Co-Host Frenesa Hall, MD with guest Dr. Martha Boone

Episode Transcript

Speaker 1 (00:01):
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Speaker 1 (00:29):
It's time now for the Patti Conklin Show, exclusively on
healthylife dot Net Radio.

Speaker 3 (00:41):
Okay, folks, it's forness. Kay Hall, MD. As Patty likes
to say, Patty is covered up busy and so I
have my special guest today, my dear friend Martha Boone, MD,
Award winning your Urologist author and just one of the

(01:05):
smartest people I know. And Martha, thank you for agreeing
to be on the show today.

Speaker 4 (01:12):
Thank you for having me. I hope we're going to
have such an interesting to say.

Speaker 3 (01:17):
Well, I know you do. You have lots of interesting things.
It's too bad we don't have more time. But so
you know, urology is still very male dominated field, and
you've just recently retired from how many years in practice?

Speaker 4 (01:39):
Thirty five years of practice?

Speaker 3 (01:42):
Wow, So let's talk about as you've talked about in
your books, folks, if you want to have a good
laugh and a fun read and get a little insight
into a surgical residency. So Arthur has written a book
called The Big Free and it is absolutely hysterical, but

(02:06):
just for our purposes years, it's we're going to be
more serious and talk about urological things. Let's just talk
about your training, because you know, it takes a lot
to become a surgeon, and certainly a sub specialist surgeon.
So where'd you go to school? Where'd you do your training?
I've done some extra training on top of your urology,

(02:31):
So tell us give us your sort of background.

Speaker 4 (02:36):
That was one of those crazy kids who just really
loved school and love learning. So I did the four
years of college, four years of medical school, than I
did two years of general surgery at two Lane. I
did four years of general urology at two Line, and
then I did a year of view and your track reconstruction,
which is just kind of the biggest surgeries that we do,

(02:59):
like making a new bladder for someone out of bowel
if they had bladder cancer and had to have their
bladders removed. Their bladder removes, so not crazyself did all
those years of surgical training to get to be a neurologist.
And I think most people think the urologists is somebody
who's just sees patients in the office and you know,

(03:20):
checks their urine and stuff like that. But we're actually
a surgical sub specialty.

Speaker 3 (03:26):
Yes, yes, And actually you probably don't know this, but
when I finished medical school, the two things I came
down to deciding between were urology and primary care because urologists,
you know, yes, you're you're in the office, you're you
do have relationships with your patients and the office is

(03:50):
a significant part. You're not just in the or so
it's fun fact, but that's a lot a lot of school.

Speaker 4 (04:00):
Picture is I think you would have been a great
neurologist because it takes a thick skin and a sense
of humor in addition to eyehnd coordination. And said, you
are such a good guitarist and you have definitely a
sick skin and definitely a great sense of humor. I
think you missed your calling, my dear.

Speaker 3 (04:20):
That wouldn't that have been funny? If you and I
wound up in practice together.

Speaker 4 (04:25):
Oh, well, we would have had fun.

Speaker 3 (04:28):
Well, we would have had so much fun, so much fun.
So uh, you retired, Well, you were practicing Atlanta, you
were top eurologists. You got that award how many years
in a row?

Speaker 4 (04:45):
Thirteen, which is kind of amazing. Atlanta has a great
quality of urology. We have a plethora of really good
neurologists in Metro Atlanta. And they kept butting for me
a year a year, which well, huge honor.

Speaker 3 (05:02):
Yes, and you know it's it's their loss that you retired.
But of course I get it, and you retired. He's
done some traveling. You actually you wrote the Big Free
while you were still in practice, right, Yes.

Speaker 4 (05:23):
Hurricane Katrina destroyed Charity Hospital in New Orleans, which was
one of the most important places for six years of
my training and my one of my many mentors at
Tulane was a world renowned traumasaurs and named Norman explained,
and he and I were both devastated that Charity was
not going to be, you know, a functional hospital again.

(05:46):
And so I had been writing stories to him about
things that had happened to us at Charity, and I've
been doing that probably for about fifteen years, and he
just really insisted that I write a book. He said,
you know, somebody's got to memorialized that because it was
such a special place. If I wrote the big for you,
and then I wrote the sequel to it, which is
another charity. But I would get up at four o'clock

(06:07):
in the morning and write until five, and then I
would exercise and then I'll go to hospital. Now, as
a retired person, I can't believe I was that moniacle though,
but that's why I ended up writing the book. My
old boss was forcing me too, and then I just
got up at four am instead of five am.

