room.  In doing so captured the patients that had, out of routine, been stripped totally naked by the medical staff.  Eventually the videos got out and were viewed by many people that were not even medical personnel.  And now the hospital has a big lawsuit.  Read more details article.  If the patients even had even the most minimal covering there would have been NO lawsuit.  None.  When will hospitals learn?  Protecting patients protects the hospital, too.

.... Come home from the hospital with something "fixed" only to suffer from emotional trauma from being put on display naked for a crowd in the surgery.  Seriously, when did this start being ok to everyone?  It is not ok to me.

 Apparently I'm not the only one:


 Medical Patient Modesty
Read the comments section

Another article: "What Your Doctor Won’t Tell You About Surgery"
written by a doctor where he states "We all see you naked".  He admits

"When I had my appendectomy in college, I was absolutely mortified when I discovered the next day that the surgeon, residents, nurses, assistants, techs, aides, and probably several dozen other people all saw me au naturel".

Now that he's a Doctor and is the one with his clothes on his story changes....... :-(  Apparently his own experience with his appendectomy taught him nothing!  What's so hard about letting people stay modest.  When going for a surgery on a limb (not the torso) there is NO reason to have ones' genitals exposed.  None.  Period.  Medical professionals when will you get a clue?

Even very simple changes would greatly improve patient comfort. Nurses at LDS hospital fought to make some changes to their outpatient surgery procedures. One of these, was to allow patients to wear underwear.

"SOME PATIENTS were especially bothered to spend half the day without underwear -- for shoulder surgery, say. Ms. Lelis was convinced this longstanding practice was meaningless as a guard against infection, persisting only as the legacy of a culture that deprived patients of control. "If you're practically naked on a stretcher on your back," she says, "you're pretty subservient." The nurses persuaded an infection-control committee to scrap the no-underwear policy unless the data exposed a problem; they have not. " source

And there we have a key problem, most of the time there isn't a medical need for the patient to be naked. It is just "how it's always been done" or it is more convenient for the medical staff. Patient dignity should be more important than the staffs convenience. Patients should not be put unnecessarily in a degrading and demoralizing situation that leaves them feeling vulnerable and powerless.

I think this blogger says it well (and the rest of his article is good too),

I have always stated: "Medical treatments and procedures would be radically different if the providers had to be in the same state of exposure as the patients."

More on this topic:
Patient Modesty
How to Protect Your Modesty in a Medical Setting
We All See You Naked, But We Don't Care

Preventive Medicine: Overdiagnosis

 

Over-diagnosis

 from the blog "Why is American health care so expensive" the post Preventive Medicine: is a great article that everyone should read.  It is wonderful to see a Doctor that can think and make recommendations based on the individual not just follow blanket recommendations based on averages or propaganda.

Tetanus Boosters every 10 years, a waste of time and money

Tetanus Boosters Every 10 years a waste of time and money?

 The other day I scraped my knee on a piece of metal.  Thought "maybe I should go get a Tetanus shot".  Heard that preached to me at the doctors since I've been young.  I remember even getting a few boosters but hadn't had one in awhile.  Feeling a bit guilty I thought I'd better make an appointment.  Then it occurred to me to check out Tetanus shots before calling for an appointment.  In short the decision seemed quite clear to skip the appointment.  And I'm once disappointed in the lack of information that the Doctors give out.

In this article "Adults Don't Need Tetanus Shot Every Decade".  Our very own U.S. Government recommends that we shouldn't get shots every ten years but every 30!  (this article is not online anymore.  So here is another on the same topic link) Apparently the 10 year thing was just pulled out of a hat or something.  It's not based on a study or any kind of empirical data.  Where do all these bogus recommendations come from.  Why do we, like dumb sheep, just follow them.   Well now we have information at our finger tips we should be ashamed of ourselves.

In the UK they do a vaccination schedule when the children are young and that's it.  No 10 year boosters.  No 30 year boosters.  none.   Their information on Tetanus seems to have a bit more science around it.  Check out the UK government's article here.

Here is a quote for those that don't want to go to the link:
"In 2013, there were only seven recorded cases of tetanus in England and Wales, and no deaths.
Most cases occur in people who were never vaccinated against the condition or didn't complete the entire vaccination schedule. People who inject illegal drugs are also at an increased risk."

 Well then.  My fear of Tetanus has dropped substantially.  It appears the vaccine is a good idea.  But the 10 year booster.  Nope.

Medical personnel forget its a Tetanus vaccine

This scenario occurs all the time.  Pretty sure it happened to me as a teen.  Get a serious cut then let's give you a Tetanus shot.  Wait!  Tetanus shots are Vaccines!  Not Cures.  Seriously?  If you went in with chicken pox would you get a chicken pox vaccine?  No.  How about the flu.  If you have the flu should they give you a flue vaccine?  No. Vaccines only work if they are used BEFORE the person is infected.   Then why when do they want to give someone with a cut?  If they already have tetanus then the vaccine isn't going to help.  And if they don't then they aren't going to get it now.  People have forgotten that Tetanus shots are vaccines as they leave that word off when talking about Tetanus shots.  It is a Tetanus vaccine.  Let's not forget that.

Think you night have Tetanus

Again don't get the Vaccine.  See above.  What you need is "tetanus immunoglobulin".  Which is not what we call a "tetanus shot" in the USA.  And good luck getting it.  Most doctors don't keep it around.  But tetanus immunoglobulin what you need.  And if you ask for it be sure to see the label on the container.  Unknowing people will try to pass off the Tetanus vaccine as the correct shot because it is all they know about.  Don't they teach this stuff in nursing or medical school?

