I had an interesting experience yesterday when a patient reported that she was obviously a failure because she was still having problems after trying to implement the strategies we had covered at previous consultations. She had read the latest blog from a patient which she called ‘a success story’ and that, because she wasn’t improving, it follows that ‘she is a failure’. Now that stopped me dead in my tracks because that is the last thing I want as a message for patients and others reading my blog.
Sometimes when things are slow to improve or there is still some leakage happening, it is a good idea to use some comparative measures to encourage the patient. Check out the original bladder diary and then look at the latest one – if the volumes generally have improved by even just 50 mls from 100 to 150 or 180-230, there is great heart to be taken from that.
Weighing pads can also reassure the patient that there is some improvement. Yes, if you are still leaking and needing to wear pads that is not the ideal outcome that you had in your head. But if you weigh a dry pad and then weigh the wet pad at the end of the day or when you are changing the pad, and then compare that monthly- often there can be a significant drop in the quantity of loss. Yes there is still some leakage, but it is significantly less. Coming down in pad size can be another indicator.
The degree of urgency is another thing that can be measured albeit with a VAS (visual analogue scale). The patient can rate the degree of urgency – zero being no urgency and 10 extreme urgency and then repeat that monthly to see if the rating is coming down.
Our job is to continually encourage, cajole, find solutions for the roadblocks to improvement, and finally encourage acceptance (for not only the patient but for yourself as a clinician)- that sometimes there will continue to be a degree of leakage or prolapse or pain, but that the important message is to keep exercising, keep moving, keep dancing – even if you need to wear a pad in order to achieve that- that is the important thing!
So don’t feel disheartened if your patient story isn’t as positive as some of the others- keep chipping away at the problem and ultimately there will be change.