Sleeping through the night

Ted Johnson
Gerontologist Ted Johnson directs the Atlanta site of a Birmingham-Atlanta VA geriatric research collaborative whose work focuses on three areas: bladder control, mobility, and end-of-life issues such as pain control and swallowing problems.


 

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Like many of the 208 patients in the Veterans Affairs clinical trial for nocturia—excessive urination at night—Jasper Smith had admitted his problem to his doctor only when his wife insisted. She was fed up with his waking up four or five times a night and going around half-asleep during the day.

The doctor said, “A lot of men have this problem. I think I know someone who can help."

Finding the best ways to give older veterans the continence control they need is a passion for Ted Johnson, director of geriatric medicine at Emory. Knowing that all medicines have possible side effects, he wants them to achieve this control with as few drugs as possible. That’s why his research focuses on exercise and that’s how Smith ended up doing Kegel exercises twice daily, more often if he was feeling voiding urgency. 

Johnson’s was the first study to look at exercise as treatment for nocturia. Like Smith, most of the participants had undergone prostate cancer surgery years earlier, but many, like Smith, had only begun to experience night-time problems years later. During the three months of the study, all men took two pills daily, including a standard prostate drug to relieve muscle tightness in the urethra. Half took a second standard drug to increase bladder capacity. Smith was in the other half: he took only the prostate drug and a placebo.

His group learned about the anatomy related to continence and how to contract the muscles in the pelvic floor, the same Kegel exercises often prescribed to women to strengthen muscles weakened during childbirth. Smith’s wife couldn’t even tell when he was doing his “kegels,” but he could feel the difference—and soon could see it in the urination/urgency diary he kept as part of the study. Gentle squeezing elevates the bladder (and the uterus in women) and closes sphincters in the urethra, penis, and anus. As Smith’s muscles strengthened, he woke less often and felt less daytime urgency. Study results, published in the Journal of the American Medical Association, support his experience. The winners were the men who took only one drug and did the exercises. 

Johnson says that the Atlanta Veterans Affairs Medical Center is “well ahead of the aging curve,” because of its higher proportion of patients over 65, compared with community hospitals. “We want to improve life for the veterans who have done so much for us, but we know what we find here will benefit everyone as we all age.”


   
   
 
 

Emory doctors provide virtually all physician care at the Atlanta Veterans Affairs Medical Center (VAMC), located adjacent to the Emory campus. In the 66 years of the Emory-VAMC partnership, Emory medical faculty have made the facility one of the nation’s most successful VA centers for research, with projects focused on developing new solutions in rehabilitation, post-traumatic stress disorder, and traumatic brain injury. Since a high percentage of patients are elderly, research, like care, focuses on areas such as memory and cognition, diabetes, cancer, low vision and disequilibrium, pulmonary medicine, and other problems that increase with age.

 

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