Episode 8: Emsella Chair

Happy New Year!  Have you ever laughed hard, sneezed or coughed and oops, you tinkled a little bit?  This can definitely effect the quality of life.  Today, Dr. Saluja and Kane will discuss the Emsella Chair by BTL.

They will cover
1.  What HIFEM technology is
2.  Who can benefit from Emsella Chair
3.  Who would NOT be a candidate for the Chair
4.  What a treatment consists of with the Emsella Chair
5. What you can expect post treatment with the Emsella Chair

Hope you enjoy the episode!

Thank you for your listenership!

Transcript

Dr. Saluja: Hi everyone. I hope you're well. Welcome to 2023, and thank you so much for joining us on our podcast today, Kane, how are you doing? 

Kane: I'm doing really well. It's kind of odd to hear you say 2023, to be honest.

Dr. Saluja: It is odd! You know one of my dear friends had asked me this.  She asked, instead of a resolution for 2023, what is a word to set your intention for 2023?

And I thought about this and I thought, you know, there are multiple words, but probably the one word that I would use to set my intention is joyful. I think I'm going to go about this year with joy.

Kane, what is yours?

Kane: Now you're putting me on the spot because I haven't thought about this. But the first word that came into my mind was focus and just set my intention to what I want to focus on.

Dr. Saluja: Okay. I like it. Okay, so we're going to focus on your word. Today we're going to focus on something called the Emsella Chair.

Kane: Well before we, we do that. Speaking of focusing, I want to just acknowledge and give thanks to everybody that's listened and given us feedback.

I can say this for you, it certainly has for me, it has far exceeded our expectations with this podcast. And I mean, literally people all over the world have and are listening to it, which is kind of cool, but, but ultimately it's accomplishing, I think the goal that you set out to, which was to better inform patients and almost have it be an extension of a consultation so that when patients come in to consult with you, they can, they're already a step ahead and can, and can make more informed decisions on what's best for them, right? 

Dr. Saluja: That's the intent of it and I, I'm glad that it's we're able to have this as a tool for our patients.

Kane: Thank you and continue to subscribe so you can get the latest notifications. Okay. Back to you. 

Dr Saluja: Okay. Okay, so back to Emsella Chair, which Kane, you've had a little experience sitting on the throne.

As we get a little bit further, but when, I do want to say, when, when you hear about the Emsella chair, a lot of people may not understand what that is. But here in the Charlotte area it's actually very popular. There are businesses that run commercials on TV that advertise this. This is the only thing that they do.

And so in the Charlotte area it's a very, very popular therapeutic option for people.

What we're going to set up for today for the Emsella chair can is I want to go over a little bit about the type of condition that it can treat, and I want to set up kind of the, the appropriate patient for it. What are the contraindications and what I mean by that.  What are things that are not indicated for this type of procedure? We'll go through that, like who are the ones that we rule out? And then also talk a little bit about what the treatment is and what to expect in regard to results.

We're going to launch right into this. When we talk about urinary incontinence, which the word incontinence is basically involuntary leakage of urine, there are three main types, and I'll try to keep this short so I don't lose people on this.

1.      Stress Urinary Incontinence.

2.      Urge Urinary Incontinence 

3.      Mixed 

We are going to primarily focus on is stress urinary incontinence.  This can occur when you cough or laugh or sneeze, where you basically are increasing the intraabdominal pressure and you feel like you might have a little leak.

Sometimes when patients laugh real hard, they might feel like they have to cross their legs or they might leak a little bit. 

Now I'm going to differentiate it between urge urinary incontinence. That's when you feel the need to urinate. You feel the need coming on, but you can't quite make it to the toilet and so you leak a little bit. And there may be multiple causes for this, most of which is not treated with the Emsella chair.

It's always a great idea to get a medical exam, to really get a a pelvic exam just to determine are there causes going on.

Is there a degree of bladder prolapse that might necessitate surgery? Are there other issues going on that can be treated medically? But let's say you are healthy and indeed you've got stress urinary incontinence. Then the question comes, you know, it's probably a good idea to, to determine parameters to d kind of the metrics of it.