Speaker 3 (06:27):
Wow, four am, that's that's amazing. And then you retired
and you wrote this book The Unfettered Urologist, when I
never had time to tell you in a fifteen minute
office visit, and you sent me without my autographed copy
right here. And you know, I wish I'd had this

(06:50):
book when I had my primary care practice because there's
so much information that's useful to help get things going
in a work up, or things to do to help
patients with common neurological issues before sending them on to
the urologist and so I believe that we are cut

(07:12):
of the same vein, and that we understand that talking
to our patients and understanding them, getting to know them,
builds the trust, and that the current medical system makes
it really challenging to do that and you wind up

(07:34):
having to see volume. And so I can empathize with
this title because we just it's just evolved into a
situation where, you know, you just don't have the time
that we used to have. Even when I first went
into practice in the early nineties, you know, I had
time to sit down and talk to people. And so

(07:57):
you wrote this book, uh, you know, really for your
for your patients. How did you come What was there
something that led you to say, Okay, I need to

(08:18):
write this book. Was there some incident or a situation
or whatever that gave you this?

Speaker 4 (08:24):
Yeah, there were a number of things. I mean, what
I thought would happen when I retired is I thought,
oh my gosh, there's so many amazing neurologists and down
I walk out the door and everyone will have forgotten
about me in six weeks. And I really spent months
making sure that my patients got assigned to a neurologist
that I thought would work for them. I paid attention
to what part of town they lived in, and the

(08:46):
personality of the neurologists and the personality of the patients.
So I thought I had everybody tucked in tight and
I would just walk off and never hear anything else.
And much to my surprise, the nurse practitioners, the pas,
many of that patients would find me through all kinds
of maneuvers and me as the prime of care. Doctors
and even some of the urologists continued to call me,

(09:09):
and about six months into retirement, it was not showing
any any decrease in the cause I was getting. So
I started taking little sicking notes whenever someone would call
me and jot down the question, and it started to
take a pattern. The urologists were handling the really complex,
difficult problems, you know, pretty easily, But what people were

(09:31):
calling me about was my experience, my intuition. And they
were also calling me because they weren'ted non surgical solutions.
You know, what could I possibly do besides that? And
so they were able to go to the doctors and
get prescriptions and test ordered and surgery set up, but

(09:52):
they weren't having the time to understand why they might
choose that as opposed to something else. So the book
just kind of ca came together from all the questions
that people kept asking me, and I wrote it as
a love letter to my patients because I felt like
my job wasn't over. I thought, they've still got all
these questions, you know, and I need to make sure

(10:12):
that they have the answers to all this. And I
also started realizing there was a lot of things that
were not strictly medical science. And this is something that
you and I share in commin I mean, what medical
science is based on is the randomized double lines of
cebo controlled study, which is very expensive to run. But
then all of us who've been doing this for a while,

(10:33):
we have this fund of knowledge that has come from
our experience, and so much of it is intuition, things
we've learned from other, you know, doctors, things that we've
actually learned from the patients. And so I wanted to
include those things because they're not necessarily covered under the
role of an average urologist. Because we are surgeons. We're

(10:54):
not people who talk about the connection between meditation and
the mind. Are, you know, thinking of those other things
that are so important and so I wanted to include
that stuff.

Speaker 3 (11:04):
Also, Yes, yes, and you know that's that's just funny
things that that you know, we're all just don't talking
about meditation and those things, and that's just another place
where we've connected in that sort of spirituality intuition kind
of space, and you know, really considering all of the

(11:30):
options that are available and recognizing that surgery is effective,
but you know, surgery is cutting someone and then you
have to deal with a whole healing process, and so
certainly makes sense to be able to offer non surgical
solutions first, you know, as as opposed to going to surgery.

(11:57):
So what were the the different issues that your patients
reached out to you for help for? Was there were
there things that were recurrent?

Speaker 4 (12:15):
Yeah, and that's what the whole book is about. They
wanted deeper explanations, you know, in a short office is
that the doctor has time to look at the blood work,
you know, examine whatever part of the body is involved
with the complaint. And then a conventional doctor offers, hey,

(12:35):
you're fine, you don't need to do anything. You know,
if they reassure you, are they give you a prescription,
are they say we need more testing in the form
of you know, blood work or something that needs to
be done at radiology are you know, with a surgical
ship specialty, you go, hey, here's what we need to
do when we need to do in the operating room.
And so I realized that a lot of people wanted
to know, well, well what else, you know, is there

(12:57):
anything else I could try? Or are there any non
conventional treatments that we could try? So it was more
you know, what do you have to offer that not
so drastics seem to be a recurrent thing.

