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Ethicon 13/1
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Israeli doctor proves proactive about pelvic organ prolapse
Jan 12, 2016 | Examiner
By Diana Duel
According to the CDC, nearly 123 million women over the age of 20 suffer from some form of vaginal prolapse as the result of natural childbirth, menopause, or a hysterectomy. -
Q&A: A common complaint few women complain about
Jan 12, 2016 | Herald Tribune Health
...Pelvic organ prolapse is when a woman’s bladder, uterus, or rectum falls down through the vaginal canal... -
CDC Ending Comments on Opioid Use for Chronic Pain
Jan 12, 2016 | Mesh Medical Device News Desk
By Jane Akre
Several months ago the Centers for Disease Control and Prevention (CDC) proposed guidelines for opioid prescribing for those suffering from chronic pain and mesh pain. Since then there have been 1,800 comments registered.
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Israeli doctor proves proactive about pelvic organ prolapse
Jan 12, 2016 | Examiner
By Diana Duel
According to the CDC, nearly 123 million women over the age of 20 suffer from some form of vaginal prolapse as the result of natural childbirth, menopause, or a hysterectomy. The majority of sufferers, however tend to develop this condition are older than 40. In fact, Israeli urogynecologist Dr. Elan Ziv told me that most of his patients are women between 60-80 years old, who find that the decreased production of estrogen after menopause can cause the support muscles and tissues inside their vaginas to weaken. Yet, despite the fact that prolapse causes pressure on the pelvis, which (in turn) can interfere with sexual function as well as bodily functions such as urination and bowel elimination, only a small percentage of women seek medical help.
“Fixing the problems can be done relatively easily. Yet, too many women avoid seeing their doctors out of a sense of embarrassment, and end up suffering needlessly,” he stated.
In addition to his medical practice, Ziv is also the owner of ConTIPI Limited and CEO and Medical Director at ConTIPI Medical Ltd and is responsible for the invention of the Poise Impressa device to treat women’s stress urinary incontinence. The product, bought (and now sold) by Kimberly Clark, is an over-the-counter device that women can insert themselves the same way they would tampons to support their urethras. As a result, it is basically non-invasive and disposable. He is now concentrating a lot of attention to the issue of Pelvic Organ Prolapse (POP) in order to find new solutions for the problem.
Types of vaginal prolapse include Rectocele caused by a weakening of the back wall of the vagina (rectovaginal fascia), creating a bugle that can make bowel movements difficult and uncomfortable; and enterocele which occurs when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal skin. This condition, as well as vaginal vault prolapse primarily occurs after a hysterectomy.
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Q&A: A common complaint few women complain about
Jan 12, 2016 | Herald Tribune Health
Q: What are the options for a woman with pelvic floor problems?
A: Pelvic organ prolapse is when a woman’s bladder, uterus, or rectum falls down through the vaginal canal.
The average age women start to notice pelvic floor disorders, which include prolapse as well as urinary and fecal incontinence, is 56. By 80, half of all women have one or more symptoms. One in 10 end up in surgery — and costs are soaring as the population ages, from an estimated $66 billion a year in 2007 to a projected $83 billion in 2020.
For years, few women talked about it. Gynecologists often do not notice it in routine exams, and many women have lived with the condition without realizing anything could be done.
“This is a stigmatized condition,” said John DeLancey, a University of Michigan professor who pioneered the use of MRIs and biomechanical analysis to diagnose pelvic floor damage. “It’s nothing people would talk about in polite company. . . . And because nobody talks about it, everyone thinks they’re the only one.”
Recently, the conversation has opened up ever so slightly. The actress Kate Winslet spoke publicly about her urinary incontinence after having babies. The FDA recently approved several versions of a pelvic floor muscle trainer. And new internal devices, which advocates say work better than earlier versions, are just hitting the U.S. market.
“There has definitely been a sea change,” said Missy Lavender, founder and executive director of the Women’s Health Foundation. “We suddenly have people looking at women’s pelvic health, going, ‘Why don’t we do more?'”
References to pelvic organ prolapse appear in Egyptian hieroglyphics, Medieval woodcuts, and the Bible (which says it is a sign a wife has been unfaithful). Treatments included fumigating the lower abdomen with herbs; tying a woman upside-down to a ladder and shaking it; or menacing the wayward organ with a hot poker to frighten it into place.
In reality, pelvic floor prolapse is similar to a hernia. The condition is most common among women who have given birth. Most women have no idea there is a problem until years later — when muscles weaken with age.
Treatments include the use of a pessary, an internal support device that women can insert to hold the organs in place, or surgery to lift and repair the fallen organs. For less advanced cases, physical therapy can help reduce symptoms.
