Joe Hage: You delivered 7,000 children or so?
Dr. Laing: At least.
Joe Hage: You no longer practice OB/GYN.
Dr. Laing: No.
Joe Hage: But along the way, you thought, we need this thing that I’m holding in my hand.
Dr. Laing: Well during my 35 years of practice, most of it, especially the last 15 years was spent in the field of urogynecology, which is a specialty that deals with bladder disfunction and pelvic support disorders.
And the thing I faced everyday, multiple times – was I had to get an objective accurate feel for the patient’s symptomatology. How exactly was her bladder functioning?
So I needed voiding data, and that was something that was almost impossible to obtain with the current technology.
Joe Hage: What is the current technology?
Dr. Laing: Current technology means I give the patient a hat, a plastic container that fits in the commode and they have to then void into that, measure it, write it on a piece of paper.
And the problem is, the vast majority of patients can’t sit by their bath for three days and do that.
So compliance is poor, accuracy is even worse because they’ll skip parts of the day, they’ll miss voids, and they’ll fill it in retrospectively. It’s called hoarding.
They’ll build up the information and they’ll go back and put it in – usually in my waiting room – before I see them.
Joe Hage: Kind of like, “Yeah, I think it was 2:00 in the morning?”
Dr. Laing: Yeah, and I think I voided this much or I think it was this issue. So that doesn’t give me the information I need to make an accurate diagnosis.
So over the course of 35 years of practice, I dealt with this problem thousands, tens of thousands of times, but I got to the point of frustration saying somebody has to solve this problem. There has to be a way of doing it better.
Joe Hage: It does seem like such a chasm between what is still today, so we’re talking in December of 2019, here in Tennessee, and this isn’t on the market yet.
Dr. Laing: No, it will be second quarter of 2020.
Joe Hage: And so for as long as you’ve been in practice, the best alternative to having somebody pee naturally on their own schedule into a device that, as I understand it, collects the data of the flow, the duration, the time, the volume, and reports it up to the cloud and goes right to the doctor’s reports.
Dr. Laing: And from there it can be used, any sort of report, analyze it, any manner that the healthcare provider, the urologist, the urogynecologist, the gynecologist wishes.
The device collects flow, duration, time, and volumetric data and reports it to the cloud where it can be used in any type of report.
Joe Hage: In the absence of that I had two choices. I could pee in a plastic hat, look at the side of the thing, write down how much I think that is, pour it out, wash the thing, put it away. I’m certainly not taking that to work.
Dr. Laing: No.
Joe Hage: Or the restaurant.
Dr. Laing: No.
Joe Hage: So later on I say I went a little or a lot, basically.
Dr. Laing: That’s right, you basically make it up.
Joe Hage: I went to the bathroom and I really had to go. And that’s your data.
Dr. Laing: And if you really have to go at home, even, you haven’t got time to take out this equipment, put it in the commode and get in position before you have to void, so, many times, you just wouldn’t use it.
So we needed a way to be able to capture accurate, objective voiding data that was completely intuitive, completely automatic that required almost no interaction with the patient except to hold it in position and void through it.
It requires almost no interaction with the patient except to hold it in position and void through it.
Joe Hage: Now you know I’m a little out of my element, but I understand that there is a big expensive piece of equipment called a uroflowmeter.
Dr. Laing: You can get a uroflowmeter, which is based on the weight of the urine, and with what I would have in my bladder lab is going to be somewhere around several thousand dollars and require a fairly extensive setup so you can do a uroflow, for instance, for a man with maybe a prostate issue in the office.
Joe Hage: Right.
Dr. Laing: The problem is I only get one sample. Done in a very unusual or unnatural circumstances. And two out of three times there’s not enough, or you’re just not able to void because of inhibition in the office. So what you’re getting is a very unnatural look at what you think is his voiding pattern.
Dr. Laing: At home, he can get up in the morning and use CarePath. He can use CarePath in the afternoon.
He can go several times during a two-week period and we get a whole panorama of what his voiding function truly is, and we get it exactly in the same environment he’s voiding in usually.