Speaker 3 (13:13):
Yeah, So, you know, as a primary care doctor, I
certainly saw a lot of the common urological things. One
of the things that I know from working in life
insurance medicine and just being records over and over again

(13:33):
that prostate cancer is common and it has evolved over
the years as far as these recommendations. Because so if
you I think, I would imagine that prostate cancer would
have been something that patients would reach out about because

(13:55):
you know that PSA elevation, you know, scares people, but
the elevated PSA isn't diagnostic of of prostate cancer. One
of the things that I've found reviewing records is that
so many doctors don't do a digital prostate exam anymore,

(14:21):
So talk to talk to us about uh elevated pssays
when to be concerned is that the digital exam even
recommended anymore? And you know what are things people can

(14:41):
do to mitigate their risk?

Speaker 4 (14:45):
If if anything, I think I think the first thing, Well,
the answers to these questions are very complicated and the
urology community in the primary care community don't have same recommendation.
So that's one of the problems. To give you the
historic perspective, I believe that youurologists as a group have

(15:10):
in the past over treated protect cancer. So there were
men who had crosseect cancer and some of the treatments
that we initiated were worse than the problems historically. If
a man lives long enough, let's say he lives to
be eighty five years old, he's got an eighty percent
chance that there's some small focus of prostate cancer in

(15:31):
his prostate. Does that need to be treated.

Speaker 5 (15:34):
No.

Speaker 4 (15:36):
But let's say you're a forty five year old man
and men in your family have had crosstect cancer. You
need to be screened aggressively because you're the kind of
person who could actually die of crossect cancer. So it's
a very complicated disease to take care of. And I
think first of all, men need to know what risk

(15:56):
group they fall into. So if you're African Americans, then
you have a greater likelihood of getting protect cancer and
you have a greater likelihood of having the more aggressive
forms of prospect cancer. So any African American man who
has a father, a brother, an uncle, or grandfather or

(16:18):
multiple people in the famis multiple men in the family
who've had prostect cancer needs to be screened, probably by
age forty five. If there's absolutely no family history of
any prospect cancer, then probably between fifty and fifty five,
just depending on what their general health is. You know,
what is a PSA test and then for prostate specific

(16:40):
ANAG And it's just one of many cancer markers that
doctors use, and all cancer markers are imperfect. They need
to be used in the context of everything else that's
going on with the patient. And with the PSA it's
best as trended data over time, and that's just fancy

(17:01):
doctor speak for you check it every year and you're
looking for it to be trending up. So a specific
number is not anything to freak out about. Let's say
your blood PSA the first time you ever had it
done is four, and then you have it done year
after year of year and it stays at four, then
that could be normal for you. Let's say your number

(17:24):
was one year, if you yere a year is one,
all of a sudden, one year was four. So that's
either a lab error or it's a significant data point,
and so you would want to have your doctor repeat
that and by all means be sure that you see
a urologist if it is, and if it is indeed
a bump in the number. So a lot of the

(17:44):
people who have been exempt using the PSA blood test
because they don't really understand how to use it, and
you have gurologists, have probably overused it. But our practice
guidelines have come out from our organization, which is the
American Neurologic Association, and we have become much more conservative,

(18:05):
I would say, so, I think that the use of
the test has come more in life with the best
treatment for the patient, which was not necessarily in the paste.
And you know, you want to just get a meaning
to harm the patient. What the thought was that if
you have any phosized kids, then we want to be
very aggressive because we want to get it out and
we want to stop that. And it took us about

(18:26):
ten or fifteen years to realize that some of these
patients were going to be able to live okay with
a low grade low stage protect kids since so it
really is a very complicated disease to take care of.
The other thing for patients to know that would put
them in a high risk group is if the ladies
in their family have the brack of one or brack

(18:47):
of two gene mutations. And what that is is these
brackup genes are there to repair DNA, and so if
the person has an advarant gene that area, then they're
less likely to be able to repair DNA problem. And
so as far as project cancer goes, the bracket two

(19:08):
gene mutation, it's very very important. And so a man
who has a first degree with female relative with a
bracket two mutation has a six times greater chance of
project cancer. So sick, yeah, well two to sick, but
you know, but two to six times greater chance of

(19:29):
having project cancer. So that's an important thing in their
history to know. Is you want to keep a much
you know closer eye on that on that patient.

Speaker 3 (19:38):
Now.

