Overactive Bladder

Current literature suggests that overactive bladder (OAB) is mostly under reported.  The theory is that many patients feel there is no treatment and that urinary incontinence is a normal process of aging.  It is known that OAB affects quality of life of the affected individual.  What is not regularly know is how significant this is.

Individuals will go to great lengths, utilizing various coping strategies, in order to hide their OAB from family, friends and co-workers.  Through this process they may  need to face psychological  difficulties such as fear, shame and guilt.  OAB patients will have concerns regarding odor and cleanliness and may also have concerns about placing additional burdens on family members when they need assistance with toiletry issues such as cleaning,shopping for incontinence supplies and doing their laundry.

Individuals may refrain from intimacy with their partners for fear of leaking during sexual activity.  Travel and work may be significantly limited for fear of being exposed due to a public bladder catastrophe.  All of this leads to emotional and physical isolation.

Even though many elderly patients may have symptoms of overactive bladder, OAB is not a normal consequence of aging.  If you, or a family member,  experience  any or all of the following symptoms, please discuss the possibility of OAB with your physician.

     The need to urinate 8 or more times a day or  2 or more times per night.
     The sudden, immediate, strong urge to urinate immediately.
     You regularly leak after urination.

Overactive bladder is primarily a bladder muscle problem.  For one of many reasons, the bladder automatically begins to contract, emptying before it needs to.  Many different disease states, either muscular or neurological, may create an environment where the bladder will begin contractions, regardless of the amount of urine that has accumulated in the bladder.

This contraction of the bladder may cause an urge to urinate and, at times, may be very difficult to control.  This loss of bladder control may lead to involuntary loss of urine, which is called incontinence.

Genitourinary antispasmodic medications help to relax the bladder muscles, regardless of the cause, This relaxation of the bladder muscles allows the bladder to fill to normal, or near normal capacity, before the urge to urinate is felt.

To learn more about the medications used to treat OAB, please visit the Overactive Bladder page on the AudibleRx website and listen to the Medication Specific Counseling Sessions.


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Pharmacy Students

The summer of 1985; I was in my third semester of pharmacy school, 21 years old, and had just received my pharmacy intern license.  I attended a school of pharmacy that condensed a four year (8 semesters) doctor of pharmacy program into three years by having summer school for the first two years.  In essence, we went to school year round, semester after semester, until all eight semesters were complete. 

The first six semesters were done on campus as class work while the last two semesters were done off campus and were called our clinical clerkship.  This clinical clerkship consisted of six rotations, each lasting six weeks.  The theory of the clerkship rotations is to expose the pharmacy students to various pharmacy practice settings, with the opportunity to learn which particular field we may like to pursue after graduation.

When I was a student, we were required to participate in four required rotations, including hospital, clinical, ambulatory care and out-patient pharmacy.  We then had the opportunity to choose two elective rotations and I chose psychiatry and oncology.  For me, the entire nine months was amazing. 

During the clerkship I had the opportunity to work side by side with 4th year medical students, discuss medication therapy regimens with medical residents, participate in daily psychiatric rounds, watch a baby delivery, view a colonoscopy through the scope, hang and administer chemotherapy medication, develop and deliver an out-patient education program, participate in the placement of a central line in the I.C.U. and deliver a 30 minute presentation at grand rounds to the medical students and residents regarding anti-depressant medication therapy and treatment options.

This was an incredible learning experience; however, the one area that was not covered in any great detail was how to talk with patients.  Let me back up to the summer of 1985.  I had just received my intern license and was ready to get a job as a pharmacy intern.  Our pharmacy school didn't necessarily encourage or discourage students from getting a job in a pharmacy, it was up to the student to see if they could find one and then work it into their schedule; school came first.

The city I was going to school in had plenty of pharmacies and it didn't take long to get hired on as an intern pharmacist at a retail/grocery store pharmacy.  Of course, the first few days involved learning my way around the pharmacy, answering the phone and pulling files, practicing on the type-writer, putting the order away, and learning about filling out the third party insurance forms. 

After a week or so, I remember I was doing just fine typing prescriptions, so I was left for two hours with a retired-relief pharmacist at the end of the day.  At this particular store, patients would pick up their prescriptions at the pharmacy counter and then take them up to the front of the store to pay at the register.  This particular customer came to the counter to pick up her medication, I found it and then turned to get the pharmacist so he could come out and tell her about her medication. 

In 1985, patient counseling was not yet a requirement; however, for most pharmacists it was still the current standard of care.  It wasn't until the Omnibus Reconciliation Act of 1990 that patient counseling and education regarding their medications became a required practice. 