Product Review: Minna kGoal Smart Kegel Exerciser

Product Review: Minna kGoal Smart Kegel Exerciser

Sitting in the provided stand

I purchased kgoal, produced by Minna Life, in December and have been using it nearly every day since-- so for nearly two months. I typically do each of the workouts each evening, so 10 minutes of total exercise. (Yes purchased.  This is not a sponsored review.  Free stuff would be great.  But sadly I haven't received any.)

The kGoal  is basically an air-filled rubber bulb which you insert in your vagina. It also has a little arm that stays outside.  It connects to your phone or tablet via Bluetooth. When you squeeze the bulb with your vaginal muscles, it registers on your electronic device. There is also the option of a vibration response to squeezing with two different levels of vibration possible. There is an internal vibrator and an external one. I found I did not care at all for the external one (on the little arm that sticks out). It was distracting rather than helpful. So I turned it off and for a number of weeks used just the internal vibrator and that was okay. Then I turned that off as well and found I like it best with no vibration, but that is a personal preference. The setting is easy to change in the software settings and worth experimenting to find what works best for you.

Size relative to a typical tampon

I've seen complaints in other reviews about the size of the unit. Yes, it is larger than a tampon but if you have had sexual intercourse (if you haven't why do you want this), it is no larger than the other thing that usually goes in your vagina.  And it whole lot smaller than the baby which came out-- causing you to need a kegel exerciser. With a little bit of lubricant, I have had no trouble inserting or removing the exerciser and have experienced no discomfort.

Air valve at bottom

I have had a bit of trouble getting the amount of air in the bulb just right. There is a little valve at the base which you press to allow air in or out. Sometimes, I don't get the right amount and it seems to throw off the calibration with my phone-- I release my muscles but it doesn't register as zero in the software. If I mess with the air valve a bit more, it usually fixes that problem. (For whatever reason, my husband is better at operating the air valve than I am!)

The little light on the arm glows white when first turned on then turns blue when connected via bluetooth.

I have had no problems with the blue tooth. However it is important to turn things on in the right order.  Turn on the exerciser first, THEN open the app. Wait a few seconds and it connects and the light on the exerciser turns blue. My iPhone 4s has connected every time and never disconnected during a workout.

The software includes two 5-minute exercise workouts. "Moving Target" is very basic. It runs you through a series of contractions-- alternating holding strong squeezes, more gradual squeeze and contract, and fast pulses. It is frankly kind of boring, but effective. At the end of the workout, it scores you on strength, endurance and control on a 0-10 score. It also gives you a composite score for the workout. The app displays a graph of all your scores from the past 30 days so you can see trends.

Playing "Moving Target"

The line/number tells you how hard to try to squeeze. The blue shows your contraction

The other workout is called "Shape shift." I think it is more fun. There are various shapes that move along the screen and by squeezing you open the gate to let them through. The goal is to try to trace the outline of the shape as closely as possible. They vary in width, length and shape-type to force you to do different types of squeezes. If you do well enough on one level, you advance to a more difficult level. I find it fun to try to get to higher levels. At the end, you are given scores for strength, endurance and control. My biggest complaint with this product is the scoring of this game. The workout score at the end seems completely inconsistent with what I experience in the game. I can never predict what my score will be. I have gotten higher scores on days when I passed fewer levels in my 5 minutes than days where I easily cruised through them, and that makes no sense. And it is the opposite of motivating! Basically the workout score on this one seems like garbage and you can't use it to track your progress. I try to ignore it and focus on trying to pass more and more levels.

Screen shots of the Shape Shift game

The shapes come in various shapes and sizes

After use, the kGoal is easy to clean up. It has a uniform and smooth surface so no cracks or crevices to collect crud. Just wipe/rinse it off well. Do not submerge the unit and be careful of the end when cleaning. Water up the charging port would not be good.

The light is also the charging port. Charges with a USB cord.

So biggest question: does it work? Have I seen increased muscular strength and control? I'm not the best judge of that question because I'd already been working with vaginal weights for 8 months before I tried this product and I continue to use them daily. So I'd already greatly strengthened my muscles before starting this and on day 1, I scored a 10 on strength and that has remained pretty constant. What it has done is increased my muscle control. The first few times I used it, I had more trouble with relaxing than squeezing. Mid-workout I'd get stuck contracted and unable to relax. Working consistently with the kGoal has helped make me more aware of my muscles and more able to both squeeze and relax on demand. I also felt very tired after the first few workouts-- the good, just worked hard kind of tired-- and now I don't. I think that is a an indication of increased strength and endurance.

Overall, I think it is a useful product. It provides more feedback then weights and teaches muscle awareness and control. It is interesting to visually watch the strength of your contraction on the screen. I would love to see additional development of the accompanying software. Some additional workouts would be nice.  And it would be extremely helpful if the scoring was more accurate and consistent. The price seems a little steep for what it is-- $150 on Amazon -- but it is comparable in price to other options like the Kegelmaster.

UPDATE: I was really excited when I got an e-mail that they'd added a new game to the app. You can now also play Bricks with your Kgoal.

Sadly, the bricks game itself is a disappointment. At least for me, it is not a natural relationship between the squeezing and successful control of the game. It is frustrating. It was also exhausting--since you are squeezing nearly constantly without rest periods. It has not become part of my usual exercise routine.

