Edition #140 – est 3/2020
This week’s Bulletin discusses Overactive Bladder as well as updates for
From The Philadelphia Dept of Health:
Instructions if you’ve been directly exposed to someone with COVID-19
If you’re fully vaccinated and have been DIRECTLY exposed to someone with known COVID-19, you:
  1. Do not need to quarantine unless you develop any symptoms
  2. Should get tested 3-5 days after the exposure, even if still asymptomatic
  3. Should get tested immediately and quarantine if you develop symptoms
If you’re not fully vaccinated or not vaccinated at all and have had a DIRECT known exposure to someone with COVID-19, you:
  1. Should immediately quarantine at home for 10 days.
  2. You may end quarantine after day 7 if you continue to be asymptomatic and receive a negative COVID-19 test 48 hours before you plan to end quarantine.
  3. After stopping quarantine, continue to monitor symptoms until 14 days after exposure.
Overactive Bladder

Overactive bladder affects about 33 million Americans. If you have an overactive bladder, you will:

  • Feel a sudden urge to urinate that’s difficult to control
  • Experience unintentional loss of urine immediately after an urgent need to urinate (urgency incontinence)
  • Urinate frequently, usually eight or more times in 24 hours
  • Wake up more than two times in the night to urinate (nocturia)

Urinating is how the body removes waste fluids. Urine –– which contains water, uric acid, urea, and toxins –– stays in the bladder until it reaches a point of fullness. At this point, a person expels it from the body. Most people urinate 6–7 times per day. Frequent urination, or urinary frequency, is when a person needs to urinate more than 7 times in 24 hours if they have consumed about 2 liters of fluid across that day.

Normally, as your bladder fills, nerve signals sent to your brain eventually trigger the need to urinate. When you urinate, these nerve signals coordinate the relaxation of the pelvic floor muscles and the muscles of the urethra (urinary sphincter muscles). The muscles of the bladder tighten (contract) and this pushes the urine out. Overactive bladder occurs because the muscles of the bladder start to contract involuntarily even when the volume of urine in your bladder is low. These involuntary contractions create an urgent need to urinate.

An overactive bladder can be caused by several things, or even a combination of causes.:

  • Weak pelvic floor muscles: Pregnancy and childbirth can cause your pelvic muscles (the muscles and tissues that support the organs in your lower abdomen) to stretch and weaken. This can cause the bladder to sag out of its normal position.
  • Nerve damage: Sometimes signals are sent to the brain and bladder to empty at the wrong time because of:
  • Medications, alcohol and caffeine: All of these products can dull the nerves, which affects the signal to the brain. This could result in bladder overflow.
  • Infection: An infection, like a urinary tract infection (UTI), can irritate the bladder nerves and cause the bladder to squeeze without warning.
  • Excess weight: Being overweight places extra pressure on your bladder.
  • Estrogen deficiency after menopause: This hormonal change causes thinning of the vaginal tissue and irritation of the urethra
  • Nearly two-thirds of cases of OAB in men are caused by an enlarged prostate.

The prostate gland surrounds the urethra, which is the tube that urine passes through from the bladder out of the body. According to the National Association for Continence, up to 50 percent of men experience symptoms of an enlarged prostate by the time they turn 60. A whopping 90 percent of men experience symptoms by age 85. Pressure on the urethra from an enlarging prostate prevents the bladder from completely emptying. and causes your bladder to work harder to expel urine. That eventually can weaken the bladder. Over time, other symptoms develop, such as a frequent or urgent need to urinate and a weak urine flow.

It can be difficult to manage symptoms from an overactive bladder because they are unpredictable. If you suffer from overactive bladder, you may worry about having an accident while in public. You may feel like you can no longer travel, exercise, or enjoy the activities you once did. You also may feel less attractive and worry about how your condition will affect your sex life. All of these worries can contribute to overall feelings of stress and anxiety. Fortunately, you can take steps to manage your symptoms and your emotions so you can get back to being yourself.Certain lifestyle modifications can limit the strong urge to go, such as:

