Medical Records

It has always bothered me that at most doctor's offices, medical records are treated like secrets. It would bother me that when the nurse left the examination room, she would take the records with her and plop them in the door. Heaven forbid I should sneak a peak at records describing me!

According to the government, "The Privacy Rule gives you, with few exceptions, the right to inspect, review, and receive a copy of your medical records and billing records that are held by health plans and health care providers covered by the Privacy Rule." But actually getting providers to hand over those records can be expensive and sometimes frustrating. 

I have had a few doctors offices that are great. When we asked our cardiologist how we could get a copy of the echocardiogram he was running on our son, he happily popped in a CD and burned us a copy on the spot. When I went by later to get a copy of his EKG, the receptionist printed it out from her computer. Part of the trick is knowing who to ask. When we arrived for the echo, we asked the receptionist if we'd be able to get a copy ad she acted like it wouldn't be possible--in reality she just had no idea. Persistence paid off and the doctor gave us no trouble over it all. 

Many offices and especially offices out-source their records to third-party companies. That means if you want a copy, you usually have to fill out a form and commit to an indefinite amount of money for copying said records. How much they can charge you varies from state to state. You can look for your state here. 

After fun experiences with knee surgery and a decision to never go back to the Carilion hospital near us, I wanted to gather all the records from their system. After talking to the records department on the phone, I filled out the necessary form and submitted it. The records office warned me that asking for all my records could result in thousands of pages and thousands of dollars so I might want to be more selective. I wanted it all so I continued on. I was very surprised when I received a very thin envelope from HeathPort, the 3rd party information company that Carilion uses to store and retrieve its medical records. There were so few pages that it fell into the free category. The documents contained spotty information on a few procedures I'd had done and none on others. We called HealthPort. Their customer service was unfriendly and unhelpful. They insisted that they'd sent my complete records and demanded to know how we could know something was missing.  Hmmm, because they were missing entire procedures! We finally got them to grudgingly agree to try again. A few weeks later we got a larger package. This time it included an invoice for around $20. This time it at least had mention of all the procedures and had a more complete record of the surgery I'd had done. The copies were terrible quality but at least they were there. Still no images, though, even though we'd expressly checked that box on the records request form. No images from EKG, EEGs, MRIs, surgery, etc. We called HealthPort again and were told they don't do any images and that we'd have to contact the hospital. 

Back I went to the hospital record office. I sat there for over an hour while they tried to find and print out my images. They kept asking, "Are you really sure you had it done here? We can't find you?" That is definitely confidence-building. Finally they managed to find and print one EKG. I was told that they didn't have my EEGs. I'd have to try to contact the neurologist who ordered them. And they didn't have any images from the surgery. I'd have to ask the orthopedic surgeon about that. They also told me that I'd have to go to Imaging to get copies of the MRIs. That would have been nice to know before I'd already waited an hour because when I went to Imaging, sure enough, they could burn a disk for me, but it would be an hour or two wait. And no one ever, in the process of getting the MRIs, had let me in on the fact I could get copy of the images or how to do so. They only tell you if you ask. 

It was a long and frustrating day. I still haven't gotten up the energy to go through all that again with the orthopedic surgeon's office, but one of these days, I will.

So why bother getting them at all? Because unless you stay in the same town with the same doctor your whole life, this information will disappear. And someday you might want it. After all this, I realized I should try to get some records from a previous doctor in a previous state. I called... but it was too late. They'd been destroyed. How long medical facilities must keep records varies from state to state. You can check out yours here. 

Even if you stay with the same practice, if your doctor changes it seems to make your records vanish. I requested my records from the family physician's office I've been using. It came from another third party and was decently complete, except that it contained nothing from the first doctor I'd seen at that practice years ago. She was my doctor for several years and then left the practice and I was transferred to another doctor. The records contained none of the tests or visits I'd had with her, and there were a few things I wish I had.

So the moral of the story is: demand what belongs to you. You paid for these tests and treatments. You should have a record of what was done and how it was done. Don't wait for some one to offer the records to you (they won't).  Don't wait until you need them or they may already be gone.

