Breaking Down Urologic Care with Dr. Wendy Nunes

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Welcome to Western Wisconsin Health's season three of our Redefining
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Rural Healthcare podcast. When most think of rural healthcare, they
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think of small towns and simple services. At Western Wisconsin Health,
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we break the mold. We provide world-class care in a
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community setting with a large breadth of service that rivals
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urban facilities. Our independent status is unique in a sea
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of system hospitals. We believe this independent status allows us
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to be close to our community and best understand and
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respond to our community needs. We can't do this alone.
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Our mission is to build healthier communities together. This involves
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our community partners. During Season 3, we will explore these
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community partnerships to share how our work together improves health
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outcomes for all we serve. Rima Lindquist, Western Wisconsin Health's
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Director of Community Relations, will serve as our primary host
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and our tour guide. She will ask questions that will
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spark your curiosity and pique your interest. Join us as
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we chronicle our journey to redefine rural health care.
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Take a listen.
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Welcome to Redefining Rural Health Care, a podcast from Western
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Wisconsin Health where we explore the people, ideas, and innovations
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that are helping redefine what health care can look like
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in a rural community. I'm your host, Rima Lindquist. And
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today we're talking about a specialty that many people may
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not think about until they need it, urology. I'm joined
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today by Dr. Wendy Nunez, a board-certified urologist here at
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Western Wisconsin Health. Dr. Nunez brings extensive experience in urology care,
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as well as a long history of involvement in hospital
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leadership and credentialing.
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What I think makes Dr.
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Nunez's story particularly interesting is her connection to this community.
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Originally from Portland, Oregon, she has called northwestern Wisconsin home
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for nearly two decades. And after spending many years practicing
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medicine and serving on hospital credentialing committees, she has a
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unique perspective on both the clinical and organizational.
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Sides of healthcare.
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Today, we're going to talk about urology, what patients should
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know about their urologic health, the importance of having specialty
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care available close to home, and what it means to
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provide high-quality specialty care in a rural community. Dr. Nunez,
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welcome to Redefining Rural Health Care. It's great to have
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you with us.
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Thank you. It's great to be here.
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Let's get started with your story. What originally drew you
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to medicine, and what ultimately led you to choose urology
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as your specialty?
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Well, it wasn't an obvious choice for me. Originally, I
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wanted to be a veterinarian, and I had worked in
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a vet clinic for small animals throughout most of high school.
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I would ride my bicycle from school to the clinic
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about three miles away and just got to see what
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it was like to be a veterinarian inside out for
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small animals. But it was a little boring. And when
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I got to college, I got exposed to large animals,
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but that's a pretty difficult lifestyle. You know, the animals
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can hurt you, step on you, kick you, etc. You know,
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you're going to them usually and That can be at
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all hours of the day and night and all kinds
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of weather and physically demanding as well. So it just
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didn't seem like it was a very good fit. And
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I wanted more interaction. Medicine and the scientific fields always
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really interested me, but there's very little that you can
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do for interaction with animals.
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They can't really tell you how they're feeling.
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No, they can't. So anyway, I decided to change my
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focus to human medicine and went to med school and
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Got exposed to urology as part of my medical school
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curriculum and didn't anticipate liking urology. I knew very little
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about it, probably like average people know very little about it.
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And just figured out it was a really neat aspect
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of medicine, the kinds of things that we care for
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for people that have urologic needs is unique. And it's
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both medical and procedural medicine. It covers all kinds of
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ages from birth all the way to the elderly and
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everything in between and men and women. So when I
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figured out that that kind of medicine really interested me
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and I liked the procedures and the kinds of things
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that I could offer for care, the kinds of things
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I could take care of, I realized it was also
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a great lifestyle because I wanted to have a life
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outside of medicine. I wanted to be fulfilled in and
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out of work. And urology allowed me to do that
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without spending every waking minute in the hospital.
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Fascinating I'm sure you get to be on call sometimes
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and have some odd hours but with I know veterinary
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things I grew up on a farm and it always
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seemed like animals would get sick nights and weekends and
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you know having to go out on call and things
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so we're certainly glad that you're a urologist and that
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you've joined our team here me too what do you
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enjoy most about being a urologist today I love.
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The patient interactions. I love, especially when I get to
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know a patient and sometimes they're part of their family.
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It's something that is really close to home. It covers
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a lot of things that are very important to people
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and have a huge quality of life impact for their care.
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And there are some conditions where they need long-term follow-up
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and observation. And then I get to know those folks
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really well. I came to the St. Croix Valley in
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2007 and I was very pregnant with our first child.
