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The Continence Connection Blog

Interview with The 2017 Continence Care Champion Award Winner

Holly Kupetis

Interview with Dr. Timothy Boone

2017 Recipient of the Rodney Appell Continence Care Champion Award

1.)   What lead you to focus on Neuroscience and spinal cord injury with vets specifically?

I got my Ph.D in Neuroscience and my father is a Urologist so I grew up around Urology. Initially,  I was interested in ENT,  but my father and colleagues talked to me about how much we still don’t know about in the field of urology.  Most of the work in Neuroscience has to do with speech and the brain and changing to the field allowed me to use what I knew neuroscience and bring that into urology.  Bill Steers (Sp?) and Rodney Appell were big influences in my career.  Bill introduced to me the power of networking and who you know and Bill connected me to academic neurology, the brain and the connection to the bladder.  I met Rodney through the Cleveland Clinic where Bill recruited him to come. Bill ended up declining the job, but Rodney stayed.  

2.)   What do you believe are the biggest challenges for in caring for patients with neurological conditions and spinal cord injury?

Neurological conditions can include people with MS, Parkinson’s, stroke survivors, Brain tumor patients, brain injuries and dementia.  Once of the biggest challenges is working with the VA is trying to get patients to the spinal cord center where their care would improve and you wouldn’t be taking on the whole VA system. Working with vets can be challenging given all they have been through and their issues beyond urology including anxiety, depression, PTSD. Often the biggest challenge is to get them to do self-catheterization.  They need physical rehab, many have ulcers and malnutrition and are non compliant with catheterization.  They may have survived Vietnam, but they succumb to renal failure. Intermittent catheterization and draining the bladder is critical to saving many vets.

3.)   So many patients with incontinence issues believe that it is product of getting older or their condition and are resigned to dealing with incontinence on their own. What do you believe could be improved to get treatment for the millions who remain undiagnosed, untreated or unsuccessful in their treatment?

With any patient regardless of neurological condition or not, education is critical. These patients need to know the why. Why it is important to take control of it. If they  don’t know why then its hard to get them to do something like self catheterization or physical therapy. Buy in comes with education and with better education comes better compliance.

4.)   Since you have been in practice, what changes have you observed in patient expectations of clinical outcomes?

Biggest changes I have observed is proliferation of advertising and news stories in prime time.  News and advertising about drugs for bladder, diapers and ED commercials.  I can think if a better use for that kind of money, but it has raise the awareness for the condition.

5.)   What do you believe are the critical success factors in treating your patients?

I believe in data collection and the use of physical therapy. I have incorporated Physical Therapy much more into my practice. It is amazing how much more can be done with PT as a part of the treatment plan. PT can do a lot of good for patients in pain and with incontinence and intimacy. I am more educated now on physical therapy and more of a believer in the importance of it and having trained professionals do that.

It should be a part of the triage for men and women in their evaluation. Physical therapy is something that can empower them, like being healthy and exercising.

There is a lot to be said for the power of this practice. It is important to outcomes.

8.)  What accomplishments in your career are you most proud of?

I am most proud of my trainees and residents.  I enjoy helping them succeed and fostering education with them. It is gratification that is similar to having kids.  Rodney felt the same way. He was big on education and he was close to the fellows he trained.  You become the most proud to see the successes of the ones you participated in the training and education.

9.)  What kind of advances or changes in the field of urology and urology care would you like to see over the next 10 years?

Technology has changed so much with wireless and bluetooth changing our equipment. It has advanced the field in many ways and I embrace that. I think now with phones present everywhere and always in peoples hands that apps for this condition would be successful.  Apps that would provide reminders for timed voiding and voiding diaries. Even help with self- diagnosis for conditions like Nocturia with simple metrics to encourage finding diagnosis and treatment.  It would be a tremendous application for everyone in reach of phone regardless of age.

There will be new discoveries in pharma, new classes of drugs that are more targeted and work a lot better. I am hopeful we will see that too.

10.) You were just selected as the 2017 SUFU Rodney Appell Continence Care Champion. Can you tell us how it feels to be named a Continence Care Champion after your fellow friend and colleague?

My connection with Rod is the highest honor.  Rodney was a good and trusted faculty member.  Rodney was always the one to volunteer to do anything including the thankless jobs. He always raised a hand or take calls a public hospital. He was one to be glad to do it and was selfless in that regard. He was also not a wallflower. You better not ask him a question as it may not be the answer you wanted. He always had an opinion.  He always had a story and was hilarious to be around.