Carilion hospital Patients are denied Emotional Support

Carilion hospital denies patients emotional support

After moving to the area 10 years ago we went to the Carilion hospital (New River Valley Medical Center) for some tests.  We found some of their policies a bit strange and uncomfortable.  We chalked it up to new laws or something.  Over the years we have been back to the same hospital and found the same uncomfortable treatment.  After a extremely stressful situation before outpatient surgery we did some checking.  What we found was it was only their hospital policy and nothing to do with ANY laws.   

Carilion's policy is to isolate the patient from their support to interrogate them.   Right before a medical procedure is a super stressful time and when a patient needs support the MOST.  It is not the time to be isolating them.  Other times it is irritating and annoying but before a traumatic experience, like surgery, it can be emotionally damaging.  Practically all, if  not all, patient advocates recommend patients should have their support person present at all times to listen and assist in preventing errors.  Even Carilion’s own over-site commission (Joint commission) recommends that that patient advocates always be present.

After our emotionally traumatizing experience we contacted the Carilion management and asked why this had happened and that we did not want to be treated that way.  They stated that all their patients are required to be questioned alone.  They said in order to better serve illegal drug users this was the best policy.  They treat all patients that way and will not make any exceptions.  Nice to know my emotional welfare means less to them than protecting illegal drug users.

It may seem like a minor issue but if they will not work with their patients on a seemingly small issue, you can imagine how inflexible their management is on big issues.  It is absolutely not a legal requirement to be questioned privately.  We will no longer allow separation for questioning at any medical facility.  Which leaves us with... 

Since Carilion demands its patients be isolated when questioned they left us with only one choice, change providers.  Which we did and we have found that the LewisGale hospital has more patient friendly policies.  It has been years now and the only time we returned to a Carilion facility was to get copies of our records. (And that was yet another unpleasant Carilion experience).

As a society we do not have to put up with bad service from hospitals.  Everyone should consider carefully where they choose to go.  Do not support business with bad policies.  And above all, never ever let "it's our policy" be the end of the conversation.
__________________________________________________________________________________

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. 

Patient Modesty

Patient Modesty

"We all see you naked, but we don’t care" (but does the patient care?)

From a doctor:

"during the first operation that I witnessed as a medical student, I immediately realized that no one in there cares. We’ve all seen it a million times, and trust me, despite what you may believe, yours is no different than anyone else’s. I’ve had many patients who have been apprehensive about disrobing before surgery, but there is nothing remotely titillating in the operating room. Nothing."link

I've heard similar responses like this so many times.  It is such a big lie. It just makes me sick. First off, he says "the first operation that I witnessed."  There is a first time for EVERYONE.  There is no med student or nurse that was born with having "seen it a million times".  And keep in mind not only doctors are in the operating rooms.  A nurse, scrub tech, other techs, trainee, visitor, auditor, management all could be there watching.  I've read where a guy boasts that his friend that worked in the O.R. took him in to see a woman being prepped for a GYN surgery.  Woman totally exposed to a stranger off the street.  Without her knowledge at all.


Second " there is nothing remotely titillating in the operating room. Nothing." heard that from medical professionals all the time too.  Is that for real?  Let's look at some real world examples:

Examples:
 "New Orleans breast surgeon sent himself 'surreptitious' photos of naked patients during surgery"
"A noted New Orleans breast surgeon “surreptitiously” took nude photographs of patients during surgery, emailing himself pictures showing the patients’ “faces, breasts and vaginas,”

Seems this doctor didn't get the message.  Maybe he hasn't seen enough yet?  And notice he took pictures of their "vaginas"  His purpose is to work on their breasts.  But he takes advantage of the fact that the hospital doesn't allow patients to cover themselves.  Have to wonder what kind of person is making the rules.

For some practical tips and suggestions for maintaining modesty, check out our post on maintaining modesty.

