August 15, 2023

Unsaid things during your urologist appointment with Dr. Martha Boone

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On episode 603 of the 40+ Fitness, we meet Dr. Martha Boone and discuss her book, The Unfettered Urologist: What I Never Had Time to Tell You in a Fifteen Minute Office Visit.


Let's Say Hello

[00:01:25.690] – Allan

Hey, Ras. How are things?

[00:01:27.230] – Rachel

Hey, Allan. Good. How are you today?

[00:01:29.890] – Allan

Doing all right. We had another incident this weekend.

[00:01:35.080] – Rachel

Oh, no.

[00:01:36.270] – Allan

But this is a happy ending.

[00:01:38.580] – Rachel

Okay, good.

[00:01:40.110] – Allan

Well, it's happy because here's the deal.

[00:01:43.190] – Allan

A friend of mine here, another friend. Here had actually listened to our podcast when I talked about losing my friend, Greg to a heart attack. Well, this weekend, he's short of breath, pressure in his chest, not feeling well. The night before, he felt kind of an odd thing in his shoulder. Now he sees these lineup of symptoms.

[00:02:10.170] – Allan

And you get nervous and so blood pressure goes up and a lot of the things going on. Anyway because there's not really an ambulance. There is an ambulance service on the island, but you do better to walk. Even if you're having a heart attack, you'll get there faster. But my wife went by, she has a car, so she picked him up and took him.

[00:02:30.000] – Allan

And I just stayed online with them and just kept him calm and said, okay, here's what you do when you go in to talk to the doctor. Here's what you tell them, and then you don't leave there. Even if they tell you it's nothing. You don't leave there until you get an EKG. They can do anything else they want to you, but you're not leaving there till they do an EKG and tell you it's normal.

[00:02:53.110] – Allan

And he did that, and he actually did have to advocate for himself to get the EKG because the doctor just wants to say, well, this is indigestion, and you've got bronchitis and you're old man, so this is normal and it's not normal.mAnd we're going to talk about that a little bit later. But the whole point being is, it was probably not a heart attack. At this point, we're not sure.

[00:03:14.220] – Allan

The doctor says it's not, but at this point, it's like you have to be an advocate, you have to be demanding. His wife had to go in there because he was sitting in the waiting room and she literally had to go in there and start raising hell to get them to come out there and start taking care of him. So if you find yourself in a waiting room and you were having chest pains, don't sit in that waiting room. You go up there and tell them, I'm a middle aged man or woman. And I'm having chest pains and I'm not going to die in your waiting room while you sit here and do whatever the hell you think is more important.

[00:03:49.610] – Allan

If nothing else, get me an aspirin, get me a nitroglycerin, get me something that you know is going to help someone if they're having a heart attack. But I'm not going to just sit here and not be cared.

[00:04:00.330] – Allan

You know, again, we're not in the United States, but you hear horror stories of emergency rooms in the United States too, so it happens everywhere, I'm sure, but it's just you got to advocate for yourself. And he did.

[00:04:11.040] – Allan

And fortunately, the outcome is not a bad outcome. And he was in the right place he needed to be. If he was having a heart attack because he didn't ignore the symptoms.

[00:04:22.160] – Allan

And it might have been indigestion and it might be bronchitis, it might be a lot of things, but at least at that point they confirmed to him that it was not a heart attack. They did the EKG, they did the blood work. And so he's reasonably confident that he was not having a heart attack, which, again, very good, but it's also convincing him he should probably quit smoking.

[00:04:41.330] – Allan

And I concur. okay.

[00:04:45.320] – Allan

But these are the health conversations we need to be having and we need to be aware and pay attention to ourselves. So again, if you don't know the symptoms for a heart attack, a little different from a woman and a man, but take some time, get yourself familiar with those things because it's not normal to fall apart over time. If we do the right things for our body, our body will be healthy for a long, long time. And so if you notice symptoms, pay attention.

[00:05:11.420] – Rachel

Yeah, for sure.

[00:05:12.420] – Allan

And then the second thing I want to talk about is I've been planning our trip.

[00:05:15.890] – Allan

We're going to take September off from Lula's for sure. We're shutting down Lula's and I'm going to not take any new clients in September. So today is August 15 and so after got two weeks. Now if you want to work with me, this is your time to sign up. I'll be servicing clients. Podcast will keep rolling on through September, but I won't be taking on new clients. So if you decide you want to message me in September, I'll take your details, you can fill out the form.

[00:05:45.600] – Allan

But you're not going to see anything on my calendar to book, so you could email me and send me your details, and I'll say, okay, I'll talk to you October, probably October 2, and that's it.

[00:05:54.790] – Allan

So if you want to work with me, you can go to 40plusfitness.com/discovery. It'll let you there's a calendar right there that actually ties to my calendar.

[00:06:03.980] – Allan

So if you see open dates, that's times that I'll take those calls, but I promise you right now, you will not see one of those dates in September. So, 40plusfitness.com/discovery if you're looking to make a health and fitness change.

[00:06:17.380] – Rachel

Awesome. Sounds great. Glad you get to take this time off, Allan. It'll be really nice for you and Tammy.

[00:06:23.120] – Allan

Yeah. I mean, I'll still service the clients that I have that are remote online because I can. But I'm not taking anymore. It's too much work to onboard a new client, and I don't want to be doing that while I should be on a beach somewhere

[00:06:38.200] – Rachel


[00:06:39.170] – Allan

Yeah. Or doing something fun.

[00:06:41.090] – Rachel


[00:06:42.050] – Allan

Tammy's planning 99% of it, and I'm just going along for the ride.