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And so now I know exactly how long I've been
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here because I delivered right after I got here. And
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so 19 years later, I'm still here. And there are
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literally some patients I saw from nearly the first month.
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And so it's been really nice to have that kind
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of relationship, kind of like primary care, how you develop
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those relationships over time and care for multiple people in
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the family as well. But then I have the surgical
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aspect and have a very problem-focused relationship kind of care
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that I can offer. I'm not doing preventative or a
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lot of very broad topics. I'm very focused.
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That's incredibly interesting.
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So you grew up in Portland, Oregon, but you've now
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been in Northwestern Wisconsin for nearly 20 years. You said
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you gave birth to your daughter 17 years ago?
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19.
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19 years ago. And then what brought you to Wisconsin?
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So I went from Portland, Oregon, where I graduated high school,
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to Washington State University because I was going to be
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an early admission candidate for their veterinary college up there
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but changed my mind after my sophomore year in college
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and then my parents moved to Missouri so I went
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to Missouri and then down to San Antonio for training
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six years of residency training longer than most specialties except
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for neurosurgery neurosurgery seven but urology was six so you're
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very well trained when you come out of that and
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I met my husband down there And he got recruited
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to a critical access hospital in the area. And we
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went up and visited and absolutely fell in love with
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the St. Croix River Valley and love the topography, you know,
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the hills and the landscapes and whatnot. And the people,
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the people are so warm and so genuine and likable
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and relatable. And that's something I felt was very common
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in the Northwest as well. That kind of mentality, you know,
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very down to earth, very honest, straightforward, kind people. So
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it felt like a home away from home. And I've
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now been in this area for longer than any other
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part of my life. And it's truly home.
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So when you were in school in San Antonio, it
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had to have been hot.
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Incredibly hot.
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Yes.
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For like four months of the year.
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Yes. I think that encouraged you to maybe go the
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polar opposite to where we have some frigid weather here
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in Wisconsin.
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You could say so.
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Yeah.
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Down there in the summertime, you literally go from air-conditioned
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environment to air-conditioned environment and you try to go as
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quickly as possible because otherwise you start sweating and you
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just are miserable. Even at night, it doesn't get very
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cool toward July and August and so you're not comfortable
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and you want to be indoors or in an air-conditioned car.
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And so when my husband and I came up to Wisconsin,
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we were warned the winters are cold. And we had
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no idea until our first winter. And we were walking
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from our car to the building together, and it was
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five degrees above zero. And my husband was rubbing his
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nose because he'd never had cold weather. He came from Brazil.
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He went from Brazil to Miami to San Antonio. So
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this was like a whole new ballgame. And he was
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rubbing his nose and saying, I feel like I've got
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something in there. What is going on? And I told him,
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I said, no, honey, the moisture that you're exhaling is
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freezing on your nose hairs. He looked at me just shocked.
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I'd blown his mind because he had no idea it
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was even possible because it's a whole new level of cold. But,
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but like in San Antonio in the winter, you go
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from heater to heater. So you just change a different extreme.
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That's all.
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And we, we love the winter. Even, even when it's cold,
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it's still really beautiful.
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Layer up.
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You can always put on more clothing and go from
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heat to heat and things like that. But sometime in
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the summer, it's really difficult.
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You can always put on more clothes. You can't take
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them all off, especially not in public.
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I agree.
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I agree.
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When you tell someone you're a urologist, what is the
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most common reaction you get? Really?
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If they understand what it is. Or they think I
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say neurologist and I'm taking care of people with nerve
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problems or strokes or what have you. So when I say, no,
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I'm a urologist. they kind of go through a weird
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little calculation in their brain. They're not quite sure what
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to think about that. But yeah, it's something that's kind
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of interesting I get to tell people about once in
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a while.
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Right. So I think urology is one of those specialties
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where people sometimes aren't quite sure what falls under that umbrella.
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So can we talk a little bit about what you
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actually do today?
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Love to.
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So for someone who has never seen a urologist, what
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is exactly does a urologist treat?
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So urologists will treat the entire urinary tract from the
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kidneys down to the end of the urethra and everywhere
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in between. We also take care of the adrenal gland,
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which is where you get adrenaline from, and it sits
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on top of the kidneys. And then for urologists, we're
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kind of like the counterpart to an OBGYN. So OBGYNs
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take care of the female genital tract. Urologists will take
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care of the male genital tract. So that would include
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conditions like nodules of the adrenal gland, tumors of the kidneys, ureters, bladder, prostate, urethra, testicles,
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all of that, urinary tract stones, incontinence. That's a big
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thing that I treat that people may not realize can
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often be treatable. And then also difficulty amping the bladder,
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particularly for men.
