Bladder Control Issues: A common problem that may be overlooked

Bladder Control Issues: A common problem that may be overlooked

Christopher Marinakis, MD, is a urologist at Boone Urology Center. His clinical focus includes complex stones, incontinence, pelvic floor therapy and BPH surgery. Learn more about Dr. Marinakis >

Bladder Control Issues ImageBladder control problems are more common than many realize. Many people assume that this is something they must live with, or is just a part of life. Even worse, many believe that nothing can be done to fix the problem except invasive, painful surgery. While it is true that incontinence predominantly impacts older adults, it is not a natural part of aging.  More women tend to be bothered by bladder control issues than men, but the underlying causes tend to be different. Your primary care provider (PCP) will often screen you for these conditions during your annual wellness visit, but occasionally this problem gets overlooked. There are solutions, and continual leakage is not something that one must live with.

Don’t suffer in silence. Discussing bladder control issues with your provider is the first step to regaining bladder control and improving your quality of life. Call Boone Urology at (828) 264-5150 and we can help answer any questions or concerns. 

What is Overactive Bladder (OAB)?

OAB is a constellation of symptoms that includes urinary frequency and urgency. Urge incontinence arises from being unable to control these factors and results in loss of bladder control. Factors that often go along with OAB include being female, post-menopausal, prior pelvic surgery, excessive fluid intake and caffeine intake. As with many health conditions, prevention is the best strategy. Maintaining a healthy weight and being active can help prevent bladder control issues.

Treatment options for overactive bladder

The first step in improving bladder control is to address this with your PCP. Often, symptoms can be controlled by changing behavior. Try reducing fluid intake, reducing or eliminating caffeine and doing “timed voiding,” which is a trick played on the bladder to empty it prior to the onset of “urgency.” For many, these steps are enough to regain bladder control.

If overactive bladder continues, there are several medications that can improve bladder control. For the patients that do not wish to take medication, or find them ineffective, more advanced treatments can dramatically improve bladder control and quality of life.

Your urologist may recommend sacral nerve stimulation, either with an implanted nerve stimulation device called Interstim, or with a noninvasive treatment called Percutaneous Tibial Nerve Stimulation (PTNS). Interstim is an innovative technology that involves modulating nerve signals to and from the bladder. A simple office test can tell if you may benefit from the technology.

PTNS involves placing a tiny acupuncture needle adjacent to the ankle and connecting a small nerve stimulator to it for a 30-minute session. The treatments are done weekly for several months, and then performed periodically for maintenance of the treatment effect.

Botox is a drug that many associate with injections for facial wrinkles. The reason that it smooths out wrinkles is that it relaxes the muscle, smoothing out the overlying skin. Botox injections can be done in the Boone Urology Center office to relax the bladder muscle resulting in improved bladder control.

“I leak when I cough, sneeze, or exercise”

Stress Urinary Incontinence (SUI) is a condition that affects many women, particularly those that have had multiple vaginal child births. Women with SUI often void normally, but are bothered with the occasional loss of control with exertion. This robs many women of the ability to exercise, or to perform normal household activities. Occasionally, men are bothered with this condition following surgery for prostate cancer.

Treatment Options for Stress Urinary Incontinence

SUI occurs because the muscles that are involved with holding urine tend to become weak. Like any other muscle, this can often be improved with conditioning. Performing Kegel exercises, which involves contracting the muscles that you would use if you wanted to interrupt your urine flow, can improve bladder control. Like any exercise program, this requires some commitment and dedication. Just as having a personal trainer can improve strength training, physical therapists at The Rehabilitation Center can often improve success on pelvic floor therapy to improve bladder control.

Modern surgery for stress incontinence has evolved to minimally invasive, outpatient procedures with quick recovery. It no longer involves large incisions and extended recovery times. The surgery for stress incontinence is done through a ½ inch incision, takes about thirty minutes, and is highly successful.

For some women, SUI can be treated with a simple injection procedure where a drug is injected through a scope to “bulk” up the urethra.

