Health & Continence Institute

Helen Carcio, founder and director of the Health & Continence Institute was awarded the National Honor as Entrepreneurial Nurse Practitioner of the Year.  Below is an interview that was conducted following the award and will appear in Advance for Nurse Practitioners, December 2008 issue

1.  How did you get where you are today? What is your nursing background, how long have you been an NP, what other NP positions have you held?

My energy and passion to provide a service to men and woman with incontinence and my belief in the role of the nurse practitioner as an entrepreneur to provide that service has propelled me to where I am today.  I have two masters which have benefited me, the first being in Education from the State University of New York and the second in Nursing from Simmons College in Boston

.  I always felt that I had the best of two worlds professionally.  Since my graduation from Simmons in 1988 I spent half my time in women’s health clinical settings and always taught at the college level the rest of the time.  Both roles complemented each other.  I was an associate clinical professor at the University of Massachusetts at Amherst in their nurse practitioners program for ten years. 

2. Why continence care? What drew you to your patient population? Any anecdotes?

I have always felt that my own aging process seemed to parallel my clinical interests.  When I first graduated I was interested in birth control and when I decided to have a family I set up an infertility clinic.  When I started having hot flashes I become interested in caring for women approaching menopause.  A few years back I became passionately interested in helping patient who were incontinence.  I was shocked at how few resources there were.  I was interested in how patients perceived their condition and started having them write down their feelings in a few words.  On 92 year old wrote, in her feeble shaking hand….”SHAME”.  I was stunned. How could it be that this dignified, intelligent, elderly women who was the matriarch of her loving family would feel “shame” about anything.  I vowed to do what I could to reverse her incontinence and restore her dignity.

A second reason it that my grandmother lived with my family when I was growing up.  She had had 10 children and was very incontinent.  I even remember that she had a pessary. (I sure learned about them at a young age).  She always smelled of urine and would leave stains on our furniture when she exited a chair in our living room.  I remember feeling embarrassed to  have friends over who would tell me my house smelled like “kitty litter”.  If they knew the real truth!  I really believe that this scenario still inspired me today in my quest to restore dignity to my patients.

3. I know you’re a women’s health NP and treat mostly women, but how extensive is the problem in men? About how many men do you see? Do they find you the same way women do, or are they the husbands of female patients?

I am actually an adult NP who specializes in women’s  health but I do treat  men.  It is probably less than 10%.  I certainly do not feel as comfortable but my bladder  health program successfully restores continence in men, particularly in  those who have had prostatectomy’s. Overactive bladder and urge incontinence is as prevalent in men as it is in women.  Stress incontinence is much more prevalent in women because of having babies.  There is an amazing lack or resources to help this male population.  As I wrote in my original application I do the “senior tour” of Senior Centers and find the men more open and responsive to my talks than women.  Interestingly I have only treated  a handful of men whose wives were originally my patients.

4. We selected your practice for our Outside the Box award because you spend so much time educating people who aren’t your patients (NPs and the potential patient population). Apart from your NP seminars, do you chock that time up to marketing alone, or do you get reimbursed somehow?

Time spent doing marketing is certainly reimbursed when the client actually makes an appointment to see me.  If they never make an appointment they have benefited from the education they received and are the better for it. I never charge for my senior center talks but they usually insist on providing me with lunch, which is usually a “pot luck” and quite delicious.  I speak at the YMCA twice a year and they reward me with a beautiful bouquet of flowers each time.  I rotate through the 12 senior centers in my area and view it as marketing for my center but also in raising awareness around the issue of incontinence in order to help those men and women who would never make an appointment to see me.  The groups average around 25- 30 and I might receive a call for an appointment from 3 of 4.  Many state that they don’t need to see my after my talks because I have given them enough information during the talks to help them a great deal. Which is great….its all about reaching out and helping someone.  I speak at length about avoiding foods and fluids that are irritating to the bladder and teach them the right way to do kegel exercises. If these small steps help improve their quality of life then that is great.  I just had a women yesterday who came with the booklet I had handed out to her at a talk 4 years ago.  It is great that they secretly file it away until their incontinence become intolerable.  In this woman’s instance, she was spending $50 a week on incontinence supplies and just couldn’t afford to anymore. 

5. Any favorite anecdotes from your talks at senior centers, etc.?

It is important to get the participants at the senior centers to relax and feel comfortable talking about incontinence, particularly since the audience is usually mixed.  I begin by asking if they know the different causes of incontinence and they always respond with “having babies”, as they cast side glances at the men in the room.  I respond that while pregnancy is certainly a cause, a more important cause for people in their later years is constipation.(If  one thinks incontinence in an off-limits topics, one should try constipation). Prevention of constipation and its consequent strain on the pelvic floor muscles is key.  I tell the woman that they now have an assignment and need to ask those men they had earlier cast glances toward an important question.  I have all eyes on me now.  You need to ask them how they have a bowel movement.  The room is in total silence, then the dawn comes and the silence turns into laughter.  That’s right.  Men disappear into the bathroom with the newspaper or Newsweek tucked under their arms and emerge 45 minutes later.  NO strain on their pelvic floor! Women are in an out in 5 minutes.  No one ever told women that one has to relax to have a bowel movement.  It is the pushing and straining that has taken its toll on their pelvic floor muscles.  This anecdote is the onethat gives me the most delight.  In addition, it totally relaxes the group so that the education around issues of incontinence can begin!

My second anecdote is the women who took the diamond ring off her finger and insisted I keep it.  I think I did send you the article published in the local newspaper about it.  .  She is a stoic Vermont yankee who would not take it back. I do have it in safe keeping for when her children come looking for it

Click to review related article

6. Tell me more about your seminars for other NPs and physicians and your help with other continence centers. What does a seminar day entail? Where are they held? How can interested NPs sign up?

My seminars are offered four times a year and are taught at my center, the Health & Continence Institute, in South Deerfield Massachusetts which is just blocks from the Yankee Candle Flagship Store.   I always leave time for the participants to shop there.    Interested NP’s can also contact me at hcarcio@hc-institute.com for more information.  The seminar consists of a two day intensive training.  Participants receive a 350 page training manual and a CD  with templates of education handouts and practice forms. Pelvic floor rehabilitation in the mainstay of treating incontinence at a bladder center.  This figure showed a patient watching the computer screen as she exercises her pelvic floor muscles. (figure  Rose) Additionally their receive power point presentation for use in education both the providers and men and women in the community.  There is no need for them to reinvent the wheel when I have assembled all the hinds and strategies I have perfected over the years to allow for instant start-up of their own bladder  health centers.  There are five articles that have been published in Advance which are invaluable tools in increasing their knowledge of incontinence and it’s treatment.  

Another great thing about the course is that nurse practitioners learn skills that they certainly didn’t learn in college such as the simple CMG shown here.  A simple cystometrogram records the response of the bladder to filling and is within the scope of practice for NP’s to perform.

The nurse practitioner practice of today must be poised to meet the demand of the emerging baby boomer generation.  The Health & Continence Institute can provide the tools for a  TURN KEY OPERATION.  The sustainability of the program is nearly unsurpassed. HCI will provide multifaceted and innovative approaches to the establishment, marketing, and management of a comprehensive continence program or center to include:

I do charge $10,000 for the two day course and all the course materials.  Also will be available as a consultant.

I was asked to speak on how to establish a bladder health centers at a national conference and I was specially asked not to dwell too much on their profitability or else I might be construed as being too avaricious.  How sad is that!

To view another interview with Helen where she disucsses her feeling about incontinence treatment today please click on the following    Relevant continence treatments today