Continence after Radical Prostatectomy

I read an article today in the Journal of Neurourology and Urodynamics that appears to be a realistic counterpoint to the optimistic predictions from urologists and medical practitioners regarding the likelihood of a bloke being incontinent after a radical prostatectomy.

Many of my clients tell me the advice they received gave them a 10-20 percent chance of incontinence following the procedure, and that it might take months to come good (following an early period when almost all men have continence problems in the first four to six weeks of recovery). My clinical observations suggested this might be much higher. But then, I see those blokes who are struggling with the problem.

The study analyzed data from 1990 to 2007 and found that 90.3% of 1,616 men who underwent a radical prostatectomy without any radiation or hormonal treatment remained incontinent at 12 months post surgery.  The researchers cautioned that this needs to followed up with other large studies to confirm their findings chiefly because they could only follow up 37% of those who underwent surgery.  A further 4367 blokes were not fully followed up after surgery.

Perhaps of most interest to me was their attempt to link the ongoing incontinence to a range of independent factors. Having looked at the stage of the prostate cancer, the blood loss during surgery, the nerve sparing status at surgery and age of the men, the only one of these factors that correlated with the incontinence was age.  Sparing of the nerves did not make a significant difference.

Obviously more research is needed. For example, is the outcome different if the men undergo pelvic floor training before and/or after surgery?  A study along these lines is currently being done in Australia on the Sunshine Coast, but data is not in yet.

Ref:  Petersen A., Chen Y., 2012. Patient reported incontinence after radical prostatectomy is more common than expected and not associated with the nerve sparing technique: Results from the  Center of Prostate Disease Research Database.  J Neurourol0gy & Urodynamics, 31(1):60-63

Management by Stealth

I may be a little slow at times, but I reckon I have finally worked it out.  My wonderful wife Mary has for some time talked of us getting some chickens to produce quality home grown eggs.  Of course, I pointed out that we don’t have a chicken run, there are foxes around, we have a cat and lots of other practical implications to owning chickens. So nothing happened.

Until three months ago when Mary’s son Daniel arrived with two live chickens as her (belated) Mother’s Day present. He also provided some feed pellets and a grand wire and timber chicken hutch measuring one metre by not much. We were suddenly set.  Except the chickens needed to be let out of the hutch to forage, scratch about and poo everywhere. Immediately on release they headed for the roadside and on one occasion, yes here it comes…. the chicken crossed the road!  Why? I Don’t care – but luckily some passers by let us know and I retrieved them and back into the hutch.

I purchased some chicken wire and spent the next two weekends building the Taj Ma-hen of chicken runs: 4 X 3 metres, fully enclosed with chicken wire (fox proof) and complete with shade cloth for the summer months. We now have two more chickens thanks to Dan’s Christmas present for Mary!  Eggs galore.

For her birthday, he arrived with seven fruit trees to plant in our orchard.  What orchard? No orchard – we have talked about it and even decided where it might go when the time comes…..  The time has come.  Today I spent hours clearing long grass, digging out rocks and planning a watering system ready to plant these trees.  Another couple of sessions and it should be ready.

I see what is happening.  There is a complicity between mother and son to push projects that in her mind have stalled by bringing on the urgency factor.  The arrival of chickens or trees necessitates the project be accelerated to a whole new time frame, with no consultation with me. Just an expectation that it will now be done.  Brilliant system. And hardly surprising that it is driven by a middle child.

But I am on to it now, so don’t get ahead of yourself Maggie (other middle child). Mind you, knowing what is going on and beating the system are two different things.

Now, I wonder how I can utilise this principle into a management strategy in business….

Prevention is OK – if within budget

I was reading a very interesting article on Medscape this week which makes the point that preventative medicine is quite likely the only healthcare area in which cost is the prime driver.

Holding preventative medicine to a cost standard is something not practiced in disease care where a cure is the prime driver irrespective of price. Hence there are many government subsidised medical procedures, pharmaceuticals, screening programs and so on of questionable evidence base or cost/benefit value but are based in the disease care model so are less questioned.

Any suggestion of a preventative program is immediately costed and if not meeting budget targets, discarded. This may be a bit strong, but you get the idea.