Speaker 4 (19:39):
Also, something that's kind of soft data is if multiple
people in the family have had different types of cancer,
then demand is it greater risk of project cancer. We
don't know exactly what that connection is. Being over fifty
is a risk factor. And then interestingly enough, obesity is

(19:59):
a risk factor. And the thing that's specific about project
cancer is in obesity, we have increased insulin levels, which
cause all types of tumors to grow quicker. We have
chronic inflammation, which causes all types of tumors to grow more.
We have increased cell growth, which can cause someone to

(20:22):
have you know, worthing metastasis. And in the mail we
see increased estrogen with the increased testosterone which can cause
the worst kinds of project cancer. And we'll talk more
about that after your break.

Speaker 3 (20:39):
Yes, well, we say at twenty minutes goes by fast, folks,
we'll be right back. Stick with us and we'll continue
talking about prostate cancer.

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Speaker 3 (23:23):
Okay, we are back with doctor Martha Boone urologists and
we were talking about prostate cancer and uh that obesity
was something that increased a person's risk for prostate cancer

(23:43):
but also risk of recurrence. So let's pick up. Let's
pick up from there and talk about that more. What
obesit's doing.

Speaker 4 (23:54):
So most people think that bat fells are just sitting
there not doing anything.

Speaker 3 (24:00):
We think, oh, yeah, you know, a little bit overweight.

Speaker 4 (24:02):
But what's the big deal, Well, there actually is a
big deal. Those fat cells make all kinds of things
that are toxic to our bodies. And what's specific to
procect cancer and the risk for project cancer with obesity
is that those fat cells causes to have increased estrogen,
which in the male is semonizing and decreased testosterone. Now

(24:26):
it used to do when I first became a neurologists
thirty five years ago, we thought the testosterone caused project cancer.
Well it turns out that that's unlikely to be true,
and the worst forms of procesct cancer, the most deadly
forms of project cancer, appear to occur in people who
have had love testosterone. So we're having excess atipose tissue

(24:48):
in the mail. We have increased estrogen, lower testosterone, which
definitely can affect your direction quality but also contributes toss
tet cancer and the worst site of project cancer. We've
also seen that in obesity, we have those, like I
said before, the increased insulin levels which adds to tumor growth.

(25:10):
So let's say you are a man who had procect
cancer who was caught early. By all appearances, you appear
to be cured. If you don't address your obesity or
you become obese, you're at greatly increased risk for metastatic disease.
So to have the procest cancer come back, you know,
when your doctor has done surgery or done radiation or

(25:32):
whatever treatment you chosen for project cancer, and your PSA
goes to a low level and everybody's celebrating and thinking,
oh great. You know, if you're this procect cancer, there's
always the chance that there is microscopic disease somewhere in
your body. So that's when you really want to address
all of your habits. You know, like you and I
were talking during the break, you want to be sure

(25:53):
your sleep is okay? Do you want to be sure
that your stress levels we excuse you want to be
sure you're in lots of brightly colored fruits and vegetables.
Do you want to be exercised. You know, all the
things that make your general health better will also lower
the incident of having your process cancer come back and
come back as a metastatic disease. And part of that

(26:16):
is maintaining you know, as best you can in your
ideal body way.

Speaker 3 (26:21):
Wow. So you know, as we when we're looking on
the break, you know the things you just mentioned, sleep,
addressing stress, eating a wide variety of fruits and vegetables
with many colors, and exercising. I mean, these are foundational
things for good health in general. But now you're tying

(26:44):
it directly to cancer risk and recurrent cancer risk, which
really I think highlights just how important our habits are
on our overall health and wellness.

Speaker 7 (27:00):
And so.

Speaker 3 (27:02):
I think this just adds to that understanding and hopefully
will motivate folks that are listening to this to a
go get checked out and be really understand that our
habits and our weight can have long term dangerous consequences

(27:23):
to our health. So let's go to another topic that
I ran into often in practice. It was recurrent urinary
tract infections, and it just seemed to be, you know,
there was just certain women that just always had a
urinary tract infection, and can you tell me talk to

(27:47):
me about you know, what are the risks? What are
the factors that contribute to a woman having recurrent UTIs?
I mean, obviously there's the anatomy and the proximity of
the urethra to the rectum, but why certain people, what

(28:10):
what is that that causes these this group of people
to have the current UTIs?