So it’s a completely natural snapshot of his bladder functioning.
That’s not possible without it.
Joe Hage: The fact is, there was no way to do this before. And this is because of the advent of remote patient monitoring?
Dr. Laing: Exactly, new technologies allow us to capture that data easily, to send it to the cloud, and then use from the cloud in the form of reports. And before it was possible, people just didn’t do it.
You would ask the patient what her symptomatology was or his and they would try and remember and the reality is people do not remember what they do in the bathroom.
That’s nothing that people normally remember.
And the really important part is we were basing our diagnosis – basing our expensive management decisions, our invasive management decisions – on information that most of the time was incomplete or even worse, incomplete and inaccurate.
Joe Hage: How, how big a deal is getting it wrong in this field?
I told you I think I peed this much or that much. If I really peed 100 ccs, I have no idea how much that is, of course, maybe that’s like a gallon, I don’t know. But I actually only did 70.
Is your diagnosis gonna be so different that, oh, I would never have put you on that medicine or we never would have taken an MRI?
Dr. Laing: Well, if a person even had that degree of recollection, then the need is not as great. But the reality is, what they’ll say, is, “I think I went four times last night.” Or, “Maybe I went two times, and ‘it was kind of like a normal amount.'”
You’re not going to get anything like, “I sat there voided 100 ccs.”
They’re not going to have any idea. So we get really, sort of a general idea. “Yeah, I went. I’m going a lot, Doctor.” Or, “I think I’m going less than I should.”
Joe Hage: So what do you do with that information?
Dr. Laing: You try and make a diagnosis. You may do what we call bother indexes, which is a form to fill out that gives you a score that say okay, your bladder’s bothering you to a certain degree, especially if you’re a man with a prostate issue and we use what’s called a prostate symptom score.
The problem with that is, it doesn’t give me the data I need to really use to make an accurate diagnosis. I know it bothers you, and from the IPSS score I can tell there may be a prostate issue here, but it’s not definitive.
Joe Hage: So I’m in my early 50’s. I haven’t had to worry about this issue just yet.
Dr. Laing: But you will eventually.
Joe Hage: How old will I typically be when I start to say I think I have a problem?
Dr. Laing: Yeah, over 80% of men in the 70 group, at age 70 and above are gonna have issues with their prostate, resulting in lower urinary tract symptomatology that bothers them. You’re 50, so you’re not quite there yet. When you get to be 60, you’re up to probably 60+ percent so it’s a very common issue.
Joe Hage: And my issue’s going to be?
Dr. Laing: You’re going to have a problem in terms of emptying your bladder. You’re gonna have a problem getting started. You’re gonna find you have to strain sometimes. You’re gonna find you’re getting up several times a night, which is probably the worst symptom.
Joe Hage: And like I never feel like I’ve completely emptied my bladder?
Dr. Laing: Right, yeah.
Joe Hage: Like I feel like I always have to go.
Dr. Laing: Yeah, so there’s a frequency to it. There’s an urgency issue, and as we call nocturia, which is going at night. And all of those issues over time become extremely bothersome to the patient.
It’s a very common concern, but it has a great impact on quality of life for the patient, be it male or female. Obviously, the woman’s issue is different. It’s gonna be more likely to be overactive bladder.
But even in the man, there’s a dozen different reasons you might come in and give me the same symptomatology.
Now, unless I know how much you’re voiding and accurate data of how often you void, and what those were to, like I can’t tell which of the 12 possibilities it might be.
Do you have an overactive bladder?
Do you have a prostate issue that’s causing obstruction?
Do you have inflamed prostate issues?
Do you have an underactive bladder?
These are all things I’ve got to sort out when I see you.
And the best I can do is go off of what you tell me you think you remember about your bladder function.
It’s not a very accurate piece of information to allow me to make an accurate diagnosis, and I’m gonna make decisions, like okay, let’s put you on medication or let’s go into surgery.
I don’t want to take you to the operating room, operate on you, and then come back and you’re no better because I didn’t get the diagnosis right.
I’m treating you thinking, well, from your symptoms score, I think that you have moderate to severe obstructive disease.