  1. Dietary Changes: caffeine and alcohol can act as diuretics, which means that they can cause a person to produce more urine. Caffeine is present in coffee, tea, energy drinks, and many sodas. Other drinks that may trigger additional urination include carbonated beverages, drinks containing artificial sweeteners and cranberry juice. Some foods, especially spicy and acidic foods — such as orange juice and tomato sauce – can also irritate the bladder and exacerbate the symptoms of an overactive bladder.
  2. Bladder Training: In bladder training, a person resists the urge to urinate. The aim of this is to train the bladder to become used to holding more urine. Bladder training can take time, and it can require patience. A person usually begins by resisting the urge to urinate for just a few minutes. They gradually build up until they can wait an hour or more between bathroom visits.
  3. Pelvic Exercises:   These exercises, which people often call Kegel exercises, aim to strengthen the muscles that control urination. They involve tightening, holding, and then relaxing the muscles that the body uses to urinate. People can perform these exercises anywhere, at any time, but it is best to empty the bladder first.
  4. Weight Management:  Obesity is a risk factor for an overactive bladder, possibly because the additional weight puts pressure on the pelvic floor. Losing weight may relieve symptoms.

Medications may also be helpful. They work by blocking certain nerve impulses to help relax the bladder muscle, making it easier to resist urges. Gosha-jinki-gan is a blend of 10 traditional Chinese herbs that some research has shown can positively affect bladder contraction.

Nerve stimulation is a relatively simple and promising treatment for an overactive bladder. This treatment may help people whose symptoms do not respond to lifestyle changes or medication. Percutaneous tibial nerve stimulation (PTNS): A professional puts a small electrode through the skin of the lower leg. A device sends pulses of electricity to the electrode, which stimulates a nerve in the leg. This, in turn, stimulates a nerve in the lower back that is responsible for controlling the bladder. Sacral nerve stimulation (SNS): SNS uses the same process as PTNS, but the professional will place the electrode under the skin just above the buttocks. They use this to stimulate the nerve in the lower back that helps control bladder storage and the urge to urinate.

Although research is limited, the following complementary or alternative treatments may prove useful remedies for OAB.

  1. Acupuncture: Some research suggests that acupuncture provides benefits for those with OAB symptoms. These benefits include reducing urgency and frequency of urination, and improving quality of life.
  2. Biofeedback: The Mayo Clinic suggests that biofeedback might be helpful in treating OAB. In biofeedback, sensors attached to your body give you information about how your body is functioning. This information may help you learn how to strengthen your pelvic muscles, which will enable you to better control feelings of urgency.

Depending on the cause and symptoms of overactive bladder, surgery may be an option if other treatments do not help. The choice of procedure will depend to some extent on the cause of overactive bladder, the person’s sex, and the severity of the symptoms of urinary incontinence. A doctor will usually recommend surgery only as a last resort or for specific cases.

Overactive bladder can be a nuisance at best, and debilitating at worst. It’s frustrating to constantly be running to the bathroom, and can cause anxiety, shame and even depression when it’s is also accompanied by urinary incontinence. Contrary to what many people think, overactive bladder is NOT a normal part of getting older, and isn’t something you should think you have to live with. It’s a real medical condition that deserves treatment.


How much immunity does someone have after recovering from a coronavirus infection and how does it compare with immunity provided by vaccination?
The CDC has weighed in for the first time in a recent, detailed science report. Reviewing scores of research studies and its own unpublished data, the agency found that both infection-induced and vaccine-induced immunity are durable for at least six months — but that vaccines are more consistent in their protection and offer a huge boost in antibodies for people previously infected.There is substantial immunologic and increasing epidemiologic evidence that vaccination following infection further increases protection against subsequent illness among those who have been previously infected,” the CDC science brief said.

The CDC’s bottom line: Given what’s known and not known about immunity, people who have been infected with the virus should still get vaccinated. More than 45 million people in the United States have had confirmed coronavirus infections, and tens of millions more — the exact number is unknown — have had undocumented cases.
As of September, France, Germany, Italy and Spain are among more than a dozen countries that recommend that people without underlying health conditions who have already been infected receive one dose of a vaccine if it comes in a two-shot regimen.
                    % of Population
Country                       Fully Vaccinated

 USA                                 58%                             UK                                    68%
France                              69%
Spain                                80%
Italy                                  73%
Canada                            76%
Chile                                 82%
Japan                               76%
Brazil                                60%
                             Mexico                             49%                                                                                                                                                                                                                                                           