UPDATE (5/26/2017):
Since I've had this, I've struggled with getting it to zero at times. I thought I was just using the vent thing wrong because with my husband's help I could usually play with that and get it to behave. But-- I went searching on Minna's help page the other day and found this very useful information on recalibrating the machine. Don't know if it wasn't there before or if I just missed it:

The other key to using kGoal in different positions (or even in the same position from day to day) is the Recalibration feature. We recommend the following procedure before each workout:

1. Get kGoal positioned where and how you want it (location, orientation, level of inflation)
2. Fully relax your pelvic floor muscles
3. Briefly press the Power button on kGoal. When you do this, it will reset the measurement baseline to whatever level of squeeze and inflation it senses at that moment. This way, each workout will start on equal footing (with fully relaxed muscles corresponding to a reading of "zero" on kGoal's squeeze strength scale).

Product Review--PELVINN Kegel Exercise Weights

Product Review--PELVINN Kegel Exercise Weights:

I purchased this Kegel Exercise Weight set in April of 2015 and have been using them ever since-- so for 10 months now. There are many different shapes and styles of weights on the market. I chose these because the shape looked like it would be comfortable and I liked the fact I could easily increase the difficulty by selecting a heavier weight.  These were my first attempt at a kegel exerciser. I knew my muscles were week, but I didn't want to spend $150+ on some gadget. At $30-40, this felt like a less risky investment. Here is an example of them on Amazon

The weights are a smooth plastic with a string at the end to help remove. There is a free phone app designed to use with them. It is called Kegels4me. I've taken a few screenshots but it is essentially just a timer. It does allow you to record which weight you used and how difficult you found the workout each time, but it is pretty crude.

I started using the weights for 15 minutes every morning and evening. At first I was surprised that I couldn't even hold the lightest weight for the full time. I'd have to push it back in a few times when it started slipping. But it didn't take long before I could hold it, then I'd switch to the next weight up. I always stand while using them-- sitting down would be pointless-- and at first I had to stand still. But once I started getting stronger I found I could walk around without losing hold. That made it easier to get my 15 min because I could do it while I got ready in the morning and then while getting ready for bed at night.

Once I got to the heaviest weight, I experimented with leaving it in longer and also with attaching additional weight to the string to make it heavier.  But found this more trouble than it was worth.  I'm to the point now where I can do a whole aerobics video with it in. I'm quite satisfied with my muscle strength now but continue to use the heaviest weight 15 min a day for maintenance.

It's an incredibly simple thing to use, and I've seen huge changes in my pelvic muscles. I don't understand why Kegel weights are not more popular.  I have struggled with urethral spasms for years and they are finally under control thanks to getting my muscle tone back. I HIGHLY recommend the use of Kegel weights.

Illustration of size relative to a typical tampon

As to these weights in particular, I've generally been satisfied. They insert easily and are comfortable. I don't need lubricant.My only real complaint is the seam in the center. For one thing, it is a little bit rough feeling when you are inserting. But more of a concern, it makes the weights hard to clean.

The rest of the surface can easily be cleaned with soap and water and occasionally some rubbing alcohol, but I find crud accumulates in the crack that takes special care to remove. The only other complaint is that the end where the string attaches is pretty wimpy. I've had several break. That might be due to me dropping them on the floor (which does occasionally happen). But this isn't a big deal because frankly you don't need the string to be able to pull it out.

Weight with broken end

Why I won't be having a mammogram

I'm getting close to that age where mammograms start getting recommended. While learning more about cancer testing, we thought we'd learn more about them. I've always heard that mammograms are terribly uncomfortable. Think about it, the try to squish your breast in a vise. What fun. So are they worth it?

The first thing that scares me about mammograms is the amount of radiation involved.

We all know that x-ray radiation can cause cancer.  No medical professional will deny this. Thus the lead apron at the dentist.  Controls about who is near x-ray machines (even family support).  And so on.   With that in mind think about this:

According to the ANS a mammogram has 4 times the amount of radiation as a chest x-ray 1.  And it's fully concentrated on the breast!  Should I routinely blast my vulnerable breast cells with high levels of x-ray radiation, to prevent cancer? It's like they are thinking "we'll keep on x-raying until we find something"  And if they keep x-raying they'll make something and then yes they will find it.  

Be wary of anyone recommending mammograms that simply state the amount of radiation is "small".  Or other vague or subjective terms.  If they are afraid to quantify the amount of radiation then they aren't being open about the potential harm.

The Second thing that scares me is the false positives.

"Approximately 50% of women screened annually for 10 years in the United States will experience a false positive, of whom 7% to 17% will have biopsies".2 A breast biopsy isn't the worst thing in the world, but it still isn't pleasant. Worse yet is the fear associated with it. You get that dreadful panic for the week or two between the worrisome mammogram and the biopsy when you are literally afraid for your life. I've seen friends go through it. It isn't pretty.

Another aspect, and this one was definitely news to me, it is possible to have small cancerous lumps in the breast which go away on their own untreated! Sometimes, these cancerous cells that must be found through a mammogram, because they are too small to be noticed or symptomatic, are not actually dangerous! Sometimes the body can make the necessary corrections on its own.3 So detecting them "early" with a mammogram leads to unnecessary invasive treatments-- mastectomies, radiation, chemotherapy-- and once again, terror. And those treatments in and of themselves can be life-threatening.

"Of all breast cancers detected by screening mammograms, up to 54% are estimated to be results of overdiagnosis." 2

Am I suggesting that no one should ever be tested?

Of course not. If you detect an abnormality, by all means you should get it checked out. I'm wanting to have people consider is routine testing of healthy people with no symptoms. Rather than giving these blanket recommendations, we should be given factual information about the risks and benefits so we could make educated decisions for our personal situations.

There are alternative Screenings.

And there are also alternatives to mammograms, although you rarely hear about them. Ultrasound is also effective at testing for breast cancer-- without the discomfort or the intense radiation.

So why are mammograms pushed so heavily?