I am reminded of a meeting I attended at the local private hospital some ten years ago where the Director was outlining their increase in medical specialists based at their brand spanking new specialist centre attached to the hospital. ‘Four cardiologists, two orthopaedic surgeons, two ENT, three physicians…’ and on he went proudly.

Later I sidled up and asked how many preventative medicine specialists they had recruited? He look at me incredulous and said ‘None, of course – they keep people out of hospital. We want doctors who admit patients.’ The business model of private hospitals is based on people getting ill or injured, and while they can’t actually promote this, they can certainly pave the way to their admission desk.

It makes you think.

Operational Breakdown

I recently picked up a brochure on relationship breakdown (planning to pass it to a mate who is going through some tough times) and took a moment to read it.

There was a list of  ’10 Sure Ways to Breakdown’ and I realised much of the list applies to managing people in the workplace.  So, borrowing from Shirley Cornish in Maroochydore, I offer the:

7 Sure Ways to Mismanage Your Staff

  1. Think ‘It’s my way, or no way’
  2. Blame or criticise the other
  3. Be intolerant or inflexible
  4. Behave in a hurtful manner
  5. React before you think
  6. Dismiss or oppose the others viewpoint
  7. Give up

These 7 items are pretty obvious when you read them now while your emotions and ego are in check.  Avoiding them in the heat of battle when dealing with situations or pe0ple is indicative of a strong leader. Managing others always begins with managing ourselves, this list might help you identify where to focus your improvements.

Premature Congratulations

Unlike the Captain of the Italian cruise ship that recently ran aground I do not suffer from premature evacuation.

I do however, display repeated symptoms of premature congratulation (PC) – a condition I have observed in many men.  While not technically a medical condition PC does impact on the health of those afflicted. So what exactly is PC?

Premature Congratulations

This condition is very common at this time of year, around four to six weeks after the making of New Year Resolutions.  Whether the promise was to drink less, lose weight, stop smoking, spend more time with the family, reduce working hours, tidy the backyard or read more books is irrelevant.

The first week or so of the program is usually quite positive.  You are at your most motivated and changes come more easily when fired up and the early signs of improvement are good.  A few kilos less on the scales, knocking off earlier at work, and half a book dealt with. In fact, you are surprised how easy this is and wonder why you didn’t do it years ago.

The next couple of weeks are also good, you goal is in sight. It is clear that if you continue the smoking will be forgotten, the beer will last longer and again you are pretty chuffed about the progress you are making and the ease with which it is happening. You are so chuffed and finding it so easy that you start to imagine you have achieved the goal already!  I mean, it is going well and obviously working so it wouldn’t matter if you eased up a little on the discipline…

Bang! There it is – Premature Congratulations: the foreseen achievement of a goal when it is in sight but not yet actually completed leading to a lapse of concentration and relapse of your previous habits. Have you ever seen an athlete begin to celebrate before passing the finish line as he or she enjoys the moment of achievement and basking in the adulation of the crowd (or themselves), only to be passed at the penultimate moment by a competitor who has not waivered and fallen victim to PC.

This happens a lot.  I am an expert in this PC phenomenon because I have indulged it many times.  And consequently disappointed myself. So how to combat this common problem?

  1. Set a goal beyond what you want to achieve so if you get PC you still make the grade.  This strategy requires the unique ability to believe your own lies.
  2. Stay the course. When PC kicks in, focus on what remains to be done, not what you have already accomplished. This may have to be repeated several times as you near your goal.
  3. Seek help. Recruit either a like minded and perhaps a little bit competitive colleague who will provide an external drive to your internal project.
  4. Give up. Recognise that your expectations exceed your ability and remain as you were: a disappointment to yourself.

Now, how close am I to my pre-holiday preferred weight……. Damn, no where near it.  I will let you know when I make it, not when I get close.

Craig Allingham

Work Life Balance – Is it Achievable?

What a load of wishful thinking.  When I was a trainee physiotherapist studying human gait and locomotion skills my tutor pointed out that walking is a process of constantly losing balance in a forward direction, and catching it again by thrusting out a leg.  Repeat and you have walking.  Repeat at speed and you have running.  Don’t repeat and you have standing still, which itself is a constant process of almost losing balance and automatically correcting to remain stable.