  • In PA, more people died from cardiovascular disease in 2019, than from COVID-19 within the past 19 months
  1. 32,633 people in PA have died from COVID-19 since 3/2020
  2. 38,895 people in PA died of cardiovascular disease …. in 2019 alone
  • The Mummers Parade will be returning to Broad Street on New Year’s Day after the COVID-19 pandemic prompted the cancellation of last year’s parade. The parade became an official city-sponsored event in 1901. The traditional spectacle now includes competition in four divisions: comics, the satirists; Fancies, with the flashiest outfits; Fancy Brigades, with choreographed theatrical works; and String Bands, the dancing musicians, with their traditional theme “Oh! Dem Golden Slippers.”
  • Inflation hit a 30-year high of 6.2% for the 12-month period ending on Halloween and distributors to independent local stores such as John’s Roast Pork, beset by steep increases in fuel and driver shortages, are jacking up prices.  Here are some local food price increases:
  1. At Philly Pretzel Factory in Boothwyn, in Delaware County, pretzels that were five for $3.75 in June are now five for $5.25.
  2. Jaindl Farms, the Lehigh Valley-based turkey grower, has had to raise prices by about 10% to 12%
  3. Sliced deli turkey at the ShopRite on Concord Pike between Chadds Ford and Wilmington listed Thursday at $10.99 a poundup from $8.99 in the summer of 2020
  4. At Wawa on Concord Pike, a six-inch Shorti hoagie that listed for $4.39 over the summer — and $4 during the last pre-pandemic summer Hoagiefest — now starts at $4.99.
  5.  John’s Roast Pork on Snyder Avenue in South Philly, raised his base sandwich price to $12 on Thursday, from $11.75 last week, and $9.75, pre-pandemic. Roast pork was 89 cents a pound pre pandemic, now it’s $1.89,
  • The Philadelphia Department of Public Health on Wednesday released the first glimpse at how vaccinations among young children is progressing and it’s not great. Almost 6,400 Philadelphians ages 5 to 11 — or 4.8% — have received a first shot of COVID-19 vaccine since federal authorities approved doses for young children two weeks ago.
  • Pharmaceutical giant Pfizer requested emergency authorization Tuesday for its five-day antiviral pill regimen, Paxlovid, making it the second easy-to-take treatment aimed at keeping newly infected people out of the hospital to go before the Food and Drug Administration.  When Paxlovid was given to people at high risk of severe illness within three days of symptom onset, it reduced the rate of death and hospitalization by 89 percent compared with people given a placebo. The Washington Post reported that the Biden administration is set to announce this week that it has procured 10 million courses of treatment.
  • Pfizer’s booster COVID-19 shot is effective for 9 – 10 months and maybe even longer, according to preliminary data from Israeli research. The booster shot yields more antibodies, and the antibodies are also better at preventing the disease. According to the report the third dose was 93% effective at preventing admission to the hospital.


  • Times Square will be reopened to the public this December for the 2022 New Year’s Eve ball drop celebration. This marks the first time in two years that the public will be present for the annual festivities, as last year’s celebration was only open to a few first responders and medical personnel amid the ongoing COVID-19 pandemic. For those who are interested in attending the celebration, several COVID precautions will be in place, including mandatory vaccinations for all guests, ages 5 and up.
  • The CDC’s page on breakthrough hospitalizations by vaccination status is only current through the end of August. Katelyn Jetelina, PhD, MPH, an epidemiologist at UTHealth School of Public Health in Dallas, said that for researchers, following the numbers in real time is crucial, as is having a way to communicate trends to the public. “Without a national, coordinated surveillance system that’s publicly available, both of those are very difficult to do, and we’re basically flying blind right now,” Jetelina told MedPage Today.
  • A new study revealed that telemedicine visits accounted for well over half of patient care at New York community health centers during spring 2020, the peak of the COVID-19 pandemic. Despite challenges, providers had positive experiences delivering care remotely using both telephone and video during the COVID-19 pandemic and believe both are critical for enabling access to care in the safety net.
  • A large US study finds that hospitalized COVID-19 patients taking medications that suppress the immune system, including cancer patients, are not at overall higher risk for dying of their infection or requiring invasive mechanical ventilation than those not taking these drugs. Of the 303 drugs in 15 medication classes included in the study, none were associated with elevated risk of invasive mechanical ventilation or death except for the monoclonal antibody preparation rituximab for rheumatologic disease and cancers. The authors said that patients taking immunosuppressive drugs can safely continue, but that those on rituximab should talk with their physician about their options.
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Please stay safe and be smart,
Dr Bralow