It is a big industry and in a lot of ways it is all about the money.  If the number of  mammograms was eliminated or reduced people would lose their jobs. Hospitals would not be able to recoup the money they spent on their expensive machines.4

More articles on Mammograms:

"experts now advise against mammograms"
http://articles.mercola.com/sites/articles/archive/2012/03/03/experts-say-avoid-mammograms.aspx

"Evidence also suggests that risk of breast cancer caused by exposure to mammography radiation may be greatly underestimated"
http://www.breastcancerfund.org/clear-science/radiation-chemicals-and-breast-cancer/ionizing-radiation.html?referrer=https://www.google.com/

"The shocking truth about cancer tests"
http://drjockers.com/new-research-reveals-how-dangerous-mammograms-are/

References:
1. ANS radiation dose chart: http://www.ans.org/pi/resources/dosechart/
2. http://www.cancer.gov/types/breast/hp/breast-screening-pdq#section/all
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320224/
4. http://www.whyisamericanhealthcaresoexpensive.blogspot.com/2012/11/mammogram-screening-reconsidering.html

Dr. Kegel Cliffnotes

While Dr. Kegel's paper is very informative, it is also exhausting reading. Here's my layman's attempt at summarizing it:


A Nonsurgical Method of Increasing the Tone of Sphincters and their Supporting Structures

ARNOLD H. KEGEL, M.D., F.A.C.S.
Assistant Professor of Gynecology
University of Southern California School of Medicine
1948

 

Background

Through experience as a surgeon and research with cadavers, Dr. Kegel had noted that the pelvic muscles of women were often weak and thin from disuse. He theorized that just as we exercise other body parts to tone and improve the strength of weak muscles, surely there must be a way to repair these muscles that way as well-- instead of resorting to surgery, which was not effective long-term anyway.

He focused his attention on the pubococcygeus, nicknamed PG. He describes it as the most versatile muscle in the human body. It helps support all the pelvic organs, helps the muscles that control the openings, and is essential for maintaining the tone of the other pelvic muscles. The PG gives off countless fibers which interlock and insert themselves into the muscles of the urethra, middle third of the vagina and rectum.

When a patient's organs were in the right positions, the PG and its components would be found to be well developed. When the muscles were weak and thin, symptoms like uterine prolapse (uterus falling down), incontinence and sexual disfunction would occur. The next step is to test whether a patient can voluntarily contract various muscle groups. First he would have them retract and draw in the perineum (the diamond-shaped area corresponding to the outlet of the pelvis, containing the anus and vulva.) Next, the index finger is inserted to the middle third of the vagina (as above) and the patient is asked to squeeze it. A normal patient can immediately respond with a firm grip felt over a wide area. Others will state that they didn't know it was possible to contract those muscles. These patients will have the most weakened muscles.

Dr. Kegel would quantify this response using a device he developed called a Perineometer. It was inserted in the vagina and could measure the pressure exerted by contractions of the vaginal muscles. In a well developed vagina, a slight rise in pressure is detected when the device is inserted, without any patient effort. In weakened patients, this initial pressure is much lower. The pressure change caused by intentional contractions were then measured. Strong, immediate increases in pressure indicated a strong, well-developed PG. A weakened PG resulted in small or even imperceptible increases in pressure with attempted contraction.

Therapy

He points out that it is super important while doing these movements to make sure the patient is actually contracting the PG muscles and not just the muscles around the outer edges of the openings. He points out that women with poor PG function have compensated all their lives by depending on these external, surface muscles. So the goal is to focus more inward and upward, so that the inserted finger feels the contractions as these movements are made.
 

Most patients can learn pretty quickly to find these muscles, but some may require weeks of this practice. There is no point in further therapy until this can be done.

Diagnosis

A firm vaginal canal indicates that the fibers of the PG are well developed. Loss of tone and and prolapse of the vaginal walls indicates that the PG fibers are weak and thin. You can test the vaginal muscles by inserting an index finger into the vagina, up to about the second joint, so that you are feeling the middle third of the vagina. In a normal vagina, the canal is tight and the tissue resists from all directions. The walls naturally close around the finger. The walls feel firm and deeply attached to the surrounding tissue. On the other hand, if the middle of the vagina is roomy in all directions, regardless of whether the opening is wide or tight, and the walls offer little resistance to touch and feel thin and loose, this indicates that the PG fibers have weakened from lack of use. 

Education

The first step in therapy is to help the patient find and learn to activate the muscles. He found that 1/3 of patients could not contract their PG voluntarily on the first visit. He would use a process of pushing with a finger at different internal locations to prompt the patient to contract the correct muscles. He'd basically find a connected muscle that they could contract and then work from there towards the PG. This teaches the patient to find and feel these disused muscles. For continued practice, the patient is directed to squeeze the inserted finger, draw up and in the perineum, draw up the rectum as though checking a bowel movement and contract as though interrupting the flow of urine. 
 

Resistive Exercise

Dr. Kegel felt that patients were unlikely on their own to be able do continue to use the correct muscles without help and supervision. He also felt that without measurable results, they were likely to become discouraged and stop exercising. So he recommended his Perineometer for contraction practice at home. It provided resistance to the muscles that needed strengthening and provided measurable results. Patients were advices to use the device for 20 minutes, 3 times a day. They were also encouraged to do additional contractions without the device throughout the day. He found that 50% of patients would slip back into their old habit of using the external muscles, so he recommended weekly appointments for the first month to firmly establish proper technique. He found that most complaints of fatigue and aching muscles were due to improper technique. 