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So let's make this practical for our listeners. What are
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some signs or symptoms that you should pay attention to
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that should prompt you to seek out care from a provider?
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Basically, if you notice your urinary tract and you're thinking,
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I don't know if I like this and maybe this
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isn't normal, that would be a good one. So difficulty
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holding the urine, getting up at night to pee, having
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that key and lock syndrome where the closer you get
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to your house and the bathroom, the more you have
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to go. Certainly pink or red urine is never normal.
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Back pain that's off to the side, so not in
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the center of the spine is, but off to the
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side where the kidneys live, that could be an indication
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of a concern. And basically anything that you're worried about,
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you should always get checked out.
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So you said that blood in the urine is never good.
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So that's one example that people might be tempted to ignore.
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or hope it goes away, but they should really come
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in immediately, would you say?
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Yeah, it's not an emergency. Like you go to the
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ER unless you are passing clots that are hard to
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get rid of or you're lightheaded. But typically that should be,
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you know, immediately call and make an appointment for your
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physician to get the process started. Okay. And there are
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two types of blood in the urine that I worry about.
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There's the kind that you can see and the kind
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that your doctor tells you or your provider tells you
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is on your lab test. And those are both important
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because they can both be red flags that something is amiss.
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And it can be something as simple as a urinary
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tract infection that needs treatment or a kidney stone that
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hasn't started passing and causing you pain yet. And then
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there's the sinister kind where it can actually be a tumor,
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but the first sign is blood and you don't feel
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any difference yet. And you want to catch that as
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early as possible, which is why you should never ignore blood.
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In the urine. Sounds incredibly important to come in as
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soon as you need to. What are some misconceptions about
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urologic health that you wish people would stop believing?
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I think one of the things that's really caught my
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attention is that usually by the time someone sees me
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for urinary symptoms, they've already been treated by somebody else
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and they're not happy. They haven't gotten the result they
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wanted or they wouldn't have come to see me in
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the first place. But they come with a little bit
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of a sense of frustration or like they're defeated, like
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they don't expect that there's anything else that can be done.
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And as a urologic specialist, I have things that I
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can offer that primary care are not trained to do.
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They do a great job on starting things and getting
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the ball rolling and doing some conservative treatments. But if
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someone needs something a little bit more advanced, that's where
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urologists can possibly help them.
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So many people think that urology is just a men's
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health specialty, when in fact urologists treat many conditions that
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women struggle with as well. Can you share with our
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listeners what conditions you treat for women?
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Yeah, so kidney stones and cancer don't discriminate. Men and
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women both get them. Men tend to get them more
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often for both situations, but still women do as well.
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And then bladder control. That's the biggest thing I see
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for women. They don't know that a urologist can necessarily
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help them as well. They think it's usually older men
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with their prostates, but there are quite a few treatments
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that women can undergo for leakage as well.
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I know that previously we've talked with some OBGYNs about
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bladder control. Is the surgery that they would perform for
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some of those issues the same as what a urologist does,
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or is there a difference between that?
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There is some overlap for sure. Any physician or provider
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can prescribe a bladder medication, but that works only on
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overactive bladder. So I like to explain to my patients
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there are two reasons why women leak. The first one
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is called stress incontinence, and that is not a bladder problem.
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That's an outlet issue, meaning the pelvic floor muscles and
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the sphincter in particular are not strong enough to hold
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the urine in place when we do activities that increase
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pressure inside the abdomen like coughing, sneezing, jumping, laughing.
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Running. Running.
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Oh, yeah. And getting out of a low chair sometimes
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doesn't have to cause some women leakage. So that condition
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isn't treated by medication because, again, it's not the bladder
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that's the problem. It's what medications work on. It's an
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outlet issue. So conservative things like physical therapy, weight loss
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for those of us who are overweight, those are usually
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the mainstay for conservative treatment. And then there are surgical
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procedures like a sling, and that's where some OBGYNs do
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a sling procedure. And that's basically where a piece of
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permanent mesh is put under the vaginal skin to help
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support the urethra during those times of activities that provoke leakage.
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But it's not put in place so it can't let
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you urinate like normal. And then the other kind of
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leakage is urge incontinence. And that is where the bladder
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is the problem. And the bladder, for whatever reason, is
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not storing urine appropriately and it's trying to empty on you.
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And usually people say, oh my gosh, I get the
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strong need to pee and I just can't hold it.