Speaker 4 (28:19):
Well, it's it's multi factory. Some people have inherited a
type of E coli called a peace embriated e coli
and it's basically an organism has these little legs that
allows it to track out of the rectum into the vagina,
which is a warm, moist culture medium, and then track

(28:40):
up into the urethra and really be able to take
hold onto the lining of the bladder and sometimes up
into the euroiners and up into the kidneys. So this
peace cymbriated E coli which is inherited is one of
the factors. And multiple countries in Europe have created a
vaccine to this particular and to my knowledge, it has

(29:02):
not been approved in the US yet. But for your
listeners who do suffer with chronic bladder infections or kidding
infecsions are both. They definitely want to pay attention that
does this become available in the United States, because I
think that will actually cure a number of patients, But
that is not being approved yet that I'm aware of.
What are the other factors? One is not drinking and

(29:24):
not fluid. The mechanics of having fluid rushing through the
bladder and rushing through the urethra can actually wash out
some of the bacteria before they can really take hole
in the semi urinary track. We want to be sure
that we hit that sweet spot with fluid intake. If
you drink too much, you can actually stretch your bladder
and your urders and everything so that they don't empty effectively,

(29:47):
and you can make the problem worse. So I would
see patients coming in my office, who are, you know,
five feet tall and drinking two downs of water a day,
and you know, I look on ultrasound and inside their
kidneys and uriners and bladder, we'd be all dilated and
then w build empty and they'd be making the problem worse. So,
just like we want to eat an amount of food
that's proper for our bodies, we want to drink an

(30:07):
amount of fluid.

Speaker 3 (30:08):
That's proper for our body, and so you do.

Speaker 4 (30:11):
You definitely need to discuss this with your primary care
doctor because you may have medical reasons that you would
need certain amounts of fluid or even fluid restriction. But
for the average healthy woman, usually it's about half of
your weight in pounds in ounces and flood that you drink.
So let's say you weigh one hundred and sixty pounds,

(30:31):
then your goal over twenty four hours of total fluid
intake would be, you know, around eighty ounces. And it
will very depending on your level of activity, and if
you're a marathon runner, you're going to need more. If
you're somebody who's just hanging out in the house not
doing much, you might need less, but that would be
kind of a ballpark to shootout. So amount of fluid
intake is one thing. The other thing that's very important

(30:54):
is it's about activity. If you have chronic diarrhea or
chronic occupatient, then you're going to have much more bacteria
hanging around down there than the average person. So talking
with your promo care doctor or your gi doctor to
try to get your bowels more normalized would be important.
And there's not been a lot of studies on this,

(31:16):
but I had really good luck with people taking probiotics,
and so I would definitely encurase the patients to talk
to their doctor, you know, about using probiotics, because that
did seem to be a helpful thing. And then when
we're young, our vagina is naturally very aesthidic. We have
high levels of vestrigen and that causes a vagina to

(31:37):
be stick and so to some degree that appears to
protect you know about your come out of the rectum
and go into the vagina and then they're killed by
the acidity. And then as we get older, you know,
we're more alcoholic. And we can talk about that after
the break.

Speaker 3 (31:55):
Okay, so fascinating information here, folks. We have to take
another break and we will be back to continue talking
about factors that contribute to UTIs.

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Speaker 3 (34:40):
Okay, folks, Vanessa Hall here with my guest doctor Martha
Boom and before I forget, if you want to know
more about Martha, what's your website.

Speaker 4 (34:54):
Www. Marthaboo dot com.

Speaker 3 (34:59):
That's O n E. So you can catch her there
and you can get her books at all the usual places.
So when we left off, we're talking about UTIs you
want to just continue on that data. I mean, it's
such a common problem. And I think last we're talking

(35:20):
about bowel issues and making sure you get those things
cleared up because they can contribute, So go ahead, so.

Speaker 4 (35:33):
Definitely, you know, make sure that you treat you to
computation or diarrhea because that can contribute. And then I
was speaking about the difference in the pH changes in
the vagina. When we're young and have a lot of estrogen,
the vagina is more acidic, and then as we age
and lose that estrogen, it becomes more alcoholotic. The acidic
environment is likely to kill the bacteria, which is good

(35:56):
for us, and the alkohotic environment is actually making makes
it a happy place for the bacteria. So a lot
of ladies that are posting an a puzzle flatters than
taking so many antibiotics can be treated with a low
dose vaginal estrogen and it's something that they would you
get from their gycologists of their primary care. And I

(36:17):
think this is something that's really underutilized. Just about every
woman if she has no indication to using topical estrogen,
no counter, no contraindication to using topical estrogen, should seek
that out because that will change the vaginal pH and
that can stop the whole cycle also. And then the
number one thing that we want to make sure of
his invitation is emptying the bladder. After about age thirty five,

(36:41):
women start to get a little bit of sagging of
the bladder, which you know, kind of SAgs into the
front of vaginam and so without knowing it, we could
be having it emptying problem. So that is the one
test that women would definitely want to get a bladder
ultrasound to make sure that the bladder is emptying. Okay,
So with that, I thought we could move on to

(37:02):
treatment that workstream.