"Doctor accused of taking photo of unconscious patient's private area"
How could she notice the tattoo and be interested enough to take a photo.  I thought they had seen it all a million times. Apparently sometimes it is interesting enough to warrant taking a personal photo.


Doctor taking photos of Sedated patient
Tell me again doctor that patients are all the same and the medical staff doesn't notice anything?

Doctor sexually assaults patient while unconscious
He also performed genital exams on a female despite being an Ear Nose and Throat specialist.  But they have seen it all, "yours is no different than anyone else’s". Apparently not all Doctors feel that way.


Prominent Emergency Room Doctor accused of four sexual assaults
This doctor seems to have made a habit of preying on young adult women who happened into his emergency room-- yet they "all look the same"...


Cardiologist snapping nude pictures of a girl in the bathroom.
If he's seen it all a million times why is he trying to sneak a pic?

And it is not just a problem with male health care workers. Female workers notice and respond to their patients' bodies as well.
Nurse texts photo of unconscious patient's penis

Female ENT doctor accused of routinely giving genital exams to male patients while they were sedated. 

Here's a whole article on protecting patients from sexual predators in the OR.

Why do these things happen?

The above are just a few examples of countless cases of criminal sexual misconduct in a medical setting. Cases where someone actually got caught.  Which you know that most of the time they aren't caught. Since they've "seen it all" and there is "nothing stimulating," why do these things happen? Why do we pretend that professionals aren't human and don't even see their patients? That is simply unrealistic and not accurate.

A medical training document published by the government of the United Kingdom states:

"Students must be taught that there is nothing unusual or abnormal about having sexualised feelings towards certain patients, but that failing to identify these feelings and acting on them is and likely to result in serious consequences for their patients and themselves."

"If a healthcare professional is sexually attracted to a patient and is concerned that it may affect their professional relationship with them, they should ask for help and advice from a colleague or appropriate body in order to decide on the most professional course of action to take. If, having sought advice, the healthcare professional does not believe they can remain objective and professional, they must:
• find alternative care for the patient
• ensure a proper handover to another healthcare professional takes place
• hand over care in a way that does not make the patient feel that they have done anything wrong."
link

"There is nothing unusual or abnormal about having sexualized feelings towards certain patients." It is biology. It is going to happen. So rather than pretending that doctors can turn off their sexuality like a switch, which they can't.  Why isn't the topic dealt with realistically so that proper protections for patient and doctor can be provided for?

What about chaperones in the room during exams? This article talks about how seldom chaperones are used and how often patients are more uncomfortable when one is used. I can understand this since the general approach to chaperones is to grab some other employee (so generally a stranger to the patient), so now the patient has two strangers ogling them instead of one. And sometimes that extra has little medical training. Plus, if there is an environment of inappropriate behavior at a medical facility, it often involves more than one employee or else other employees are quiet out of fear of employment repercussions. This case, where a surgical tech was both sexually assaulted and witnessed inappropriate behavior towards patients, is an example. Bringing in a coworker does little to encourage patient trust. In fact, when chaperones are used, it is generally to protect the doctor (from accusations and lawsuits) rather than the patient. This article  explains how and why chaperones are typically used and how they aren't much help to the patient. It also includes this great reminder that doctors are human and aren't magically blind to their patient's appearance:
"A third reason respondents said they used chaperones was protection from their own sexual feelings. One male doctor talked about a female patient of his who he considered “gorgeous.” He had a difficult time examining her. “…I needed to use a chaperone." he admitted. "A chaperone not for her comfort but for mine.”

Wouldn't increased modesty for patients make the situation more comfortable for both the patient and for the doctor and other medical staff who may be sexually aroused, in spite of his/her best intentions? The less they can see, the less likely they will be notice something they wish they hadn't. You can read more on this topic here.

Isn't there also a very logical argument for using doctors and nursers of the patient's gender for intimate procedures and exams? This article shows that patients would prefer it, but are often too embarrassed to request it, in part because of the derision with which medical personnel tend to respond to these requests.

For some practical tips and suggestions, check out our post on maintaining modesty.

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