[00:06:47.400] – Rachel

Nice. That sounds awesome.

[00:06:49.280] – Allan

How are things up there?

[00:06:50.960] – Rachel

Wonderful. I'm having a very relaxing week. I'm in taper mode for a race that's coming up this weekend. So besides talking with you and run club later tonight, I literally have nothing on my calendar, and I'm just taking the time to relax and chill and get ready for the weekend.

[00:07:09.330] – Allan

That's awesome.

[00:07:10.520] – Rachel

It is. Feels good.

[00:07:12.700] – Allan

Well, good luck with your run.

[00:07:14.590] – Rachel

Thank you.

[00:07:15.260] – Allan

I want to hear next or over the next couple of weeks how that went.

[00:07:18.860] – Rachel

Sure, yeah. I'll keep you posted.

[00:07:20.570] – Allan

Let us know. All right.

[00:07:21.980] – Allan

So are you ready to talk to Dr. Boone?

[00:07:24.440] – Rachel



[00:07:58.810] – Allan

Dr. Boone, welcome to 40+ Fitness.

[00:08:01.940] – Dr. Boone

Thank you for having me. I'm excited to be here.

[00:08:04.540] – Allan

Now, your book is called The Unfettered Urologist: What I Never Had Time to Tell You in a Fifteen-Minute Office Visit. And as I went through the book, it's set up really well for you to if you just had an incident or issue and you wanted to flip to that part of the book, you could. But quite frankly, I would encourage anyone that wants this book or wants to learn more about this. Maybe you're having some issues or have had some issues and you just don't have the answers, read the whole book, because there's things in the book that, as I went through it I'm like, okay. And then it was like juxtapose backwards and forwards, and I was like, okay, this is actually kind of interesting because everybody wants simple rules, right?

[00:08:50.320] – Allan

They want, okay, vitamin C is good for you. Well, it can be for a UTI and maybe not so much for a kidney stone.

[00:09:01.170] – Dr. Boone


[00:09:02.410] – Allan

And so it was just kind of that thing of saying, everybody thinks, well I'm just going to have my orange juice every morning, and that could actually be a problem, even though we would personally call it healthy.

[00:09:14.450] – Dr. Boone

Exactly. Everything in moderation.

[00:09:17.660] – Allan

Yeah. And so that was just one of the interesting things as I went through the book, to sit there and say, I didn't know that. And so if I had kidney stones. I wouldn't have thought to avoid citrus. And then I didn't even know there were two different types of kidney stones. And so it's just as I went through the book, I'm like, there's a lot more to this than it sounds like. It seems like simple plumbing till you really start looking at what's down there.

[00:09:38.440] – Dr. Boone

Yeah, we've made a whole field out of good.

[00:09:42.250] – Allan

Actually visited a urologist not long ago because there was a little bit of blood involved. And so I did go see a urologist and my co-host Rachel, who'll be on the know, we talk about this episode in other sections. Her husband had some blood, and he got diagnosed with kidney cancer, and he's had one of his kidneys removed, and he's just 50 years old. And you actually had a girl in the book that was much I mean, she was young young, and she had kidney cancer. So there's a lot in this book to help us stay healthy and know when and how to work with our urologist. So I really appreciate the opportunity to profile this.

[00:10:23.510] – Dr. Boone

Thank you.

[00:10:25.110] – Allan

So let's jump into kidney stones, because I've actually had a little kidney stone before, and I say little because it wasn't nearly what a lot of people go through. And fortunately, technology, I was able to excrete it. So that was the cool part for me. But kidney stones are, I guess, the way you said in the book, they get rated up there as being worse than pregnancy or at least as bad. Can you tell us a bit about kidney stones? What they are, how they form, how we can prevent them? And then if we do find that we have kidney stones, we can't pass what we should consider for treatment.

[00:11:01.820] – Dr. Boone

So when I first was interested in becoming a urologist, we would make foot long incisions on people to get a kidney stone out. The technology has advanced so that we can get most kidney stones out with a quarter inch fiber optic tube. We can use laser energy to break up the stones, and we can take the pieces out with baskets so most people do not have to get cut on their bodies at all. But women who have had both childbirth and had a kidney stone would pick childbirth every day. So it is one of the most painful things that can ever happen to a person. So we want to prevent them as best we can. Now, even though the technology for getting rid of stones and surgically treating them has greatly advanced, the incidence of kidney stones or the number of people who have them in the population has skyrocketed. We're seeing so many more children with kidney stones. We're doing surgeries on children for kidney stones. And most of this is totally preventable because it's based on our bad dietary choices and our lifestyle choices. So the number one thing for preventing kidney stones is to make sure that you're adequately hydrated and adequately hydrated.

[00:12:17.040] – Dr. Boone

For a simple test, all you have to do is look in the toilet. If you're not taking a drug or a supplement that can make your urine dark, then your urine should look like pale lemonade. If it starts to get dark or psychedelic yellow, then you're very far behind with your hydration. So what causes the kidney stone to form? Our body gets rid of toxins in multiple ways. We breathe them out, we defecate, we sweat, and we get rid of liquid toxins through our urine. So anything that our body perceives that it doesn't need will show up in our urine if it's a liquid form. And what we have in that urine are crystals. And if we become dehydrated or we have the right environment, the crystals could stick together, almost like those crystal experiments we saw in middle school, where you would put all these things together and then the crystal farm would grow. That's exactly what happens in the kidney. So we want to make sure that what is presented to the kidney is either dilute enough through good hydration so that the crystals don't stick together, or that the components of the crystals are decreased.