Such is work life balance.  A constant process of being out of balance and trying to restore equilibrium before falling over. Sometimes it is work that dominates other times it is family or leisure activities.  If we sway too far toward work or life – one or other aspect will become neglected, triggering a recovery movement which will probably be an overcompensation until we perceive the next imbalance. 

To remain perfectly balanced demands extraordinary awareness and perception of small changes acting on us.  Increased work demands, family commitments, study, relationship maintenance, recreation, leisure hobbies or sports will all act on our balance.  It is easy to be unaware of the shifts until brought to your notice by a spouse, partner, child, employer, mate or mentor that you are getting out of control.

Personally, I feel work life balance an impossible concept.  Work is part of life, a subset of life that can swell or shrink from time to time.  It can never be larger than the life that contains it.  So if life is always larger, balance is not possible. Instead, I think of the work life ratio.  The proportion of life taken up by the physical, mental and emotional demands of work that will displace the same applications to the other aspects of life.  This ratio constantly varies as the demands ebb and flow.  It varies throughout a work day, a week, a year and a career.  It varies with the cycle of child rearing, steering and cheering. And, the optimal ratio for happiness, productivity and health will differ between individuals as well as across time. Understanding this concept within relationships (work, home, friends) should allow some elasticity without breaking the links.

The trick for each of us is to be conscious of the appropriate work life ratio for us at any particular stage, and to recognise when we have departed from this optimum and in which direction we need to shift to maintain equilibrium.  And to make the correction before too much damage is done to career, family, relationships, health or sanity.

Being open to advice, counsel or at least listening to the view of others may provide us with an early warning that we may be swaying too far.  Our natural hubris or confidence in our coping abilities can shield us from the internal messages, so the external input is vital.

What is the action plan?  Give some thought to your optimal work life ratio, and how close you are at the moment to achieving it.  Think back to when you had it right and what tools you used to get and keep it there.  If you are currently outside your preferred range, are the reasons legitimate and within your influence to manage them toward equilibrium using such skills as delegation, negotiation or just saying ‘no’. Discuss the concept with important people in your life (life partner, kids, business partner, employer, coach or parent) and consider their thoughts instead of putting up your defense shields.

Diseases of Lifestyle – choosing to be sick

At a UN gathering of NGOs and Public Health Organizations a consensus ‘Statement of Concern’ has been released asking the United Nations (UN), to hold accountable those in the food and beverage industry “whose products and marketing contribute substantially to the development of non-communicable diseases (NCDs) that kill 36 million people every year.” They are talking about lifestyle diseases such as diabetes, obesity, many cancers, cardiovascular disease and other diseases predisposed by consumption of alcohol, tobacco and foods high in salt, sugar and/or fat.
This is a fantastic idea but only strikes at the supply side of the market.  Until individuals are held accountable for the actual consumption of these products and prepared to foot their bills for healthcare costs and the lost social capital due to illness and death of parents, breadwinners and producers little will change.
Excessive consumption of these products, combined with an inactive lifestyle, often results in disease and associated costs of care.  The decisions made and actions taken on a daily basis by individuals exert market pressure on suppliers – we just need a critical mass of people changing the way they think, shop, consume and live to back up the Statement of Concern.
It starts with each of us.

The Real Secret….

Ever noticed when a sports person gives a conference talk they focus on motivation, goal setting, persistence and so on.  Which is OK, but they usually miss the most fundamental component of their success (or failure). The one factor on top of which all the rest is delicately balanced.  Maybe they don’t mention it because it is so obvious, but I suspect it is because they take it for granted – just like the rest of us. What is it? Here is the secret – the secret to success in business, life, sport, fun and enjoyment: stay healthy.  Don’t get sick; don’t get hurt; don’t get sad.

Obvious, but not easy.  There is a powerful world out there full of germs, bugs, stress, flu, pressure, expectations, duties and expenses just waiting to bring you down. 

If you would like a speaker bring the message of how your body drives your business and simple strategies to defend yourself against lost productivity – contact Craig Allingham. Trained in Sports Physio, Sports Science and Men’s Health, I can deliver a tailored message for your industry, group or workplace.