For men that are bothered with SUI following prostate cancer surgery, sometimes simply a “tincture of time” can allow the body to recover naturally from surgery and improve bladder control. For others, implantation of an artificial urinary sphincter can often eliminate pad use.

Do you have bladder control concerns?

Boone Urology Center can help! Call us at (828) 264-5150 today!

Summer Health and Safety (with infographic)

Summer Health and Safety (with infographic)

With the summer season in full swing, most of us want to find as many reasons as we can to spend time outside. More time spent outside though can often mean more risk to our health and wellbeing. Avoid any possible trouble this season by safely preparing for the most common summertime health risks. 




In 2017, the National Safety Council reported that excessive heat exposure was the third leading cause of death due to weather related events. When experiencing excessive heat or heat stroke, symptoms aren’t always obvious. It is important to check in with yourself and others if you feel you may be at risk. 

Signs of a heat stroke or overexposure can include rapid breathing, headaches, dizziness, confusion, irrational behavior, convulsions, unresponsiveness, or a temperature above 103 degrees. Sweating usually stops and is replaced by skin that is flushed, dry and hot to the touch. 

Take immediate action if you or anyone you are with is experiencing signs of a heat stroke or overexposure. Call 911 right away then move the victim to a cool place. Remove unnecessary clothing and cool the victim by immersing their body up to the neck in cold water. If complete immersion isn’t possible, place the victim in a cold shower or cover as much of the body as possible with cold, wet towels. Keep cooling until the victim’s body temperature drops to 101 degrees. Continue to monitor the victim’s breathing and be ready to give CPR if needed. 

People who have more risk of experiencing heat stroke include infants and young children, people ages 65 and older, individuals who are overweight, and people who are ill, have chronic health conditions or are on certain medications. 


Each poison ivy leaf has three leaflets with either smooth or notched edges.

Poison Ivy Dermatitis 


Many people can agree that at some point in their life they have experienced or have come close to experiencing the effects of physical contact with poison ivy. According to Makisha Stamper, Practice Manager at AppUrgent Care, poison ivy dermatitis is the most common reason patients visit during the summer months. 

According to the National Institute for Occupational Safety and Health (NIOSH), Poison ivy dermatitis is easier to prevent than it is to treat. Recognizing and avoiding urushiol, poison ivy sap oil, is the most effective way to reduce the risk of coming into contact. It is important to avoid direct contact with the plant, indirect contact such as touching clothing or objects with urushiol on them, and inhalation of particles if the plant is being burned. If you are exposed to poison ivy, immediately wash skin using antibacterials and lots of water. Be sure to also remove and wash all clothing that may have been exposed. 

Symptoms of poison ivy dermatitis can include a red rash, swelling, itching, bumps, patches, streaking or weeping blisters. Severe itching can be relieved by applying wet compresses, using calamine lotion or hydrocortisone cream, taking oatmeal baths, or using an antihistamine. In severe cases or if the rash is on the face or genitals, seek professional medical attention.  




When participating in outdoor activities this summer, insect repellent is something to always have with you. Various bugs, especially ticks and mosquitoes, can carry and spread diseases that can have lasting consequences. 

Depending on your location, mosquitoes can carry diseases such as the West Nile Virus, dengue, Zika, and malaria. According to the Center for Disease Control and Prevention (CDC), these illnesses can have severe consequences such as body aches, rash, fever, and even death. The CDC suggests using insect repellent, covering exposed skin, and avoiding bugs where you are staying in order to prevent mosquito bites. 

Diseases caused by ticks are most often found in people returning from an outdoor activity. Although there is no vaccine in the United States to prevent illnesses spread by ticks, there are steps you can take to prevent the risk of being bitten. The CDC suggests people dress appropriately, use insect repellent that contains at least 20% DEET, treat clothing and gear in permethrin, and stay out of heavily wooded areas. Be sure to check your body for ticks after each outdoor adventure. 




During the summer months, there is in increase in the number of ATV, biking, horseback riding, motorcycle and car accidents according to Cindy Hinshaw, RN, Director of Emergency Services for Watauga Medical Center and Canon Memorial Hospital. When traveling or riding this summer, be sure to wear a helmet and appropriate gear, follow traffic rules, drive or ride defensively, be well rested and don’t drive or ride while impaired. 