Left untreated, it can become dangerous if the prolapse causes blockage in the tubes that attach kidney to bladder. And it can put older women at risk of reduced activity and social isolation.
“Urinary incontinence is one of the top reasons people end up in nursing homes — people don’t want to deal with the smell,” said Cheryl Iglesia, director of MedStar Washington Hospital Center’s Section of Female Pelvic Medicine and Reconstructive Surgery.
New attention to the problem is driven in part by the Baby Boom generation, Lavender said: “We’re the generation of ‘Our Bodies, Ourselves.’ We grew up wanting to know more than our moms did.”
That thick tome did not include a section on pelvic floor disorders; rather, the information tends to spread by word of mouth. Urogynecologists joke that when one member of a bridge club or neighborhood coffee klatch comes for treatment, others are sure to follow.
“I did a whole cul-de-sac, one woman in the cul-de-sac after the other,” Iglesia said.
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CDC Ending Comments on Opioid Use for Chronic Pain
Jan 12, 2016 | Mesh Medical Device News Desk
By Jane Akre
Several months ago the Centers for Disease Control and Prevention (CDC) proposed guidelines for opioid prescribing for those suffering from chronic pain and mesh pain. Since then there have been 1,800 comments registered.
Wednesday, January 13th, the CDC closes the comment period.
With 259 million prescriptions written in 2012 alone, prescribing has become a problem, reports the CDC.
Many women who have complications from a mesh implant also experience chronic infection and chronic pain as an adverse events. They too are prescribed opioids. In fact, some of the worst pain cases, now have complications from their prescriptions, not to mention addiction.
The CDC reports about 140,000 patients have died from opioid use since 1999. In 2013 alone, there were 16,000 deaths associated with opioid use, four times the number of overdose deaths in 1999. With physical dependence, tolerance and addiction long-term problems of opioid use, these guidelines were developed with the help of a core group of experts, Core Expert Group (CEG).
Again, public comment closes January 13th. Public Comment here in the Federal Register – it says Comment Now!
http://www.regulations.gov/#!documentDetail;D=CDC-2015-0112-0001An Institute of Medicine (IOM) committee in 2011 published Relieving Pain in America. It reported there were 100 million Americas living with chronic pain, about one-third which is called high-impact chronic pain or disabling pain. While doctors have an ethical obligation to treat pain, they do not have to prescribe opioids to all pain patients, says the government.
THE ARGUMENT
The Center for Practical Bioethics (here) is advocating for letting opioid management be between the doctor and patient without government involvement. One of the new guidelines states that those with acute pain can only have three days of narcotics. Period! The proposed guidelines are a requirement that physicians do urine drug tests before they prescribe opioids for pain.
“Ridiculous,” says one MND reader. “Think about someone who has extensive dental problems such a TMJ that does need medical management…can you imagine dentists having to do this? The invasiveness of it it chilling..almost stating that everyone who needs opioids is a drug seeker. And who is going to pay that cost? Really such a bad direction for those in pain.”
One mesh survivor, involved with this issue professionally, tells Mesh News Desk(anonymously, she is represented by counsel),
“If they do not hear from thousands of people with chronic pain, this new opioid policy will slide through, which will have devastating consequences for mesh-injured women and others with chronic pain. We need to push many comments out so please encourage your readers to be part of the conversation AND please encourage them to send out the link to anyone on their contact lists. It’s that important.”
“If these guidelines are not rewritten there will be a feeling of desperation across the country, our expert says. Forgive me for pushing this, but this is where the rubber meets the road in pain management We need voices that are loud and clear! If these guidelines are not rewritten there will be a feeling of desperation across the country.”
BACKGROUND
The CDC Guidelines for Prescribing Opioids for Chronic Pain- United States, 2016, is a guideline proposed by the Centers for Disease Control and Prevention (CDC) for doctors and any care providers. The guidelines consider – when to begin or end opioid use for chronic pain; which opioid to select and for how long; and assessing the risk of a specific opioid.
Opioids are commonly prescribed for pain not just for cancer but for acute and chronic pain. In 2012 there were 259 million prescriptions written for opioids. Opioid prescriptions increased 7.3% from 2007 to 2012.
Chronic pain is defined as pain lasting more than 3 months after the normal healing time and can result from an underlying me3dical condition, injury treatment inflammation or unknown cause. In 2005, its estimated 9.6 to 112.5 million adults about 3-4 percent of the U.S. population were prescribed long term opioids.
Options to opioids include physical therapy, weight loss (for hip and knee implants), complementary and alternative therapies (acupuncture, massage manipulation), and psychological therapy.
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