[00:13:19.690] – Dr. Boone

So number one is hydration. Of course, your hydration will vary based on what you're doing. I mean, if you're outside a big athlete like you are, and you're sweating a lot, you're going to need a whole lot more fluid than a 90 pound elderly woman who's sitting at home all day. So you'll have to calculate your fluid intake based on your activity. And for the average person who's not doing anything extraordinary, it's basically your body weight in pounds divided by two. So if you weighed 140 pounds, most people would be hydrated. If you took 140, divided it by two, which gives you the number 70. If you stay somewhere in that range with your total fluid intake on a daily basis, you should be hydrated. The second thing that leads to kidney stones is a high salt diet. And this is ubiquitous in the world right now. If you went and had one fast food diet that would be more sodium than you should have for the entire day. And the problem with sodium is that the kidney level is exchanged for calcium. So anytime that you're eating high sodium, you're leaching calcium out of your bones, which can lead to osteopenia or loss of calcium in the bones, and it is delivered to your kidneys, which can lead to kidney stones.

[00:14:32.370] – Dr. Boone

So managing the sodium in your diet is very important. For the average person, you should have less than 2300 milligrams for 24 hours. Sounds like an awful lot. But if you start reading labels and particularly looking at anything that comes in a box or fast food, you'll quickly see that we are having way too much sodium in our diet.

[00:14:54.590] – Dr. Boone

One of the old wives tales out there is that you should limit calcium in your diet. There are actually types of stones that are more likely to occur if you limit your diet too much in calcium. And we need our calcium for bone health, so please do not be limiting the calcium in your diet. Now, if you were a chronic stone former, somebody who's made more than one stone, that would indicate that you would want to have either your urologist or your nephrologist do a panel of blood tests. It's about 30 blood tests and a 24 hours urine. And what the doctor would do is compare what's in your blood to what's in your urine, and then they could make very specific dietary changes. Sometimes medication is necessary. Sometimes it's something that you're taking. You had mentioned the vitamin C, so vitamin C is healthy for most people, but if you take too much, it's exchanged at the kidney for oxalate, and oxalates form stones. So if you take too much vitamin C, like the typical scenario we would see in the wintertime, people think if they take a whole bunch of vitamin C, it wards off colds or the flu.

[00:16:01.720] – Dr. Boone

And we would see people come in who'd never made a kidney stone before, and they had made one based on taking way too much vitamin C. So if you are making stones regularly, your doctor would check your blood and your urine to figure out exactly what needs to happen. Now, if you've made one or two stones and you just want to try to do what you can best do for yourself, I would encourage you to look at a product called therolif XR. I have no financial relationship with this company. It's a quality company. The company name is Theralogix Theralogix, and this product has some natural compounds in it that are actually stone blockers. And so if someone wanted to start themselves on something that definitely wouldn't harm them and could possibly decrease their stone incidence, then that would be a product to try. The other thing we want to be careful about is going on these really high protein diets. I had never made a kidney stone in my life, and I decided that I was going to lose weight going on a very high protein diet. Well, I had my first experience with kidney stones because high protein can lead to dumping of calcium in the urine, which can lead to kidney stones.

[00:17:12.020] – Dr. Boone

So we want to make sure that we're taking in the right amount of protein for our exercise level and for our age and for our body weight. Those are the prevention things.

[00:17:25.230] – Allan

Good. Because yeah, even though the surgery is a little less invasive now, waiting for that to happen and having them get in there and all that, that's not going to be a joyous moment. So being a kidney maker, I mean, a stone maker is not necessarily a good pastime.

[00:17:45.730] – Dr. Boone

No, not at all. I was very indignant when it happened to me. I was like, how could this happen to me? I'm a urologist. In fact, at first I didn't know what it was. I thought it was ovulating. And then I looked in the toilet and there was all this blood and I was like, oh, that might not be an ovulation.

[00:18:01.290] – Allan

All right, so now, another thing that is fairly common in women, a little less common in men, are urinary tract infections, UTIs. And I know as women get older, the incidence of UTIs tends to go up, right?

[00:18:16.130] – Dr. Boone


[00:18:17.020] – Allan

So let's talk a little bit about that, what that is, and then what we can do to prevent and if we need to treat it.

[00:18:24.290] – Dr. Boone

So as urologists, we all have kind of wacky sense of humors. And I think of urinary tract infections as very good evidence that God must be a man, because the anatomy of the female is a set up for having an infection. You have the rectal area which has the highest content of bacteria in the body, right next to the vagina, which is basically a warm, moist, culture medium which is right next to the urethra, which is connected to the bladder, which is supposed to be sterile. So you have an organ which is sterile in most people, very close to an organ that is the highest content of bacteria. So the real question is why don't all women have urinary tract infections? And we believe that it has to do with local immunity. The person's local immunity is able to fight off the bacteria. Now, again, what could prevent bladder infections? We go back to this being hydrated. It's simple flow dynamics. If the bacteria have tracked from your rectum up into your bladder, if you're drinking an adequate amount of fluid, you can flush them out. So it's kind of mechanical. The second thing is to be sure that your hygiene is good.

[00:19:35.460] – Dr. Boone

So the old thing that your mother teaches girls to wipe from front to back, it's a very valid thing. You don't want to pull the bacteria from the back to the front, so you want to use good hygiene. Another thing that works well is to be sure that you're managing your stress. There's no scientific study that shows this, but we know that stress can make all infectious diseases worse. And the way that it works is that you get stressed, your cortisol levels go up and that kind of suppresses your immune system. So even if you had the native immunity to fight them off during times of stress, you might not be as well able to do that. And we see this all the time and it can be even good stress. We see young ladies who are about to get married or who are about to graduate from college or something fabulous is about to happen to them, but they experience it as a stress will change and they'll get a bladder infection just in time for the wedding or the honeymoon or whatever they have planned to do. So the big problem with urinary tract infections is the overutilization of antibiotics.