Speaker 3 (37:05):
Yes, yes, like you know cranberry cranberry capsules. Is that
for real? It is for real, And it.

Speaker 4 (37:13):
Took me about twenty years to realize what the issue is.
Places would come in and say, you know, I've cured
my urinar infections with drinking cranberry juice. I go, yeah, yeah, yeah.
So I would recommend it to other people. I say,
I don't have any science on this, but you might
want to try it. And you know, some of them
it would work. Some of them wouldn't. Well, finally we
have the science. There is a compound code called pro

(37:36):
and tho cyanidid and we just you know, we shorten
us PACs and it is the component in cranberry that
helps flatter infections and what it does that helps prevent
them by keeping those little legs on this pea symbriad
e coli from sticking to the lining of the urinar track. Now,
the various cranberry stupplements have different levels of PACs, and

(37:59):
so some of them work in some of them dons,
And unfortunately, some of the ones with the highest advertising
budget are the ones that have the lowest active compounds.
So I don't have any kind of financial relationship with
any of these companies. And I'm just going to tell
you the three that I found work. One of them
is called the Laura B L l U R A,

(38:21):
another is called sacran t H E r A c
r A N, and the third one is called Utiva
Uti v A. And what the pill needs to have
is at the least thirty six milligram of these PACs
per pill to be able to work. Now, a lot

(38:41):
of patients would say, well, why can't I just drink
cranberry juice. You'd have to drink about a cup of
cranberry juice in the morning and at night to get
this same level of PACs, and for most people that
would lead to about a ten pound weight gain of
the course of a year. So you can do it
with cranberry juice, but even the criminageues with no sugar

(39:01):
in it can give you the weight game. So the
easiest thing is probably to get the pills, and they
do work. Now they don't treat an active infection. Once
you get an active infection, they're not going to treat that,
but they do really work for prevention. I mean, I
would have patients, but that would have a fifty to
seventy five percent lower incidents of uiniar infections per year

(39:23):
just by doing the cranberry and then an the aprobable woman.
If you added the vaginal estrogen, I mean, we would
see people cured where they just didn't get anymore. So
it's worth it's worth pursuing that, and.

Speaker 3 (39:37):
That's cheap, cheap, virtually no downside to trying it.

Speaker 4 (39:44):
Yeah, I mean, the problem was just going to the
urgent here and getting repetitive antibiotics. Is that the bacteria
are smarter than us. So every time we take an antibiotic,
what do they do? They change their morphology so that
they are resistance setting. And so what happens for a
person who just over many years keeps taking antibiotics, antibotics,

(40:05):
antibotics to get to a point where we have back
here that we cannot kill. And so both the patients
and the doctors need to be better stewards of antibiotic
utilization so that we don't end up causing the patient
to have an organism that we cannot treat. Right, the
decrease in the amount and the strength of antibiotics that
the patient gets is very important for long term management

(40:28):
of this.

Speaker 3 (40:29):
Yes, you know that's certainly a primary care doctor's problem.
And clients come in with whatever, and they want an
antibiotic as if it's a kind of sea to cure everything.
And I can't tell you how many fights I had
with patients, you know, thing that you know, an antibiotic
is just not indicated for what you have. And you

(40:50):
have these you know, ongoing effects and creating resistant bugs that,
as you said, we don't have a treat for. So
and you know, closely related to urinary track infections is
urinary incontinent and you know, being a woman of a
certain age, a lot, well not a lot, but there

(41:14):
are several of my friends that have stress and continence
and that's very common. And you know, at least back
when I was practicing, you know, it's like, okay, you've
got to do some cake exercises and get the strength
of those muscles up. But I don't know, I've not
really encountered anyone who had success with stress and continent

(41:40):
doing cake holes. How how do you address stress and continent?