Results

Patients who dutifully did their exercises experienced the following changes: stronger and more sustained contractions, thicker muscles throughout the pelvic area, improved positioning of the pelvic organs, firmer and longer vaginal walls, and reduced uterus prolapse. Patients with urinary incontinence showed dramatic results. 212 patients with severe urinary stress incontinence were treated and 84% were able to establish good urinary control through the therapy. 

The widest application is for women with genital relaxation after childbirth since 30% of women complain of this condition. Previously, women had to just suffer through symptoms until after menopause when surgical intervention would be recommended. Dr. Kegel found that progress was a slower with these cases, probably because since their symptoms were less debilitating they are less motivated and more haphazard in their exercise. But patients who were diligent felt improvement after 2-4 weeks of exercise but exercises needed to be continued longer to build lasting, structural changes. 

Preventative use

Pelvic resistance exercise during pregnancy builds thicker, stronger muscles, resulting in easier postpardum repair and less postpardum relaxation.

Exercise is also recommended after any pelvic surgery to help return muscles to working condition.

 

Conclusion

I noticed this statement in his conclusion, "On the basis of therapeutic results achieved, it seems possible that other ill-defined complaints referable to the genital tract in women might profitably be studied from the standpoint of muscular dysfunction." 

 REFERENCES:
 Anson, Barry J. Atlas of Human Anotomy. Philadelphia: W.B. Saunders Company, 1950
 Bushnell, Lowell F.: Physiologic Prevention of Postpartal Relaxation of Genital Muscles. West. J. Surg., Obst & Gynec. 98: 66-67, February, 1950
 Counsellor, Virgil S.: Methods and Technics for Surgical Correction of Stress Incontinence, J.A.M.A.46: 27-30, May 3, 1951.
 Curtis, Arthur HJ., Anson, Barry J., and McVay, Chester B.: The Anatomy of the Pelvic and Urogenital Diaphragms in Relation to Urethrocele and Cystocele. Surg., Gynec. & Obst. 68: 161-166, February, 1939
 Jones, Edward Gomer: The Role of Active Exercise in Pelvic Muscle Physiology. West. J. Surg., Obst. & Gynec. 58: 1-10, January, 1990
 Kegel, Arnold H.: The Nonsurgical Treatment of Genital Relaxation, West, Med & Surg. 31: 213-216, May, 1948
 Kegel, Arnold H.: Progressive Resistance Exercise to the Functional Restoration of the Perineal Muscles. Am. J. Obst. & Gynec. 56: 238-248, August, 1948.
 Kegel, Arnold H.: The Physiologic Treatment of Poor Tone and Function of the Genital Muscles and of Urinary Stress Incontinence. West, J. Surg., Obst. & Gynec. 57: 527-535, November, 1949
 Kegel, Arnold H.: Active Exercise of the Pubococcygeus Muscle. Meigs, J.V., and Sturgis, S .H., editors: Progress in Gynecology, vol. II, New York: Grune & Stratton, 1930, pp. 778-792
 Kegel, Arnold H.: Physiologic Therapy for Urinary Stress Incontinence. To be published in J.A.M.A.
 Kegel, Arnold H., and Powell, Tracy O.: The Physiologic Treatment of Urinary Stress Incontinence. J. Urol 63: 808-813, May, 1990
 Read, Charles D.: The Treatment of Stress Incontinence of Urine. Meigs. J.V., and Sturgis, S.H., editors: Progress in Gynecology, vol II, New York: Grune & Stratton, 1950, 690-697
 Collins, Conrad G.: Chicago Med., Soc. Bull. 241-246, October 13, 1931

 Source: Arnold H. Kegel, MD, FACS. Stress Incontinence and Genital Relaxation. CIBA Clinical Symposia, Feb-Mar 1952, Vol. 4, No. 2, pages 35-52.

Am. J. Obst. & Gynec. Aug 1948. “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles.” Dr. Arnold H. Kegel, MD FACS

Sources for the orginal content:
GyneFlex
Do the Kegel



 

Personal background - Female Urethral spasms and prolapsed uterus

To learn about our solution, read here background is below.


For any wanting more background on my symptoms and diagnosis of urethral spasms:
Nearly 15 years ago, not long after weaning my second child, I started finding myself in terrible pain every month with urinary tract infections. At least that's what it felt like--a feeling of urgency and painful cramping that pain killers wouldn't touch. I became a regular visitor to my primary care physician's office. Occasionally I would test fully positive for a urinary tract infection. More often, I would test positive for high white blood cell counts but negative for nitrates which would cause my physician to shake her head in confusion and sometimes give me antibiotics, sometimes not. Of course, going on antibiotics nearly every month also started leading to an endless merry-go-round of urinary tract infection, yeast infection, urinary tract, yeast infection and eventually a little bit of BV thrown in as well. And as so often seems to happen in the medical world, no matter how many times I came back to the doctor's office, the routine never changed. The doctor never seemed bothered by the repeated visits. She treated each one as a fresh occurrence independent of the others. Finally, after months and months of pain and frustration I came in armed with my list of how many times I'd been in, how many rounds of antibiotics I'd been on, etc. even though I knew all this information was in her charts and I demanded, " Why is this happening over and over?" and "Shouldn't we be trying to address the underlying cause?" Her answer was very illustrative of the limitations of our medical system. She explained that she wasn't trained to do that--to investigate and figure out medical mysteries. She said that primary care doctors are trained to treat symptoms and that's it. I was insistent that wasn't good enough and demanded she give me a referral to see a specialist. She wasn't too excited about doing so (thank you cost-saving insurance companies) but finally agreed.