[00:20:40.250] – Dr. Boone

When a woman goes to a doctor and has all those hideous symptoms of a bladder infection, the doctor feels motivated to do something right then. So they'll give them a full course of antibiotics. The problem with that is that the bacteria are brilliant and they will do something called become resistant to that bacteria, I mean, to that antibiotic. So they recognize that the antibiotic is present and they can actually change themselves so that that antibiotic no longer works on them. And they tend to become stronger and stronger and stronger each time that they're exposed to an antibiotic. And this is how we produce something that's called a superbug. And a superbug is something that's so strong it cannot be killed by any of the current antibiotics. If we keep going like we're going now, the way we're utilizing antibiotics, we're going to reach a point where we have all these superbugs that we cannot treat and they can cause death. So we'll go from having an aggravation to something that could actually cause mortality. So it behooves all of us, both patients and doctors, to work on this problem from a prevention standpoint. Now, the good news is, when we look at prevention, we have an excellent protocol for preventing them and it involves using a good quality Cranberry supplement.

[00:22:02.330] – Dr. Boone

Now, when we talk about Cranberry, we want to know why would this work? And what Cranberry does is it has something in it called PACs. The scientific word is a pro anthocyanidin. And this is a compound that can keep the bacteria from sticking to the lining of the bladder. So that when we're hydrated and we drink fluid, it will push the bacteria out more likely than it would be for them to grab onto the lining of the bladder and be able to set up a full blown infection. Now, the Cranberry products that have the best budgets for advertising are not necessarily the best product. So over many years of having my patients utilize these things, I learned that the following things work. And again, I don't have any financial relationship with any of these people, and there'll be information on my website. If people want to go and read the actual studies for themselves, they can do that. But pure cranberry juice works beautifully. The problem with that is most ladies would gain about 20 pounds in a year if they drank enough cranberry juice to be able to ward off infections. So the products that I've had the best results with are a product called Theracran, another product called Elura and a third product called Utiva.

[00:23:23.740] – Dr. Boone

And these are all made by small companies that don't have big advertising budgets, but what they have is quality control. So you want to make sure that each pill has the adequate amount of these PACs in it to be able to actually work. And I would have my patients, if they are not having a lot of UTIs, and if they're having three or four year, I just have them take one pill at night so that the product is sitting in their bladder and affecting the bacteria while they are asleep. If they're having more than four infections per year, then I would have them take it morning and night to be sure that they're getting maximum effect from this. And then I would make sure that the patient partners with whomever is managing their UTIs to try to use the lowest amount of antibiotic for each infections that they can possibly use, the fewest number of pills, the shortest course, and try to do everything that they can to not use the stronger antibiotics. Because we know that this is just going to get worse and worse and worse if we don't manage this on the front end.

[00:24:31.990] – Allan

Yeah. When I was reading your book, one of the things that kind of came across my mind when you were talking about the design of a woman, I was actually thinking that maybe there was a purpose to it in that. No, when you have something bad and you have something good so I have good bacteria and I have bad bacteria. And when they're forced to fight the good bacteria, the hormetic effect, they get stronger. And then now the child is born through the vaginal tract, and that becomes a part of their microbiome. So a thought to me was, this might be just a way to make sure that the vagina is properly populated with good bacteria that are strong and resilient so that they could take care of the baby. But that's just a theory.

[00:25:17.570] – Dr. Boone

I think that's a great idea. Found that anywhere in science, but I think it would be something that be worth studying.

[00:25:23.790] – Allan

Well, yeah, maybe, but that was just the whole point of, yeah, we're talking about design. And I would just say, okay, I don't believe there's an accident out there in design. I think there's a specific reason for it. And we might not like the outcome all the time, but there's probably a very good reason for it.

[00:25:43.950] – Dr. Boone

I did want to mention one other thing. So you had mentioned about how the incidence of infections becomes greater as you get older, and I wanted to address that. So when a woman is young and we have a lot of estrogen, the vagina tends to be acidic and the acid environment makes it very healthy for the local microbiome, which you were speaking of. And that makes it less likely that the pathogens can take root in there. As we get older, with less estrogen, naturally we become more alkalotic in our vagina and so the pathogens can have a much bigger party down there. Also, as we get older, our bladders don't empty as well. So clearing everything out with each emptying is not as good as it is when we're younger. So one thing that a lot of women have been able to benefit from is either topical estrogen right to the urethra and the vagina, or being estrogenized through hormone replacement therapy. So we have seen women who are appropriate for that and some women are not. Their doctor will decide, will help them decide whether they're appropriate for it or not. But that has been something that we've really seen to be able to break the cycle also good.

[00:26:48.630] – Allan

Now let's shift gears a little bit, if you will, and let's talk a little bit about erectile dysfunction.

[00:26:56.710] – Allan

It is also something that men tend to notice as they age, but it's not always related to testosterone. Could you tell us a little bit about what it is, how we can prevent it and if we do find ourselves with ED, what we can do to treat it?

