Wednesday, September 8, 2004
Chances are, if you have a friend who struggles with incontinence, they've never talked to you about it. There is an obvious stigma attached to the inability to control one's own bladder.
Incontinence is more than a nuisance -- it robs people of their self confidence, their ability to get a good night's sleep and their lifestyle. For Dr. Stacy Childs of Steamboat Springs, his best days on the job arrive when he is able to restore a patient's dignity and give them a better outlook on life by reversing their incontinence.
"My happiest patients in my career have been women (who have undergone one of these procedures) and it changes their lives," Childs said.
Childs, who joined Dr. Lyman "Rick" Brothers' urology practice last spring, has brought two new procedures for treating incontinence to the Yampa Valley. Childs most recently practiced urology in a busy office in Cheyenne, Wyo., where he began in 1995. Before that, he was affiliated with large hospitals in Birmingham, Ala., for 23 years.
One of the advantages of living in Cheyenne was that it was closer to the home he and his wife own in Steamboat.
"I had always wanted to retire to Steamboat. We've been coming here since the early 1970s. Rick just twisted my arm and convinced me it didn't make sense to wait to move here until I retired. I've been here since May 31 and I haven't had time to enjoy it yet," Childs said with a laugh.
The two procedures Childs has brought to his practice in Steamboat are for two types of incontinence. The procedures are known as "urethral bulking" and "sacral nerve stimulation." Neither procedure is suitable for every patient. However, when they are appropriate and when they work, they are a blessing, he said.
Urethral bulking is for patients who, because of age or hormone deficiencies, lack the muscle tone to control the urge to urinate.
"They know where every bathroom in town is," Childs said.
The surgical technique compensates for the lack of muscle control by narrowing the urethra. That goal is accomplished by injecting a smooth paste of microscopic carbon particles behind the wall of the urethra.
The technique works on more than 50 percent of the patients, Childs said. Although the carbon particles are expensive, the physician's fee is very modest, he said, and he can complete the procedure in 15 minutes.
Again, sacral nerve stimulation isn't for every patient, but when it is successful, it's nothing short of remarkable, Childs said.
"I think this is probably the most exciting thing to come along since I began practicing medicine in 1977," he said. "And at first, I was the biggest skeptic."
What baffled Childs most was how the procedure could be effective both for patients experiencing a form of urgent incontinence or the very opposite -- a bladder that would not empty.
The procedure was developed by a company named Medtronic, which developed the first heart pacemakers. It uses similar technology to help patients experiencing one kind of chronic incontinence. It is based on the premise that, for some people having bladder problems, the difficulty is related to a nerve that isn't firing properly. The problem can be reversed by electrical stimulation, as if the physician was reversing the polarity of a switch or relay in an electrical circuit.
Childs accesses the nerve through the fattest part of the buttock and if an initial test is promising, he will insert an electrode attached to an external battery pack. If after two weeks, the patient is continuing to experience success, he will move on to insert a pacemaker into the buttock through a 2- to 3-inch incision. It typically works for about a decade.
Finally, Childs offers patients a cryotherapy procedure for prostate cancer. The procedure can be an alternative to a radical prostatectomy for older patients or an alternative for patients who have failed radiation therapy.
It is far less invasive than a prostatectomy. The physician freezes and virtually kills the prostate gland during a cryo-oblation of the prostate.
The procedure can be completed on an outpatient basis or with an overnight stay in the hospital.