Anyway, as I turned to get the pharmacist, he looked at me and said, "You're an intern, go ahead, tell her about her medication."  No problem I thought!  This is great.  I turned to her and promptly started an in-depth discussion of all I had learned about atenolol, her medication.  I took five minutes explaining beta-blockers, how they worked, and a thorough discussion about beta receptors on the blood vessel wall and the specific neuro-transmitters that were blocked by the beta-blocker medication she was going to take.

She stood there, glassy eyed, not understanding a thing I had said.  The pharmacist came up behind me and in 30 seconds described to her how she should take the medication, what side effects to look out for and how it interacts with her other medication.  This pharmacist wasn't much for words; however, I do remember him telling me to keep it simple and make sure the patient know what your are talking about. 

I feel I learned more about patient interaction and counseling that specific evening than I learned during my entire nine month clinical clerkship rotations.  In the few short moments, when the pharmacist approaches the counter to discuss the medication regimen, the pharmacist needs to evaluate the patients barriers to receiving effective medication counseling; including social, educational, and language barriers, just to name a few.  Each patient has a different capacity for learning and the pharmacist is in a position where they need to quickly evaluate the situation and design the medication education session to meet the learning needs and ability of the patient in front of them.

In pharmacy school, much time and effort is put toward learning clinically, how the medications work; however, I don't recall spending anywhere near the same amount of time learning how to educate patients so they understand their medications and more importantly, the consequences of not taking their medications. 

As pharmacy students, I invite you to listen to the Medication Specific Counseling SessionsTM offered through AudibleRxTM.  These sessions are designed to help patients understand what they do and don't know about their medications so they may take educated questions back to their own pharmacist.  Had I, as a pharmacy student/intern, listened to the patient education session about atenolol prior to my first counseling session with a patient, I would have addressed the counseling session in a much more effective manner.


Copyright AudibleRx (TM), all rights reserved.

Prescription Insurance; A First World Problem

Not too long ago a family member told me a short story.  My nephew, Dave, explained to me that one sunny afternoon he was sitting at his local yacht club having lunch with some friends.  He goes on to describe looking away momentarily, when a seagull dives on his sandwich, grabs it, then heads off to devour the fruits of his catch.  In a moment of blind frustration he grabs the closest item he sees, his large clump of keys, and hurls them at the stealth like seagull who is already far out of reach.  Upon releasing the keys from his hands, Dave immediately realizes that he has just thrown, yes, his keys, out over the rocks and sand, toward the water, in a vain attempt to take down a seasoned, sandwich stealing seagull that is so far gone it is an impossible mission.

This is what we like to call a First World Problem.  I do understand that third world problems, such as where our next meal is coming from or the threat of our 13 year old boy being conscripted into a guerilla army, do exist, on some level, in our country; however, for the most part, we live in the safety of a first world society.  Your sandwich being stolen by a bird at the yacht club definitely falls into the first world category.

Health care coverage, especially one that includes some level of prescription medication benefit coverage, is definitely a first world benefit. This is not a politically charged discussion that debates whether prescription coverage should be a universal benefit, or who deserves this or that benefit.  More importantly, this discussion is meant to motivate each and every individual to take responsibility for the insurance coverage that they currently have.

Not less than ten times each day I find myself explaining, describing and educating patients about their personal current prescription benefits.  Individuals will regularly question why they may only receive a certain amount of a particular medication, or why one specific medication was covered last year with my previous insurance and is not covered this year with my new insurance. 

Recently I had a patient describe to me, after they had been on the telephone with a company that processes their prescription benefits, “the person I was talking to couldn’t even explain to me what my insurance benefit is.”  I followed up with a phone call to the same company to help educate the patient and the insurance company had explained the answer beautifully, it just wasn’t what the patient had wanted to hear.

Whether prescription insurance is purchased on the open market, provided to me through my place of employment, provided to me as a young adult less than 26 years of age through my parents employment, provided through a state or federally sponsored Medicaid system or obtained through various other avenues, the recipient of the benefits will be well served to take the time to understand the parameters of their benefits.

Do yourself, your spouse, your children, your parents and your health care providers a valuable service and learn your benefits.  Take the time to review your policy coverage resources and limits.  If you, like millions of others, file your terms and conditions of your health insurance policy in a drawer, pull it out and read it.  If you don't have a copy of your policy, look it up on line.  While reading your policy, be sure to keep a tablet and pen nearby so you can make questions and notes.  Next, find your customer service phone number and give them a call.  Give yourself some time, wait on the phone, then go through your list of questions with the representative.

Remember, troubles with our prescription benefits are considered a First World Problem.  These are problems that we can work with.  When we take responsibility for understanding our own coverage, we will then be in a much better position to understand what benefits we may expect from our providers.


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