[00:27:14.490] – Dr. Boone

As urologist, this is one of my favorite topics because the penis is actually an amazing organ. It has to have good nerve input, it has to have good arterial input and it has to have normal venous outflow to be able to function well. So it's actually a very complicated organ. The thing I'd like for the listeners to really remember is that it is normal for a man to occasionally have problems with erections. And the reason for that is the sympathetic nervous system. The design is such that you don't want to have an erection if you have to go out of the cave and fight the tiger. So the man is hardwired during times of increased sympathetic outflow of the sympathetic nervous system to not be able to have an erection. So the brain doesn't know the difference between it's time to fight the tiger and I had a fight with my boss or I've been on the road traveling for two weeks and I'm exhausted, or my wife and I have been squabbling because I've been on the road traveling for two weeks. So having the occasional difficulty is normal and it's not anything to get too freaked out about.

[00:28:22.450] – Dr. Boone

If you are a young man under 55 and you are having regular problems with erections, this is a wake up sign that you do not want to ignore, because what that implies is that there is something metabolically going on. Sometimes it can be pre-diabetes, sometimes it can be high blood pressure, sometimes it can be elevated cholesterol. But there's a 50% increased incidence of having a heart attack as a young man, if you are having regular erectile dysfunction. So if you are attempting to have intercourse and you can't because your penis won't become fully erect, you need to go to your internal medicine doctor and be worked up for all of these possible causes. And that is so important. I mean, this could actually save your life. So it's not anything to ignore. Now, what are the things that can cause it? Smoking will damage the blood supply to your penis, and interestingly enough, sometimes it never comes back. So if you're a young man out there and you're thinking, I'm going to smoke for a while and then I'll stop later, please don't think that smoking is very toxic to the blood flow. Unhealthy lifestyles, being sedentary, being overweight.

[00:29:38.630] – Dr. Boone

Fat cells are not just sitting there doing nothing. They're very metabolically active. And in the male, they can make estradiol which feminizes the man. And this estradiol can have a feedback mechanism that can decrease your natural testosterone. So decreasing your percentage body fat can be very helpful to improving erections. Alcohol use. Alcohol can very much affect erections, as can drug use. Diabetes, diabetes causes both damage to the nerves and to the blood supply to the penis. High blood pressure, elevated cholesterol damage the blood flow, psychological issues, anxiety issues. During the first ten years that I was urologist, I almost never saw young men with ED. In the last 20 years of practicing, I saw this all the time. People were overworked. They were trying to juggle home life and traveling and just the stresses of modern life. So I saw so many young men with really no metabolic problem who all of a sudden had erectile dysfunction. Then we have all the neurologic diseases, things like Parkinsonism, multiple sclerosis. I encourage men also to look at sleep disorders. If you have sleep apnea, that can cause you to have elevated cortisol, which can also affect your erection.

[00:31:04.510] – Dr. Boone

So if your partner tells you anything like, hey, you're snoring or you seem like you're stopping breathing sometimes at night, you definitely want to see your internal medicine doctor to consider getting a study to make sure you don't have sleep apnea. The relationship between low testosterone and erections is something that the urologic community argues about. The conventional urologic literature will tell us that the hormone testosterone causes desire or libido, but it's not necessarily connected to the actual functional aspects of being able to have intercourse. In my clinical practice, I did not find that to be the case. Over and over and over again, when men had very low testosterone and we would supplement it, they would report that the quality of their erections were much better. So I'm not sure that that case is really closed. But if you look at the literature, they're going to say testosterone does not cause you to have better quality erections. But I don't believe that.

[00:32:05.610] – Allan

I think it's on the social psychomatic side where when you are feeling better and more masculine and everything that testosterone does maybe have more muscle mass, lose some body fat percentage, those things are just going to happen as a side effect, if you will. Maybe not a direct correlation, but definitely I think when your testosterone is higher, you feel more like a man, and I think that's going to help.

[00:32:33.730] – Dr. Boone

Yes, it's very complex. I think it's fascinating. I mean, I loved seeing these patients because it was never just one thing. It was always lack of exercise, too high body fat, stress, not enough sleep, relationship issues. I mean, it's always complicated. And so I loved helping people work through those kinds of issues.

[00:32:53.370] – Allan


[00:32:53.880] – Allan

And I think one of my core takeaways from this conversation in the book was, okay, don't just go in there and ask your urologist for that blue pill and go on. Spend some time actually figuring out why this might be happening, because it could be a sign of a bigger problem for you. And if you just go straight to the blue pill, you might miss something important.

[00:33:15.390] – Dr. Boone

Yes, I think that is an excellent point.

[00:33:21.150] – Allan

Now, I love having doctors on here that are sort of not doctors as much now as they were before. And the concept of your book was, if I could have told you in the 15 minutes everything I needed to tell you, this is it. And you called it a love letter to your patients. If I go to a doctor, I'm the kind of person who wants the best health outcome possible.

[00:33:43.880] – Allan

I'm not worried about what it's going to cost me. I'm not worried about the rest of it. I'm like, okay, I want a good health outcome. And so if I go into a doctor, how do I get the best health outcome? Because it just seems to go against the way the system is designed right now. It's designed almost as a conveyor belt. And the sad part and I'll tell the story, I have a friend that had a heart attack, and so I thought, okay, well, I'm going to go get a calcium score just to see where I stand. And because I don't live in the united States, I don't have a US based GP. And so I go to call a clinic that does the calcium scores. It's $200. It's a simple little X ray thing, takes five minutes. $200. I'm like, okay, I just want one of these.

[00:34:36.070] – Allan

And they're like, well, your doctor has to call it in. I'm like, Why would I have to go to a doctor? I'm 57 years old, and I want to know my calcium score, and it's reasonable. It's not like I'm asking them for a test that doesn't make any sense. And so as I try to manage my health outcomes, working with doctors, it just seems like the system is built to make it very difficult for me to do that.