But really what you have is you have an overactive bladder with a mild degree of obstruction.
My symptom score is not gonna tell me that. I need the CarePath system to tell me that.
I need the information on how often you void, what your void looks like in terms of its pattern, what amounts you’ve voided and the sort of symptomatology around those voids.
With that, I can quickly sort out, okay, he really is more of an overactive bladder issue and he requires going on this medication to calm that down.
His degree of obstruction’s actually fairly mild. He has normal flow rates, you know, so his obstruction is a fairly mild process.
So I don’t end up treating you with surgery or wasting your time on medication based on my inability to get the objective accurate voiding data I need to make the proper diagnosis.
I don’t keep you on it, you’re not getting better because I can’t tell you’re not getting better because you can’t give me the information I need to say okay, we’ve improved.
With this I can send you out in three months and say “how we doin?” You come back and I can compare the two and say okay, here’s where you were before treatment, here’s where you are now, and we have a 60% improvement in all the parameters.
Joe Hage: Affectionately, for our audience, my loquacious friend here would be happy to talk for a lot longer, but you have other things to do today.
Dr. Laing: Nonstop.
Joe Hage: So I want to wrap with two things. One is, remote patient monitoring means you can do it in other places that you normally wouldn’t, but this is going to offer a degree of accuracy that no technology can offer.
Dr. Laing: There’s nothing in existence that will give you the accuracy of the CarePath device in the ambulatory or home environment. You can’t bring a full bladder lab gravimetric uroflowmeter into your bathroom.
There is potential to bring in device about the size of a kitchen blender that you can use and try that, but the problem is they’re not gonna give you the data you need to do a voiding diary.
And I want both.
I wanna know your uroflow pattern and I wanna know your voiding data over time. And the only thing that allows you to do that is the CarePath device. There is no other technology or device in existence.
Joe Hage: You’ve delivered thousands of babies and somehow you figured out engineering design. This is not his first medical device, as I understand it, you sold your last company to Medtronic some years back.
Dr. Laing: I did. In 2014.
Dr. Laing sold his last company to Medtronic in 2014.
Joe Hage: And you’ve already conceived your next invention.
My parting question for you is, we’re looking into the future now.
This has widespread adoption. What do you think is going to be the difference in care?
They’ll be more accurate, yes.
But do you think we’re more likely to see fewer surgeries because so many were unnecessary? Do you think we’re gonna have more because so many went undiagnosed?
Are we going to have more people on medication? Fewer people on medication?
Do you have a guess?
Dr. Laing: I think we’re going see more people managed appropriately.
The problem you have now is that people come in and they’re diagnosed maybe inaccurately, maybe the treatment they’re on is not being monitored or appropriately adjusted because of lack of information and so they get discouraged and they don’t follow through.
Now what we call patient attrition: They begin with the first visit and they don’t follow along to a point of resolution.
Joe Hage: So they just suffer?
Dr. Laing: They just suffer. So that’s one of the problems.
The other problem is it’s very expensive. That “wandering around therapy” is very expensive. Some of the therapies are surgical or invasive and also involve a significant expense.
So you want to avoid that in the wrong patient.
They’re not going benefit from it, you want to avoid doing it on them. So I think that’s another issue that we’ll know.
We also have to be very cognizant of healthcare costs.
So this allows us to take that care, the triaging part of it, and back to a community-based clinic at a mid-level provider and allow her to manage a large number of patients and then go to the urologist.
But imagine it at the community level, at a much lower cost to the system, to free up the urologist – who is in desperately short supply and getting worse – allow them to do what they’re trained to do, which is invasive investigations, third-line therapies and such.
CarePath enables appropriate care at a much lower cost to the health system.
Joe Hage: Push down part of the diagnosis, to free up what is, as I understand it, a greater demand as we age and a decrease in supply of urologists.
Dr. Laing: Yes! Most urogyns and urologists are over 55. So we are going to see.
Joe Hage: Really impressive, I’m really excited to have even a small part in your success here.
Dr. Laing: Thank you very kindly.
Joe Hage: Thank you. Brent.