Speaker 4 (41:50):
So just to give your audience a little bit of
that run information, you're basically three types in common. There's
stress and continents, which I think is a terrible name
for it, but basically what that is is coughing or
straining and squirting out you know, drops or you know,
even a large volume of urine. And the stress part
of it is the coughing and the straining. So you're

(42:12):
stressing your sphincter by straining your abdominal muscles and it
overcomes that sphincter muscle and then you squirt out a
little bit of urine. The second type of incontinents is
urson continents. Which is where the bladder has like a
little spasm and starts going on it's own before you're
ready for it to go. And then the third type
is overflowing contents. So if you're just leaking a couple

(42:35):
of drops of urine and it mostly with coughing and straining,
then I would strongly recommend going on the internet and
looking up a reputable site like maybe the Mayo Clinic
or you know, the Cleveland Clinic, and they should have
videos on how to do the kegel exercises. They really
do work, but the problem is people won't do them,
and you know, you have to do like twenty squeezes

(42:57):
a day to be able to get it to work,
and they keep doing it. It's just like any other muscle.
You know that if you stop doing it in the
muscle atrophies and becomes weak. And you know, I ain't
probably if people want to do them, and we come
back after the break, we'll talk about what else you

(43:18):
can do.

Speaker 3 (43:19):
Okay, So when we come back, folks, it's our last
segment and we will pick up on your airy incontinence.

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Speaker 2 (45:49):
Radio your way help Youlke dot Net.

Speaker 3 (46:07):
Okay, we are back with doctor Martha Boone and we
left off talking about stress incontinence where and that cagels
exercises were effective. But just like any exercise, if you
want that muscle to get strong, you actually have to

(46:29):
consistently do the exercise. So Martha repeat for us, how
go you said, go to the Mayo Clinic and find
a reputable source, and then you have to do the
cagels how often each day?

Speaker 4 (46:46):
Probably about twenty reps per day. But you know, I
found so many patients who just could not discipline themselves
to do it. So if your listeners don't hear anything
but the next thing I'm going to say, then I
will consider my time spent with you well. Since the
Pelvit for physical therapy people in America are fantastic and

(47:09):
we don't use them enough. There are all these people
who are trained in Pelvit for physical therapy and whether
you have ecal incontinence or urineary in continence, or mild
prolapse or stress and content, they can definitely help train
you to cure this problem without having surgery. I can't
tell how people would come into my office every day.

(47:32):
And want to have an operation because they didn't want
to take the time and the energy to go to
pelvitic or physical therapy. But the ones who would go
and who would stick with it, I mean I would
say there was an eighty five to ninety percent success rate.
Surgery is wonderful, but it should always be the last choice.
I mean, if you happen to be the patient that

(47:53):
everything heals properly and you don't get infected, well, then
that's wonderful. But even in the best with the best surgery,
there's about a fifteen percent complication rate. So if you
can do something that has a zero complication rate, it
would make sense to do that first. And so pelic
sorce chysical therapy should be the number one consideration really

(48:15):
for all incontinent patients. Unless you have overflowing continents, if
you're bladder just won't empty at all, then pelic sorce
physical therapy is not going to help. But for urging continent,
stress and continents, and for fecal and continents, pelic flor
physical therapy really works well. Some of the other things
to consider it stress and continents is a lot of
times that same lady who has posting an a puzzle

(48:36):
can benefit from doing the keygels or from doing pelvit
for physical therapy along with topical vaginal estrogen. There's a
lot of evidence in the scientific literature that the topical
estrogen strengthens the tissues around the urethra so that you
have actually something better to work with. And even while
it's going to operate on people, I would ask them

(48:57):
to use the topical estrogen for six to eight weeks
before we did surgery because a lot of times they
would get a better surgical outcome also, and then you
know men who having comments after a proseate operation, they
can definitely benefit from pelvic cool physical therapy.

Speaker 3 (49:12):
Also excellent, excellent, And you know the whole vaginal estrogen.
You know, those tissues I mean, as you know, get
dry and fragile, and so it makes perfect sense that
you would want to beef up those tissues before you're

(49:35):
going to go cutting on things. So pelvic for TT. Now,
when I was in practice, I don't even think I
knew about pelvic for physical therapy. Since then, I actually
have a friend that is a pelvic floor physical therapist.
But are most I mean, I'm imagining that most of

(49:59):
those referrals they are coming from urologists and not so much.
Primary care.

Speaker 4 (50:05):
Doctors are not referring to them at all. And you know,
I don't understand it because in Europe, whenever a woman
has a baby, they start to talk for physical therapy
before they ever even you know, deliver, And then America
we don't refer to for a physical therapy much at all,
which is very unfortunate. But there are a lot of
really good ones out there. And if your patients, if

(50:27):
your listeners were to have trouble finding one, then whatever,
it is a major hospital that does a lot of
odgu I n in their area, they should know who
the good pallet for physical therapists are. And in Atlanta
we've got one just about on every corner and I
know all of them and they're just amazing folks. But
I think the patients should should really really push for this.