[00:35:00.770] – Allan

So what's some of the advice that you have for us to approach the medical system the right way?

[00:35:08.690] – Dr. Boone

So, the system is definitely not user friendly. It is not user friendly for the doctors, and it's not user friendly for the patients. So to say that in many ways it's broken, I think is absolutely correct. For your specific scenario that you just mentioned, the two main reasons to not have patients be able to walk in and get whatever test they want. A calcium score is a very high radiation test. So someone who is monitoring your overall health and paying attention to how much total radiation you're getting from various tests should be deciding the benefit versus the risk and presenting that to you and then having you make an informed decision. So I think patients being able to go in and just get any test, I kind of agree that that's not a good idea because you don't know what you don't know. The other thing is, if you go in to get that test, someone needs to be monitoring the follow up that knows what the test means. So if you were to go in there and see a large percentage blockage in your left anterior descending artery, you might need a calf and a stent that day.

[00:36:19.070] – Dr. Boone

You might be on the verge of having a major heart attack. So if a doctor hasn't ordered the test and there's not a doctor assigned to review the results, the radiologist is not really the person who can do that. Radiologists don't manage patients. They look at studies and tell you what's on there and then call the doctor or whatever. So the follow up part for a test needs to be there also. So those are kind of the two main reasons that they would not have the patient be able to get it for themselves. Now, as far as how to work the system, I think managing expectations is really important. What is an MD? An MD is a person with incredible science background. Now, what does science mean? Science means it has been demonstrated in a randomized, double blind placebo control study. What does that mean? It means that we have tried to eliminate bias from the study. So Dr. A, who thinks that his little pet procedure is the best thing in the world, goes around telling everybody, hey, we've got to treat everything this way. In a scientific study, you would have people who did not know

[00:37:32.940] – Dr. Boone

Dr. So and So did not know it was his Pet study, and they were studying it blindly to see if it worked or not. And so we would get information about whether something was really effective or not. And that's pretty much what science is. So when you go to an MD, we are licensed to tell you the things that have been proven by science. And so there may be things going on out there in the alternative community that we don't know anything about, or we may have some sideways information about it, but we don't have the randomized double bond control studies. And so it's not within the purview of our licensing to recommend things that have not been proven scientifically. Now, how would a person figure out how to have their best health? I read your book, The Wellness Roadmap, and I saw so many tools in there that I think would be helpful to a person. So I think recognizing that an MD is there for catastrophic things, the doctor is the one you go to when everything's failed and you've got a big mess and you've got a problem and somebody's got to fix it.

[00:38:39.580] – Dr. Boone

My appendix needs to come out. We're really good at that kind of stuff. We don't in the past have had a lot of training in prevention of diseases. So the average MD, unless they've gone to the trouble to educate themselves, is not going to be the one who's really going to know a lot about nutrition. Many doctors don't know anything about exercise. I mean, some of the Orthopedic guys can tell you a bit about that, but most of us really don't know a whole lot about exercise and how the body responds and exactly what we need. So I think for a person to realize that they could need a lot of people other than the doctor to have their best wellness, they might need a life coach like you, they might need a trainer, they might need a masseuse, they might need an acupuncturist, they might need a chiropractor, they might need a hypnotherapist. I mean, they may need a whole lot of other things. But the main job of the MD is to help guide the patient towards what tests they need to have. Like when is the best time to get a colonoscopy, how often should you have a mammogram, those types of things.

[00:39:43.020] – Dr. Boone

The MDS have the best scientific information about what your blood test actually means. So if you go somewhere and have 50 blood tests done, you're an intelligent person, you've done a lot of reading, so you'll be able to figure out on the surface what it all means. But an MD should be able to look at the details and help give you some ideas about what's coming down the road that you need to watch out for. So I think having the best expectations of what you can get at the doctor and what you can't get at the doctor I think would be very helpful. Then there are people who are opening up concierge practices where they're trying to offer more time to the patient more discussion, someone intelligent like yourself who's done so much reading and interviewed so many people, you would go to the doctor with a different level of information, and you would want to talk on a different level. And so a concierge doctor may be the kind of person who would work better for you because you could have an hour long visit and you could go through all the different things that you've read, and they could give you the pros and cons of why you might want to try this as opposed to that.

[00:40:49.150] – Dr. Boone

But when you're going just to a standard doctor for your routine visit, it's hard to get that in the current environment.

[00:40:55.610] – Allan

Yeah, absolutely. I define wellness as being the healthiest, fittest and happiest you can be. What are three strategies or tactics to get and stay well?

[00:41:08.630] – Dr. Boone

So my personal prejudice is that it all starts in your mind. I think what you choose to think creates your personal environment. And I saw that over and over and over again. Two people can get diagnosed with the same cancer. One person sees it as a wake up call. They get rid of a toxic relationship. They change their job, they start to exercise, they change their diet, they start to take supplements. They start to look at all kinds of alternative therapies while they're having surgery and chemo and radiation. Another person will see this as a call to having a gigantic pity party, oh, my God, why did this happen to me? I'm such a good person. And they will become angry and miserable and regretful, and they'll die a terrible death and have a lot of misery until that death comes. And the difference between these two people is what they're choosing to think about the situation that they're in. And I think that speaks to all parts of our health and our wellness. I mean, you and I were talking before we started the podcast about trying to motivate people and trying to help people stay motivated and why one person will get on a program and stay on it and another person won't.