So, for example, how many times in a week do you have a little bit of leakage or is it a daily thing? And when you leak, how much do you leak? Is it something that you have to wear pads? Multiple pads in a day's time, or is it just a little bit of leakage? Because I think it's also fair to say that if someone is really having a lot of heavy, heavy symptoms. Maybe the pelvic floor is, so damaged or maybe it's very, very weakened. Again, that might not be the best type of patient for this as well.

Right. Well, in my case, I didn't have any underlying medical issues and I didn't have any leakage, but I drink a lot of water. I mean, I drink over a gallon of water a day and I all day and, and into the evening. So, I go a lot. And during the day that's, it's not a problem. But at night, you know, when you're trying to sleep, I was probably getting up four or five times a night.

And after I completed the series on the Emsella chair, it didn't make it completely go away, but I had strengthened my pelvic floor muscle to where I was maybe just getting up once or twice a night.

It did make a difference for me.

And that's impactful for your spouse too.  Who's sleeping beside you as well.

And I got a, my quality of life just with my sleep was so much better.

Sure. And a lot of the studies are looking at that. They're looking at the quality of life of what this does for the quality of life and the improvement with it.

But, but that's a good point, is that it's not just for females, it's also for males as well. It's FDA cleared for incontinence in both males and females. Sometimes with the male population, it's a little bit different in the sense that after prostate surgery or just having benign prosthetic hypertrophy, you know, prostate related issues, that's the reason why they, they have more of these issues.

But you also bring up a good point that, behavioral changes can also make an impact, meaning that,  don't drink water after a certain time period, like maybe after 8:30 pm. 

This utilizes something called HIFEM technology, which that stands for high intensity focused electromagnetic energy. The electric magnetic energy stimulates the muscles of the pelvic floor. And what it creates is supra-maximal contractions and Kane, do you know what I mean by that?

Yes. Supra is where it, it contracts beyond what you could do on your own.

That's exactly right. So, if we were to say, Hey, can you do some kegel exercises? Well, we can create this contraction, but when you use electromagnetic energy this high intensity energy, you can go above your normal amplitude of contracture so you can create greater contracture, which leads also to muscle hypertrophy.

They've shown this on MRIs and the muscle hypertrophy relates to greater strength of the muscle.

What, what does that mean?

They can see the thickening of the muscle and how when there's slight bladder prolapse, how it kind of lifts that bladder up a little bit too.

That's been shown on MRI

Because that's, this is one of those things where you can’t visualize the pelvic floor on your own, so it is good data to see this on MRI.

We have this little tube called a urethra, which basically connects the bladder to the outside of the world, and at the very end of the urethra is a little tiny sphincter, and it's basically the strength of the pelvic floor muscles that allows the sphincter to remain closed at times of increased intraabdominal pressure. And so, if you are coughing or sneezing, this remains closed. As we go through menopause our estrogen diminishes can also weaken this pelvic floor and even after vaginal birth.

So even in younger patients, they can have weakening in the first year post vaginal

Yeah, I think that's one of the things I've heard a lot of is, is childbirth. Right?

Right. And so those patients can benefit, but as that weakens, then what happens is there is when our intraabdominal pressure increases, then that little sphincter opens up and we get a little bit of leakage.

And so certainly conditioning the pelvic floor muscles again by trying to do Kegel exercises can strengthen this. But certainly, by doing the Emsella chair, which gives you. It gives you thousands of contractions in that 28-minute period,

Right. So, when you talk about supra-maximal contraction. It's a supra maximal contraction times thousands, right? In 28 minutes?

Right. And what you can notice is, so the treatment consists of six treatments, which are delivered twice a week for three weeks. And what you can notice is even after your first treatment that you can Kegel better, you can focus on those muscles and kegel them better than you could prior to.

It's almost like they become deconditioned over time, and this allows us to reeducate ourselves on contracting those muscles.

And I'm trying to think of a visual on, you know, when we talk about the pelvic floor muscles, in my mind it's kind of like a hammock, right? And, and initially that hammock is, is taught, is taught, you know, it's somewhat tight.

But as you, as you sit in it over time, and, and years and years and years, it starts to sag and you kind of lose that the tautness and eventually you're sagging so much, your kind of sitting on the ground,

Well, you're losing the benefits of what that musculature does. And, and what's so interesting too Kane is, when you look at the studies, you know, eight out of 10 patients are going to get results.