(50:49):
And in some states, people who are on Medicare can
actually self refer They don't even have to get a
referral from their primary care doctor. And I don't know
how that is in all states, but in Georgia, I
believe Medicare patients can sell refer to physical therapy. So
that's that's an important thing.

Speaker 3 (51:05):
That yeah, that's that's excellent. But you know, I mean
the primary care doctors. You know, we're quote unquote gatekeepers,
you know.

Speaker 5 (51:15):
And so.

Speaker 3 (51:17):
A patient could go and get your book unseted Urologists
and go to their primary care doctor and ask for
a referral for pelvic floor physical therapy. I mean, I
think that alone would be so beneficial. And definitely, you know,

(51:38):
surgery is a last resort, you know. As you said,
and I want to repeat this for folks, you said
that surgery, even the best still has fifteen percent complication
rate versus pelvic four physical therapy. That's zero. That me

(52:01):
is a reason enough to start with pelvic for physical therapy.
You know, primary care doctors have a lot of things
to cover. And as I said at the opening, you know,
I wish I'd had this book when I was in practice,
because I learned so much about these common issues that

(52:28):
that I encountered, you know, and obviously telling someone that, oh,
do some ke golds, you know, was not an effective, uh,
not effective advice. And clearly you know it's got to
be an exercise routine. And I imagine that with the
pelvic poor physical therapy, You're going to get sent home

(52:50):
with exercises that you need to do and maintain. So
the book is the Unfettered Urologist that I've never had
time to tell you in a fifteen minute office visit.
It's available everywhere. And then Martha Boone dot com, if
you want to know more about doctor Boone and we

(53:12):
have just a few minutes left, tell me what's what's
on the horizon for you. I mean, you know, you
are not someone to sit around and be idle and
just go fishing while you're you know though, when you do,
you got to call me because you know so tell

(53:37):
us what can we expect from your look for.

Speaker 4 (53:41):
Well, I'm writing three books, which it takes a few
hours a day to do that, and I'm trying to
take care of myself. I'm sleeping, I'm trying to get
I'm trying to expect. But one thing I did want
to say to your listening audience, the power of this
book I'm Strologist, is to give them enough quality information
to be able to ask the right questions when they

(54:03):
go to the doctor. What happens is most patients show
up at the doctor and they don't even know what
to ask because there's just a pressora of low level,
low quality information on the Internet, so they come in
confused instead of knowing what to answers. So if you
have a common neurology problem, the book can help give
you quality background information so you know what to ask

(54:24):
when you go to the doctor. And that's the power
of the books. But as to what I'm doing, I'm
still getting a lot of calls from patients and nurse
pressures and so I do some time doing that, and
you know, taking really good care of myself.

Speaker 3 (54:38):
It's time consuming and it's a full time job, isn't it.

Speaker 4 (54:44):
Yes, And for those of you who really want to
know the down and dirty truth about doctor. For Vanessa Hall,
she's my husband's fishing buddy and the two of them
like stay out all day fishing. So just so you
know a little tidbit about her that you might not
find out from the other gifts.

Speaker 3 (55:03):
Yes, he is my vision buddy, and we we had
such a great time going out fishing. We had some
some tall tales to tell when we got back. Of course,
I had to pry myself out of the boat because
since sitting hunched over for so long. But that was
a great time, and we are definitely overdue for getting together,

(55:23):
and you know, time flies and we've got to sign off,
but thank you so much for being my guest, and folks,
go get the book if you're having any of these issues,
and actually there are other issues we didn't even cover,
and uh, you know, get that information and be educated
and be your own advocate when you're going to your doctor.

(55:44):
So thank you so much. Next week, thank you, Ramer
home me off as this Herbalists going to be a
great show. Martha, thank you again, really appreciate you being
on the show.

Speaker 4 (55:57):
Thanks thank you for having me. I hope the movie
else with this.

Speaker 3 (56:02):
I'm sure I'm sure that people out there, because these
problems are so common, that there are people out there
that are going to really benefit from this. And we
all know someone who has one of these problems or
more multiple and so share the information. It'll be tomorrow,

(56:28):
it'll be up on the website and you can listen
on demand. So if you're out there and you have
friends that have these issues, you know, send them the
link to the show so they can listen to this
show or get them the book as a gift. But
you know, I think anything that we can do to
help people you know be their own advocate and stand

(56:52):
up for their health and be actively participating the health
is a big benefit. So thank you for writing the
book and thank you for being on the show.

Speaker 4 (57:03):
Thank you