[00:42:31.480] – Dr. Boone

I think a lot of it has to do with what we tell ourselves. I mean, you talk in your book about having a vision. Well, you're a big accomplished athlete. Me, I'm a bit of an egghead. So my vision was to not be a little old lady with a bag full of pills going around to every doctor in town. So my motivation for going out there and exercising when I don't want to do it is to take the fewest number of pills, have the fewest number of doctors visits and test and surgeries and all that as I can possibly have. And to be able to enjoy my life, to get up and down off the floor without having to hold on to something. I have those visions. I mean, I want to be able to go sailing and jump off the boat and swim around and look at the fish. So I think having a vision and using your mind to be able to create a plan for wellness is, to me, the most important thing. Number two is also kind of something that you alluded to in your book, which is trusting your body.

[00:43:32.310] – Dr. Boone

I mean, we're all at different levels. You told a story about getting some CDs or DVDs and exercising, and the next day you couldn't get out of bed. And I think having patience, a person who is not healthy didn't get there overnight, and you're not going to get out of that overnight. I mean, I had a two year plan for my wellness, and I based it on watching so many people come in my office and getting gung ho with both the nutrition and the exercise and everything at one time. And then they just couldn't keep it up. It was just too much. So what I recommended to my patients and what I did for myself was the first thing I did was I tried to cut down on sugar, I tried to cut down portions, and I tried to just simply move more. I mean, in the beginning, I would park my car at the end of the doctor's parking lot, I would take the stairs up to the operating room. So I incrementally changed all these little things. And my endpoint was not weight reduction. It was to feel better, to not be short of breath, and then ultimately to get off some of my pills.

[00:44:38.260] – Dr. Boone

And that has happened, and I'm very grateful. The third thing is meditation. Oh, my Lord, this is so underutilized in our world. I mean, I think we should be teaching kids to do this when they're young. Our mind is like a gerbil in there jumping around. And through meditation, we can learn to calm down and to not trust all those thoughts. And that those thoughts are creating emotions, and those emotions are leading many of us to the refrigerator. And so if we can change those thoughts through calming them down, then we can stop it before we get to the negative emotions of anxiety and agitation that lead us to want to go to the food. And then the last thing I think is just to try to be patient with your body. The body is brilliant. It can heal most things if we just give it sleep and proper nutrition and move around and manage our stress. The body is just brilliant at taking care of itself.

[00:45:43.550] – Allan

Yes. Thank you for that. So, Dr. Boone, if someone wanted to learn more about you and learn more about the book, The Unfettered Urologist, where would you like for me to send them?

[00:45:53.810] – Dr. Boone

So my website is www.marthaboone.com. It has on there both my novels because I'm a fiction writer, too, and it will have the links on there for a lot of the things that we've talked about if people want to educate themselves further.

[00:46:16.730] – Allan

Awesome. Thank you so much and thank you for being a part of 40+ Fitness.

[00:46:21.250] – Dr. Boone

Thank you for having me. I appreciate it.

Post Show/Recap

[00:46:27.630] – Allan

Welcome back, Ras.

[00:46:29.390] – Rachel

Hey, Allan. That was a really great conversation with Dr. Boone. There's a lot to really talk about, but kidney stones, UTIs, erectile dysfunction, these are all really important things or situations that need to get reviewed and managed before things get out of control. And they can happen quite frequently, especially as we age.

[00:46:50.050] – Allan

Yeah, I mean, OOH, what's that?

[00:46:55.890] – Allan

We're talking about parts of the body that people don't really want to spend a lot of time talking about. But the whole point being is if things aren't normal yes, things aren't normal.

[00:47:05.690] – Rachel


[00:47:06.260] – Allan

So don't take a little thing and say, oh, it's just a little blood, or, oh, there's a little itch and it doesn't go away, or, oh, this keeps happening. It's not normal.

[00:47:19.110] – Rachel


[00:47:19.660] – Allan

They're not normal. Healthy responses. Yes. So it might seem like a little thing. You're not a hypochondriac. If there's blood in your urine and you go see a urologist, they're not going to call you a hypochondriac unless you're seeing them five times a month, you know, I recently went to urologist because there was blood where there wasn't supposed to be. What's going on? And I've had kidney stone before, so I kind of knew. But you can't help but Dr. Google search.

[00:47:57.190] – Rachel

Usually not good.

[00:47:58.090] – Allan

There's blood. What are the possible things? And again, some people will poo poo it and say, oh, well, maybe this happened or maybe that happened, and I can excuse it. I can say, oh, well, this is why this is this way. It might not be, and so it might not be what you think it is, so it's at least worth going and nothing else. They'll give you a couple of blood tests or they'll do a little bit of urinalysis or something to at least give you the appropriate treatment.

[00:48:26.710] – Allan

But recognizing that these things are happening, there are lifestyle changes for almost every one of them.

[00:48:35.480] – Rachel

Oh, for sure, yeah. There's a lot of preventative measures we can take to maybe stave off kidney stones and UTIs and anything else. Supplements we could take. Exercise, eating well, staying hydrated. Super important.

[00:48:53.290] – Allan

That sounds so much like the five pillars of health.

[00:48:56.220] – Rachel

As usual. Yeah, as usual.

[00:48:59.110] – Rachel

And even lowering stress. Like Dr. Boone had said, stress can begin the snowball effect for some of these illnesses.

[00:49:09.710] – Allan

You're not going to be able to go into a urologist office and have a 15 minutes conversation with them today. She said 15 minutes, but I don't know. I mean, I was because it's Panama, so it's a little different. But most of the time when you're in there, you're going to see their nurses and keepers, people that are hustling you around, moving you from place to place, and you're going to see the doctor for a few minutes, probably no more than seven or eight. And that's the way the medical system is set up right now.