Now, two out of 10 may not get results, and that's important to know and to stress as well. But eight out 10 patients will receive results from this and the type of results they can achieve are about a 65% improvement in symptoms. So, it doesn't mean it cures it, it doesn't mean that you'll never wet again.

Well, that was my experience.

Or if you're leaking daily, well, maybe you're only twice a week, and maybe the amount of leakage is less because you're getting some control over that, over the pelvic floor to kind of contract the sphincter of the urethra again.

It improves the symptoms and I think the studies really show the quality of life is improved. 

The quality of life has improved and that's what I experienced is that when I sneeze or laugh really hard, Sometimes I still have to cross my legs, but I'm not always doing that.

I feel more comfortable in that regard. 

I want to go back to where you had said about 80% will have satisfactory results and 20% really don't. Is there a way, so, you know, for eight out of 10 patients, is there a way to kind of identify who might be in the 80% category versus the 20% category? Is it really just a crapshoot?

Well, there's some things you could rule out. Like there's some patients, and for, so for example, if someone has really extensive symptoms, they might not, they might mean that that pelvic floor is so weak that, that the amount of strength that they're going to get from this may not be enough to show benefits.

So, it can be kind of too far gone.

It can be too far gone. Or if someone is obese, that increases the pressure the intraabdominal pressure, and that might also not give the type of results that you want to see as well. So those are things you can screen out now in, in regard to contraindications.

Patients that are not candidates for this are patients who have metal in the area. Because remember, this electromagnetic energy can, can contract about 10 centimeters upwards. So, 

no metal in the spine, no you know, copper IUDs either because that can impact what the electromagnetic energy and no pacemakers and, and those type of things.

Defibrillators, you know implantable defibrillators, et cetera. Those are patients that are contraindicated.

Okay, so now I want to go back to the 80% that did have satisfactory results.

Is there a way to kind of generalize.

Who, What type of patient that would, would fall into that category.

So the answer is kind of no.

So when we have a device called Emsculpt, which is also made by this company, BTL, those patients, I can visually see that if they've got more than two centimeters sub of subcutaneous fat, they might not show the results as much as patients that are lean. I can't really necessarily see that with these types of patients, but I will say patients with who've had examinations and have noted bladder prolapse or that are, that is at a greater extent or other conditions can certainly be ruled out as well.

Otherwise, it's hard to discern, but the majority patients will show a benefit. So that's important to note.

That can range from younger patients post childbirth to the menopausal patient.

Correct. And what's also interesting is it's not just improvement with stress urinary incontinence, but they've also shown that it also improves sexual function and sexual satisfaction because what it does is it improves that pelvic floor strength, which allows for better orgasms, for stronger orgasms.

And these contractions also increased blood flow, which improves sensation and just the whole sexual pleasure component.

And we've actually had that feedback.

We have, we've had patients describe that. And while it's seen as a secondary benefit, there is a study that actually just looked at this.

They looked at 75 patients’ female patients that had poor sexual function and satisfaction. And they found indeed that in the majority of these patients, they improved as well.

That's kind of a nice little secondary benefit.

To summarize the Emsella chair again, it's, it's a series of six treatments twice a week Correct.

For three weeks. That equals six. And, and what else?

And so it's important to know that it's not that you do a series of this and you're good for life. It's a muscle that has to be retrained and has to be worked and strengthened. We have different options where patients can come in to maintain these results with, you know, a month or three months or whatever that might be for them.

Okay. And so, maintenance is appropriate and it's really appropriate for a lot of different people, both men and women. And, and you can expect to see good results. Don't expect a cure, but there's been a lot of people that experience the satisfactory results so much. So again, that in Charlotte, I mean, you see it advertised on tv.

You certainly do, and I think that's important, is that to set expectations is that this will not cure you.

This will benefit the majority of the patients that do it, and it'll improve the quality of life in those patients.

So that's it. That's what we've got for today and I hope you all have, again, a wonderful start to the new year and thank you so, so much for your listenership. We appreciate

Thank you so much. Have a good one.

Bye-Bye.