DEAR DR. DONOHUE: I would like your opinion on GYNECARE TVT surgery for urinary incontinence. – C.J.

ANSWER:
Urinary incontinence – the involuntary loss of urine – comes in two major categories. One is stress incontinence, the kind of urine loss that accompanies coughing, sneezing, laughing or lifting heavy loads. “Stress” on the bladder is too much for weakened bladder and pelvic muscles to keep it closed.

The second major kind of incontinence is urge incontinence. Here strong contractions of the bladder muscles produce a sudden and intense need to urinate. If people with urge incontinence cannot make it to the bathroom quickly, they lose urine.

The GYNECARE TVT is for stress incontinence. It’s a mesh band that’s inserted beneath the urethra through the vagina. The urethra is the tube that empties the bladder. The band supports the urethra and stops urine loss for many women with stress incontinence. I think it’s a clever idea and a good procedure, provided your doctor says it’s right for you. There are many other good procedures.

Before submitting to any surgical treatment, you ought to give the Kegel exercises a trial for a couple of months. They’re simple and often work. You learn what muscles to exercise by deliberately stopping urine flow. Repeat the contractions of those muscles when you’re not urinating. A good way of performing these exercises is to alternate long contractions with short ones. A long contraction is one held for 10 seconds, followed by 10 seconds of rest. The next contraction is a short one of three seconds. Perform a series of 10 contractions four times every day. You should notice improvement in bladder control in about two months. If you don’t, then you can consider surgical corrections.

DEAR DR. DONOHUE: I had a pulmonary embolism after hip surgery about four years ago. I still take Coumadin (warfarin). My son says it’s a very dangerous drug and that I should stop taking it. Do you think he’s right? I would like your opinion. – A.P.

ANSWER:
No one should stop taking medicine without first asking a doctor, especially when the medicine is given to prevent such a serious condition as pulmonary embolism.

Coumadin stops clots from forming. In common speech, it’s said to thin the blood. A pulmonary embolus is a broken-off piece of a clot formed in a distant blood vessel, usually a leg vessel. The broken piece is swept like an iceberg in the circulation to the lung, where it lodges in a lung vessel and obstructs blood flow. This can be life-threatening. Immediate treatment is giving the anticoagulant heparin by injection followed by the oral medicine Coumadin. The postoperative period is one that fosters the formation of clots in the legs.

After a pulmonary embolus, anticoagulation with Coumadin usually continues for up to six months.

If a person, however, has a condition that encourages clot formation, as some blood disorders do, then anticoagulation continues for life.

You don’t have to live in fear of Coumadin. Millions take it. It’s used by people with the common heart-rhythm disturbance atrial fibrillation. Those people take the medicine for life.

On the other hand, there’s no reason why you can’t ask your doctor the reason why you’re still taking the medicine four years after having had a pulmonary embolus.

DEAR DR. DONOHUE: I really appreciate what you said about children visiting patients who are on chemotherapy. I was worried about exposing my 2-year-old daughter to toxins. Thank you for easing my mind. – D.M.

ANSWER: Other readers took me to task for not considering the health of the person taking chemo. If a person’s medicines weaken the immune system, as many drugs do, then that person could be at risk of catching an infection from a youngster. The person’s doctor is the one who should guide a patient about the advisability of having children visit during chemotherapy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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