[00:49:42.890] – Allan

So having your questions in order and having the right conversation when you're having it, and don't think Dr. Google's better than what the doctor has to say. But if there's a misalignment, if there's a misalignment over what you're reading and you know it's coming from a credible source. So credible source, cleveland Clinic sometimes WebMD anything that's coming from probably the government, the CDC or something like that, that's information that that doctor should know. And so their response should be generally in align with what you're you know, you can go to the Heart Association website and ask for the symptoms of heart attack.

[00:50:25.400] – Allan

It's right there on the page. You can print it out, tell the doctors, like, look, I got six of these.

[00:50:30.300] – Rachel

Yeah, check.

[00:50:32.570] – Allan

So something else is going on. Let's talk about it. But what they say should make sense to you because you're the lead advocate. You're the CEO, you're the team captain. And they're the players and the coaches. And so you've got to make this all work with them. So it's about working with them. And don't ignore the little things because little things become big things.

[00:50:53.970] – Rachel

Well, I always like to say, too, Allan, I know it's a terrible statement. A lot of people hate this, but you don't know what you don't know. And I'm not a doctor, so I can do Dr. Google and maybe get some things together. But like I've mentioned to you and our listeners in the past, when my husband had blood in his urine, we were in marathon training at the time, and blood and urine is not unusual. It's a condition called grabdo. And I know there's a longer word for that. I don't know what it is, but it's when your muscles kind of break down some proteins and nutrients and it pees it out, that's fine. That's not a dangerous condition. But there are other things it can't be. It can escalate, like, everything. Yes.

[00:51:39.230] – Rachel

And that would have made sense for us at the time. But what if it was a kidney stone that came out of the blue? And in Mike's case, as I've mentioned, the past ended up being kidney cancer, which is something that we would not have known at the time had we not gone to the doctor, had the pee test done, had some scans done where they could actually see it in his kidney. So something as innocuous as maybe blood and urine, it's not always you just don't know what it could be. And that's why you need to go to the doctor to have it more further evaluated.

[00:52:14.790] – Allan

Yeah. And, yes, there's a cost involved. There's always a cost involved. But the cost of prevention is a lot lower than the cost of what happens when this becomes a chronic problem.

[00:52:31.490] – Rachel


[00:52:32.150] – Allan

And so catching it early will cost less and give you a higher probability of living longer, better.

[00:52:43.060] – Allan

So just recognize that the earlier you have that conversation, the earlier you go get checked out. It's better all the way around, it costs less, and the health outcome is going to be a lot better.

[00:52:57.610] – Rachel

And we talked about earlier, too, not necessarily reaching for a pill. Right? I mean, of course, if you have a UTI, you might need an antibiotic or something to help with the infection, but what was it that caused the infection in the first place? Is it poor hygiene? Were you swimming in a pond or a lake somewhere? Do you have an allergic reaction to maybe the detergents you're using for your undergarments? I mean, there could be just a dozen different reasons, but same thing with erectile dysfunction. That could be a symptom of a larger issue.

[00:53:32.290] – Allan

I would dare say I'm almost going to go out of limb and say most of the time it is, yeah.

[00:53:37.300] – Allan

You'Re ignoring something else in your lifestyle, and as a result, this is the outcome. And if you dealt with the lifestyle problem, because healthy thing, healthy heart, that's all I'm going to tell you right now, is that if that's struggling, your heart is struggling, period. And that's about blood. It's about blood.

[00:54:01.390] – Allan

So if you are pre diabetic or diabetic and you're having this problem, it means your feet are not getting enough blood. Okay? And so you're probably at some point, you're, like, going to lose a foot.

[00:54:11.710] – Allan

So dealing with the lifestyle stuff, if you're diabetic and those types of things, if you're having difficulty with blood flow to your pelvis, you're having difficulty blood flow everywhere else in your body.

[00:54:23.140] – Allan

So just think about that for a minute. It's a symptom. It can be treated with a blue pill or there are other pills now.

[00:54:31.750] – Allan

And they give you the warnings. There's a downside to everything you put in your mouth, food or medicine or supplement. There's always some form of downside, some reaction you could have to it, and not knowing that could be a problem. So if you're having symptoms, it's not normal?

[00:54:49.850] – Rachel


[00:54:51.450] – Allan

No. I can tell you right now that's not what getting old does to you. It's about your healthy or unhealthy lifestyle.

[00:54:59.080] – Rachel

Yeah. There could be a lot more going on than what we can figure out by Dr. Google.

[00:55:04.290] – Allan


[00:55:05.270] – Rachel

It's worth going to the doctor.

[00:55:09.650] – Allan

Little tests, blood tests or something like that. It's worth going just to know.

[00:55:13.330] – Rachel

Oh, absolutely. If you can fix this in the short term, then you won't have long term consequences later. I just feel like some things can be reversed or fixed through lifestyle changes. Save that pill for later. But, yeah, better to go now than wait till later.

[00:55:32.600] – Allan

I agree.

[00:55:33.720] – Rachel


[00:55:34.220] – Allan

All right, well, I'll talk to you next week.

[00:55:36.250] – Rachel

Sounds great, Allan. Take care.

[00:55:38.050] – Allan

You too. Bye.

[00:55:39.060] – Rachel

Thank you. Bye bye.

Music by Dave Gerhart


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– Anne Lynch– Ken McQuade– Leigh Tanner
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