Health – Taking It For Granted

Once again I am reminded of how our personal productivity is determined by our energy and health status.  Just prior to boarding a long haul international flight home recently, I got an upper respiratory tract infection.  Almost forty hours of transit (complete with two delays) is not a tonic for recovery.  Once home I deteriorated further and it has taken another ten days to start to feel well again. 

During this time I tried to continue some level of productivity but both the quality and quantity were very ordinary.  Household chores, gardening duties, errands and shopping for food were all just too difficult.  Let alone any activity requiring brain power.  Sleep was poor quality and appetite was likewise.  The only plus was managing to lose about 2kg in body weight, but not a healthy strategy to achieve this.

Two take home messages for self:

  1. be more proactive in health management when my immune system is under threat due to stress (travel, sleep deprivation, poor nutrition, whatever);
  2. be more reactive in terms of recovery strategies (turn off computer and emails, give permission to sleep more, don’t deplete energy reserves and accept any help and advice from those around you).

Message for all of us:

  • make sure your personal productivity goals have inbuilt contingency or reserve capacity in case of illness or some other factor. Packing you schedule with expectations and tasks will result in a cascade of complications when things don’t go so well, let alone being one of the reasons you get crook in the first place!

Now, must make a recurring diary note to self about this idea as when you are well it just seems logical that you will continue to be well – a default state we tend to take for granted until fate intervenes.

Do Patients ‘Shop’ online?

When I first contemplated a website for my physiotherapy clinic around 6 or 7 years ago, I was yet to be convinced my potential clients would locate me using an impersonal, electronic, new-fangled gadget.   Much has changed, including my opinion.  Your web page is now the most powerful window into your business for current and future clients.  Let alone referrers and potential employees!

The website for a physio practice is a combined yellow pages ad, practice brochure (indicating hours, people, services, etc), geographical locator, health information site and shop front.  Or at least it could and should be all those things if you want to maximise the value to your business.

Perhaps the most important contribution of your web presence is the contribution to your brand.  The online image should be an authentic reinforcement of the brand of your practice.  Not the logo – the brand.  Those elements of your business that leave clients with a  feeling or emotion associated with doing business with you.  Feelings like ‘professional’, ‘ethical’, ‘trustworthy’, ‘safe’, ‘approachable’, ‘fun’, ‘friendly’ and so on.  If you business brand leaves clients feeling ‘neglected’, ‘unvalued’ or ‘doubtful’ you should probably work on those problems long before investing in a website.

Another valuable contribution is the reducing the fear of ‘the unknown’ for people who have heard of you or better still been recommended to see you but who may be anxious or apprehensive about seeing a physio for the first time.  Your web site can do much to allay their fears and replacing uncertainty with useful information (how they can pay, where they can park, what to wear) and confidence in your professional brand.

So, what should a physio practice website be made up of?  How complex should it be and what role should it play in your business? This will differ from practice to practice, but I believe one element is common to all – get some professional help with design, composition and content.  Being a fabulous physio doesn’t make you a top class web designer or techie.  Trust me, I tried and failed miserably until I put my ego to the side and let a professional take the lead.  Not only with my old clinic website, but also with my current business sites (www.redsok.com for example).

Possible contributions from your web site to business success include accurate descriptions of your team and the services they offer.  A chance to sell them as experts long before the client actually comes in the door.  Creating an expectation of quality is a good start.  You might include health information pages on common problems you treat, or an online store for the products you sell (clients can pre-purchase and simply pick up, or ask you to post it to them).  What ever you decide to include here is the golden rule: do it well and do it soon.  Become the site of choice for physiotherapy in your area and show your brand to the world. 

If you have a web helper already and are happy with them – stay on board.  If not, or if you are yet to start looking, can I suggest the company that helped us completely rejig our website, online store (international workshops and products), newsletter systems and database building.  A small and agile company with extensive design and construction experience in large corporate websites as well as small boutique clients.  Located in Hobart this company served us so well here in Queensland we actually transferred our whole site hosting to them from a much bigger national company who basically took us for granted.

DataFirst IT Services is run by Tim Allingham and we are working together now to provide a more complete service for physiotherapy clients who want a web site that is an extension of their clinical expertise and professionalism.  If you want to know more, click through to DataFirst IT and check out the ‘Site Options for Physios’ tab.