In the mean time, I also went to my gynecologist's office for my annual well woman exam (more info about why this may be a waste) and to see if maybe there was something going on in that realm that was causing my discomfort. An earnest resident I talked to suggested that maybe I was dealing with Interstitial Cystitis and recommended I try eliminating various foods from my diet to see if that helped. As I researched IC, I didn't think it quite matched but it was closer anyway. And I greatly appreciated her at least trying to think outside the box. My actual gynecologist was less useful. She sent me in for a pelvic ultrasound, found nothing, and suggested they could try birth control pills or a hysterectomy and see if that helped. Umm, no thanks.

When I finally saw a urologist, he sent me in for a kidney x-ray and cystoscopy to eliminate possibilities. They were normal. He explained that I was having urethral spasms-- where the urethra thinks it is infected and acts accordingly. He said they had no idea why and no cure, but that it was fairly common in women my age. He gave me the helpful suggestion that if I got pregnant I might feel better during the pregnancy-- he'd noticed that was the case for at least one patient. Once again, no thank you. He put me on a couple medicines-- a low dose daily antibiotic and a muscle relaxant used to treat prostrate problems in men. Neither seemed to help much and I didn't like the side effects of the muscle relaxant (or the fact that it wasn't designed or tested for use with women) so I dropped that one but kept taking the antibiotic for a while. It didn't actually stop the symptoms, but it calmed my mind. When the pain would start, I wouldn't have to wonder and worry whether it was an actual infection that I needed to go get medicine for. Gradually I concluded that it was just as effective to only take it the days of the month I was feeling bad rather than every day. Eventually I moved and didn't bother finding a new urologist. I would just talk my primary care physician into low dose antibiotic prescriptions which I'd keep around for when I had flare ups.

And so it continued for the next decade plus. I learned that if I kept my stress down and got plenty of rest, I had fewer attacks. But they still would happen occasionally and I would just suffer through the pain. It wasn't until recently that we found something that worked. To learn about our solution, read on here.

What no one tells you about the dreaded pap smear

If you or your partner is promiscuous, this post is not for you. If you are in a long-term, completely monogamous relationship or celibate, read on.

For years I suffered through the annual torture of a pap smear. I was told that birth control pills upped my risk of cancer so I needed to be screened annually. I sort of looked at it as the price I had to pay-- I wanted the prescription so I had to take the test. Once I was off of birth control pills I no longer had to make the annual visit and the window between when I'd bother with a well woman exam kept spreading wider. I was feeling a bit guilty about not having a pap smear in a number of years, until we looked it up to see how often it was recommended... and then learned even more.

Honestly, I'm not even sure I knew which cancers a pap smear tested for-- just female part cancers. I'd just had it continually drummed in to me that it was a super important way to prevent cancer (and who doesn't want to prevent cancer, right?) The government said that I need this test. My insurance company said I need this test. I definitely didn't understand that it only tests for cervical cancer and I most certainly didn't know that a person had to had to be infected with HPV virus, a sexually transmitted disease, to get cervical cancer.  (According to the American Cancer Society "a woman must be infected with HPV in order to develop cervical cancer" link)

I have been happily married for 20+ years. My husband and I were both virgins when we married. I was aghast to find out I'd endured this uncomfortable test for a disease I had zero percent risk for! In this article it mentions a study of 13,000 nuns (not sexually active).  ZERO got cervical cancer.  Think about that next time someone quotes cancer risk statistics.  Zero in 13,000.  In another article clearly very pro testing for HPV it states, you can get HPV "unless you are both virgins and have never fooled around".  Love it when a very pro testing article makes the argument against testing for me :-)

Frankly it makes me angry. It comes down to the fact that doctors don't believe their patients' sexual history. They don't believe it is possible for someone to not sleep around and be married to someone who does not sleep around.  They don't take you seriously when you say that is the case. They do not create testing recommendations for a group they don't believe exists.  Or is it all about the money?

Pap smears are a huge industry. Think of how many tests the labs run and charge insurance for every year. Think how many annual exams are scheduled with gynecologists and family practitioners because of these recommended tests. Whatever the motivations, there is a bunch of unnecessary testing going on.

And some might say, better safe than sorry. What can it hurt to do too many tests?  You might say, well, if you really have no risk, your pap smear will always be negative. No worries. Unfortunately, pap smears are also wildly inaccurate--somewhere in the neighborhood of 70% accurate. So 30% of all pap smear readings are WRONG.  And due to our lawyer happy society if the results aren't clear they will error toward the conservative side, call the test irregular and order a cervical biopsy.

From Web MD link
"Paradoxically, increasing PAP smear sampling among low risk women actual increases your chance of getting a “false positive” one day. For example (DeMay, 2000), if you get a yearly PAP between the ages of 18 to 78, and one assumes a 5% incidence of false positives, you would have a 95% chance of getting a false positive report during that time."

From the NY times link
"In general, about 10% of Pap smears have abnormal results, but only about 0.1% of the women who have these results actually have cancer."

In other words, out of 100 women with abnormal pap smears 99 of them were scared out of their wits and likely had their cervix scarred because of an inaccurate pap test.

Biopsies are talked about as a simple test all the time, so I don't think many people register what they are. A biopsy equals cutting a decent sized chunk out of your cervix! To test for a disease which I would not have. So it is very possible that a person with no risk could have a false positive and have to undergo a cervical biopsy.  A biopsy which WILL cause scar tissue that will be there for life.  And can cause all kinds of side effects.  Not to mention the pain of the actual test.  All "just to be on the safe side"

Want to see what they do for a cevical biopsy.  Here is a video. VERY GRAPHIC.
Biopsy of Vaginal and Cervical Lesions   https://www.youtube.com/watch?v=1JgsW-HjtWs

Colposcopy Procedure (with biopsy)
At time 3:23 is when they take the biopsy.  https://www.youtube.com/watch?v=u7ld_JWH8tU

Biopsy is HIGHLY invasive "just to be safe" isn't good enough.