Whether going for a swim in a pool or a nearby river, it is important to understand how to protect yourself and avoid injuries. According to the CDC, drowning is the leading cause of unintentional injury death among children ages 1-4 years old. In order to avoid any water related accidents, there are ten rules every swimmer should follow. 

  1. Learn to swim. 
  2. Swim with a friend. 
  3. Know your limits. 
  4. Swim in supervised areas only. 
  5. Wear a life jacket when boating. 
  6. Stay alert to currents. 
  7. Keep an eye on the weather. 
  8. Don’t play roughly while in the water. 
  9. Don’t dive into shallow water. 
  10. Don’t float where you can’t swim. 

When swimming outdoors, it is very important to wear sunscreen to avoid sunburn or skin cancer. According to the Skin Cancer Foundation, swimmers should apply a Broad Spectrum Water Resistant SPF of 30 or higher 30 minutes before getting in the water. Reapply every two hours after swimming or sweating.  

As always, if you are experiencing a medical emergency, call 911 or visit your nearest emergency room. For emergencies that are non-life threatening, visit AppUrgent Care or Baker Center Same-Day Clinic. Happy Summer!

Click to download or print the infographic ▶︎

Infographic: Summer Health & Safety


Men’s Health: 5 topics to discuss with your provider

Men’s Health: 5 topics to discuss with your provider

Men's Health PhotoSome things we love to do and some things we need to do. You may love to play golf or go hiking. You may need to clean out the gutters or schedule your annual physical exam. The gutters need your attention but so does your health. By doing the things that you need to do, we at Appalachian Regional Healthcare System want you to continue to be able to do the things that you love to do.

We want to encouraging men to take time to schedule an appointment with your primary care provider.

Here are 5 important topics that you may want to discuss with your provider.



Ask your provider what age is right for you to begin colonoscopy screenings. This screening test is the most effective way to reduce your risk of colorectal cancer. Stomach pain or unexplained weight loss may be caused by something other than cancer but it is always a good idea to contact your doctor. Your provider may make other recommendations based on your family history, diet and lifestyle choices.



Although never a man’s favorite subject, it is important to speak with your provider about when you should receive a PSA test.  A PSA test is a simple blood test to measure the level of prostate specific antigen in your blood. Levels can be high if you have a prostate infection, an enlarged prostate or even if you are taking certain medications. Your primary care provider is the best person to interpret your PSA test results. Be sure to mention if anyone in your family has a history of prostate cancer. Remember that early detection greatly increases the chance for successful treatments if they are needed.


Blood Pressure/Cholesterol

The two main reasons that people have heart disease or stroke is high blood pressure and cholesterol. The good news is that you can manage both with a healthy diet and regular exercise or medication. While you can’t change your age or your family medical history, you can start the conversation with your provider about managing your blood pressure and cholesterol levels. The Cardiology Center of Watauga Medical Center is dedicated to providing diagnosis and treatment of heart disease…and to putting you back on the road toward healthier living.


Type 2 Diabetes

About 1 in 10 Americans have diabetes, and 90% to 95% of those have type 2 diabetes. You are at risk of developing diabetes if you are overweight, over 45 years of age and have a family history of Type 2 diabetes. A simple blood test is all that is needed to check your blood sugar level. Your provider can discuss the results with you and determine a plan of action. Your diabetes may be able to be controlled with a healthy diet and an active lifestyle or you may be prescribed oral medications or insulin. Type 2 diabetes is a serious condition and can lead to complications such as heart disease, vision loss and kidney disease. So, please don’t wait to contact your provider to address any concerns that you may have.


Shingles Vaccine

An estimated 1 million people in America will develop shingles this year. If you have ever had shingles, then you know the pain and discomfort that this virus can cause. The only way to reduce the risk of developing shingles is to be vaccinated. The CDC recommends adults over the age of 50 receive two doses of the vaccine to protect against the shingles. Check with your primary care provider about receiving your vaccine.