The other frightening aspect is the risk of cross-contamination. My husband and I both are HPV free. Zero risk there. I'm sure there are other patients that go to my gynecologist's office who have HPV. One sloppy moment-- cleaning equipment, changing gloves, etc.--and it could be transferred to me. Yes, it's not super common, but it does happen.  It is a risk.  Just like there is a risk of getting cancer. Having an exam and pap smear actually increases my risk of cervical cancer. But no doctor or nurse or goverment program will ever warn me of that!

Links to some articles about cross contamination.  Google and you'll find lots more.  Does unnecceary testing put people at risk?  Yes it does.

2010 in texas 70 speculums were not sterilized cross contaminating patients link
Discussion of several incidents link
Dangers of using reusable speculums link
Study finds HPV on spculums AFTER cleaning link

Another good article:
Top Five Reasons for Opting Out of Pap Tests link

Female urethral spasms and prolapsed uterus - Cure without surgery

After about 15 years of living with female urethral spasms (or bladder spasm) we did some big time internet searching and reading about all sorts of things.  Lots and lots of different things.  Some useful and some well..not so much.  And some just down right terrifying.  I forget how but somehow my husband ran across information on uterine prolapse and we started wondering if this might be part of what was causing my urethral spasms. I didn't have an obvious, extreme prolapse-- although recently I had a few days when my tampon felt like it was mysteriously trying to push itself out. The only things I knew about prolapse were that it happened after births and that lots of women couldn't hold their pee because of it. I had never had any issue holding in my urine, so I had never considered it an issue for me, and I'd certainly never had a doctor even suggest it as a possibility-- even though I'd had two very large babies.  More on my personal experience.

All the things we didn't know about the female body:
As we started to learn more, we found there were so many things we had never read or been told about female anatomy. Maybe you already know this stuff and we're just clueless, but I had no idea that the uterus moves around during the monthly cycle. I'd always thought of my internal organs as fixed points but its more a jumble of stuff shoved in together.

As the following diagram shows, the uterus changes orientation throughout the monthly cycle. It's density and texture also changes. This seems to be typically discussed in relation to pregnancy and ovulation.  But this movement will have an effect on what and how much a prolapsed uterus is pushing on.  Seems this is useful information that should be mentioned more.
Complete page

Looking at these diagrams, it made it clear how intimately related the female bladder and uterus really are. And it made sense that at certain times of month (when I would have urethral spasms) the orientation could cause the uterus to push on the bladder if the uterus shifted downward because the muscle walls were not strong enough to support things.

Physical therapy is available instead of surgery
We learned that there are actual physical therapists out there who specialize in pelvic therapy. We would have visited one, but we live in the middle of nowhere where such things are not available, so we decided to learn and try it ourselves. We found descriptions of how to measure the amount of uterine prolapse and tried to measure how low my uterus was. We found that it would slip downward at certain times of the month. And would, as described above, change orientation during the cycle.

As my husband got more experience with feeling inside me and how it would change, we learned that as the uterus would tip various ways it would cause bladder discomfort or alternately constipation, depending on it's orientation.  On the days I was having pain or discomfort, we learned that through a combination of external massage and internal pressure he could press gently up on the uterus to coax it back into a higher and more normal proper position. There were times when I was in extreme discomfort and he would shift it and I could feel this huge release of pressure from my bladder and urethra. It was the first thing I've ever found that actually relieved the pain! Anyone who has experienced chronic pain will understand how exciting that was.  On days when my husband/DIY therapist was not handy, laying in different orientations to help the uterus slide away from the bladder also was helpful in reducing discomfort.

While the pelvic adjustments had helped relieve the acute symptoms, our goal was to eliminate them starting in the first place. In researching ways to combat or cure prolapse the options seemed grim.  Most were surgical options and honestly their success rate was VERY low.  One day in reading about Dr. Kegel he suggested that increasing vaginal muscle tone could have positive effects.  And that some surgeries he had tried without exercise were only temporarily successful. I have done Kegel exercises at various times, but like many people, I think I'd mostly done them wrong. The instructions typically given are not very helpful. "Activate your muscles while urinating to stop the flow. Remember that feeling and then practice doing it later." I had activated and strengthened the muscles at the exit (which had probably saved me from incontinence)-- but that had done nothing for the muscles that make up the side walls of the vagina. They were completely weak.  The exercise described by Dr. Kegel specifically targeted strengthening the "pubococcygeus".  Muscles "of the proximal urethra, middle third of the vagina and rectum".  The "pubococcygeus" is not merely muscles around the orifices.  Something that somehow didn't get passed on clearly to the rest of us.

My summary of Dr. Kegels article

How does one strengthen their vaginal walls?
Ever hear of "Vagina Weightlifting"? Neither had did I. But check out this lady.

Complete article
Some medical folks (probably surgeons) argue that the muscles of the vagina can't hold up a uterus, even if they are in good condition. I have a hard time believing that since  the average uterus only weighs between 0.06 and 0.22 pounds. Check out this video of some average young women, with no strength training, and how much they can hold. A typical bottle of water is 1 lb for reference.  They are lifting 5 times the weight of a uterus.  Still think a vagina couldn't hold up a uterus?

 Sounded like it was worth a try.  Really didn't have anything to lose by trying.  After looking into different contraptions for pelvic strengthening, I bought a simple set of weights. There are tons of sizes and shapes available. I bought this set because I liked that I'd be able to easily increase the amount of weight.

Honestly, since I'd never had the urinary incontinence, that a lot of reviewers were fighting, I figured I'd be able to hold the heavier weights without too much trouble. First day I tried and was shocked to find that  I could only hold the very lightest weight, only .05 lbs for a few seconds before it would slip out. Those girls were holding 20 (twenty) times the weight I could.  Despite having typical pelvic exams over the years, no medical professional ever suggested my vaginal muscles were sub par and could use some strengthening.  But here was proof as I couldn't even do the lightest weight.

I started practicing twice a day-- working with a weight until I could easily hold it for 15 minutes and then moving up to the next weight. The progression happened fairly quickly, within a few weeks, I had worked my way up to the heaviest weight. Then I started holding it for longer periods of time-- 30-60 minutes and adding additional weight onto it.

And it has made a big difference! The muscles are obviously stronger than they were, and I've had fewer and fewer bad days. I rarely need my husband to do adjustments for me anymore because the uterus seems to be staying up higher where it belongs. It is so nice to finally, after years and years of discomfort, we have found a solution.  And much to our elation it didn't involve cutting on my body.  It frustrates me that no one-- not my primary care physician, not my gynecologist, not my urologist ever suggested anything like this. It makes me wonder how many other people are suffering needlessly.  This blog is my attempt to help those others out there.

And guess what, I can even lift a water bottle now.  Only for about 10 seconds, but that is still exciting. And no, I won't be posting a video of that. :-)


Some additional links:
A woman's experience strengthening her insides to relieve incontinence.  Great descriptions of how to find the correct muscles and some good humor Link

A physical therapist commenting on vaginal weight lifting.  Link

UPDATE 9/2017 If you're interested in how well this has worked for me 

Different ways to protect your privacy

Carilion vs Lewis Gale hospital

HIPAA is to help you. Not to control you

Most of us have heard of HIPAA.  It's a law to PROTECT patients privacy.  HIPAA is not there to take away the patients rights.  However some hospitals hide behind the term HIPAA.  Since most patients do not know what all it means they get away with it easily.

Example:

Carilion clinc, Carilion hospital or also know as New River Valley Medical Center incorrectly hide behind HIPAA to get the patient away from their emotional support, family or friends.  Carilion fools patients into thinking that HIPAA requires them to be alone when discussing medical issues.  They use HIPAA as an excuse to isolate the often frightened patient so they can interrogate them more effectively.  This may be better for Carilion but it is harmful to the patient.  Iit is NOT what HIPAA requires.  Shame on you Carilion for taking advantage of your patients lack of understanding of HIPAA.  In what other ways do you take advantage of your patients lack of knowledge?  Makes one wonder.

At Lewis-Gale their policy is simply ask for permission to discuss medical issues in front of the patients emotional support.  This gives the patient the choice and leaves the patient in control.  Lewis-Gale doesn't inconvenience the patient while still complying with HIPAA. Good for you Lewis-Gale. 



Why would a hospital want to deceive patients?  It doesn't seem good business.  When I questioned the nurse at New River Valley Medical Center outpatient surgery she said to me "how would you like someone to watch you do your job?".  But I guess that doesn't look very good on a sign.  HIPAA is a convenient policy to hide behind.

Something to consider when choosing between Lewis-Gale and Carilion.  Sorry Carilion after years of using your services we have seen your true colors and have switched to Lewis-Gale.  The only regret I have is that we didn't do it MUCH sooner.

From the joint commission: who oversees Carilion Hospital (New River Valey Medical Center)

"Communication with a patient’s family members or friends – Health care providers can share and discuss health information with family, friends or other individuals who are directly involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). The law allows sharing information when the patient either agrees or if present in the room with the patient, the patient does not object. For example, providers can talk to a patient about his or her condition when a family member or friend is present at the patient’s request. Information about a patient’s needs also can be shared with a health aide, interpreter, or person driving a patient. In some situations, HIPAA also allows health care professionals to use their own judgment about whether the patient wants health information discussed in front of family members, friends, or other individuals involved in a patient’s care (HHS, Office of Civil Rights, Sharing health information with family members and friends). If a patient specifically asks a provider not to share information with an individual, then that decision must be respected. (HHS, Office of Civil Rights, Sharing health information with family members and friends)." link


 HIPAA is not about isolating the patient. 

So why does Carilion do it?  Speaking with some of the management, trying to get them to change their policies, I got a different answer than the nurse.  The management said that "patents lie" and they get better answers if they are isolated from their friends and family.  Nice to find out that Carilion treats all their Patients like liars.  Lewis-Gale, you have some new customers.

Here is an interesting article discussing patient privacy laws being misused to hurt not help patients.
http://www.propublica.org/article/who-do-federal-privacy-laws-protect-patients-or-medical-centers

Front the Government on HIPAA:

From http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
"The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information."

and http://www.hhs.gov/ocr/privacy/hipaa/faq/safeguards/197.html
"Does the HIPAA Privacy Rule require hospitals and doctors' offices to be retrofitted, to provide private rooms, and soundproof walls to avoid any possibility that a conversation is overheard?"
The answer is "NO".

Even from Carilion on HIPAA https://www.carilionclinic.org/hospitals/carilion-roanoke-memorial-hospital/hipaa

"The Health Insurance Portability and Accountability Act (HIPAA) of 1996 established national standards to protect patients' personal and medical records. The regulations outlined by HIPAA protect the medical records and other personal health information maintained by healthcare providers, health plans and health insurers, and healthcare clearinghouses."

Carilion New River Valley Medical is also known as Carilion Clinic, or Carilion Hospital.  Radford Hospital

For reviews
on yelp: http://www.yelp.com/biz/carilion-new-river-valley-medical-center-christiansburg
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