So, strap on those hiking boots and conquer that mountain, enjoy that long drive down the middle of the fairway, and be careful on that ladder while you’re cleaning those gutters. Men, don’t be afraid to contact your provider to have a complete physical check-up or just to ask the questions that have been on your mind. If you don’t have a primary care provider, Appalachian Regional Healthcare System has a dedicated team to meet your needs and to help create a healthier High Country.

Peripheral Arterial Disease: An under-recognized, slow-burning emergency

Peripheral Arterial Disease: An under-recognized, slow-burning emergency

Dr. Steven Filby is an interventional cardiologist at The Cardiology Center of Watauga Medical Center, and director of the Cardiac Catheterization Laboratory at Watauga Medical Center. Dr. Filby’s practice focuses on the medical and percutaneous treatment of coronary artery disease and peripheral vascular disease. Learn more about Dr. Filby >

One in twenty American adults has peripheral arterial disease, or PAD, a narrowing of the blood vessels caused by cholesterol plaque buildup. Several different risk factors contribute to the development of PAD:

  • advanced age
  • smoking
  • diabetes
  • high blood pressure
  • high cholesterol.

A family history of PAD also increases one’s risk. Those with PAD may experience pain in the calf muscle or buttock with walking, especially brisk walking or walking uphill. Some patients may develop skin discoloration of the toes or feet and even develop ulcerations and wounds that are slow to heal.

PAD is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease.Click To Tweet

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease and go undiagnosed as symptoms may be attributed to other causes such as joint pain or back disease.

Alarmingly, many with the disease have no symptoms at all. Studies have shown that the disease may be overlooked even if a patient is followed by a cardiovascular specialist.




Diagnosing PAD


Diagnosing PAD involves a noninvasive test called an ankle-brachial index or ABI in which a reading is taken of the arms and the legs using a standard blood pressure cuff and the ratio of these readings is used to assess blood flow to the lower extremities (legs and feet). A provider may also recommend more advanced imaging such as Magnetic Resonance (MR) or Computed Tomography (CT) scans.

Once diagnosed, patients are treated according to the severity of their symptoms and care is also focused on the prevention of future events. Patients may be started on medications in conjunction with a walking program to improve their symptoms. If medicine and lifestyle intervention are unsuccessful or if a patient’s lower extremity is in jeopardy, a procedure to improve the circulation may be indicated.

Peripheral Arterial Disease (PAD) is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.Click To Tweet


Treatments for PAD


There are several minimally invasive procedures that can improve the blood flow to the lower extremities. These so-called “endovascular” procedures are done under fluoroscopic (a type of X-ray) guidance and utilize small medical tubes called catheters to deliver therapy. A small balloon may be threaded into the blockage and used to dilate the vessel, called angioplasty. New technology allows these balloons to deliver medication to the blockage to prevent vessel re-narrowing after the procedure.

In a similar way, small metal-alloy tubes called stents can also be used to expand the blockage from within and also may have medication coating to keep the vessel open. These minimally invasive procedures often allow the patient to be treated and sent home on the same day. If a patient is not a candidate for an endovascular approach, a more traditional open surgery called surgical bypass may be required.


Living with PAD


  • All patients with PAD should have their medications adjusted to prevent heart attack and stroke—the major health threats to those with this disease.
  • Taking daily aspirin and cholesterol-lowering medications can dramatically reduce the incidence of serious health events.
  • Blood pressure and blood sugar levels for diabetic patients need to be strictly controlled.
  • Patients with PAD should exercise caution with skin and nail care. The skin of the feet should be kept clean and moisturized to prevent cracking and infection. Frequently, podiatrists are consulted for routine care so as to prevent inadvertent injury during nail trimming.
  • Finally, it is absolutely critical that PAD patients quit smoking.

Accurate diagnosis of PAD is important as it allows for comprehensive changes to both lifestyle and medications which can save lives. New technologies are available which help to restore circulation in those affected. Early recognition of PAD is essential to halting this insidious and sometimes silent disease.

Do you have risk factors or symptoms of PAD?

The Cardiology Center can help. Schedule an appointment with one of our highly skilled providers today.