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So medication, sometimes diet change to avoid things we call
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bladder irritants, those things can be helpful. Physical therapy can
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help some patients with retraining their bladder. And then beyond that,
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there are surgical options like injecting the bladder muscle with Botox,
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which I actually do in the office and people do
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really well with that wide awake. And then there's a
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nerve stimulator procedure, which I'm really excited to bring to
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Western Wisconsin Health. It's a brand new procedure for us,
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but I've been doing for 20 years. And it's basically
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like a bladder nerve pacemaker. where I insert a device
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surgically while the patient's asleep to help the letter kind
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of reset and stop misbehaving. So there's some really exciting
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options out there that most patients are not aware of.
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I haven't heard of most of those, so I'm intrigued
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with this and actually want to get some friends and
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family educated about what their options are.
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So filling up your schedule should be.
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Easy. I'll be happy to help. It's, it's, it's so
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rewarding when, when someone comes to me really unhappy, they're
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not jogging because they're leaking through a pad or they're
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worried about having an accident out in public. And so
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they're curtailing their social activities. It is so rewarding to
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help those folks because they feel like, you know, a
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lot of times they just have given up and that's
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just the way life is. And they're not happy. And,
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and some things are so severe that they're difficult to manage,
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but a lot of things are very treatable.
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You had mentioned previously, too, that sometimes changing your diet
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can be a solution and removing certain things. Are there
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foods that our listeners should watch out for that you
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can share with us? Sure. Yeah.
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If they have overactive bladder, then avoiding the bladder irritants
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may be helpful. So it's any food or drink, usually drinks,
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any food or drink that is acidic, spicy, caffeinated, carbonated,
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or alcoholic. So acidic would be tomatoes. And I get
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a lot of groans from patients. I tell them to
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avoid tomatoes because when they're growing their home tomatoes, they're
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really looking forward to eating them. Or citrus fruits, that
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kind of thing would be under the acidic category. Vinegar-based
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salad dressings, you know, anything with bubbles, anything with caffeine,
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that kind of thing. And I tell people to cut
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those out for a week and see if they notice
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a difference. And if they do, great, there's a trigger
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in there somewhere. you can kind of slowly add the
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things back that you've cut out to see if you
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can find a trigger. And if you find out, yeah,
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your garden tomatoes are a problem, well, maybe just eat
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the tomatoes and you're not going to go anywhere.
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I think that being garden season right now, that's probably
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not going to make a few people happy, but I ultimately, yeah,
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I think that people really want to be more comfortable
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though too, because these things can be very embarrassing. And
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I have some family members that do not go to
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things because they have incontinence issues. So knowing that there's
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a solution out there that can help, well, I hope,
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improve their quality of life.
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I've had some patients say, I'm not giving up my coffee,
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for example. That's okay. They don't have to. Incontinence has
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a major quality of life impact on people, but it's
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not going to kill you. And it may give you
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a rash if you're wet and having trouble staying dry.
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But otherwise, do what you want. Do what you think
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is right for you. My job is not to force
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you to not to have your coffee or your tomatoes,
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but to give you the knowledge so you can make
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those choices for yourself and, and see what works and
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what doesn't.
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I think that's the biggest thing is partnering with your
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physician to know what things to try. And then you
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can make your choice from there, which thing you would
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rather not have or rather have.
379
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Right.
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Yeah.
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That's one of the things I love about the medical
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field right now, you know, back a generation or two ago,
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it was very paternalistic. You know, you did what your
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doctor said. And I remember my grandmother telling me that
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her doctor told her ex and she didn't want to
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do X, but she was going to do it anyway.
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I said, well, Why don't you tell them you don't
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want to do that and see what else you can
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do instead? And oh, no, he said I had to
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do it. There was just no questioning it. And then
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we swung the pendulum the other far direction where the
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patient is the customer and it's about customer service. But
393
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medicine is not customer service. I mean, yes, we want
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people to feel happy and healthy and like they've been
395
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given great care. But that's not something that we do.
396
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You know, the patient sometimes thinks they need something that
397
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maybe is not the best option for them. And so
398
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trying to get them off of that option and onto
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another one with education, make a shared decision together, that's
400
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really the best way to deliver great care.
401
00:20:11.069 --> 00:20:14.509
I think that's a huge point. I think partnering with
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00:20:14.549 --> 00:20:17.069
a physician who's gone to school for several years.
403
00:20:17.309 --> 00:20:18.809
Or a provider. I mean, they go through a lot
404
00:20:18.829 --> 00:20:20.210
of training as well and experience too.
405
00:20:20.589 --> 00:20:24.779
Absolutely. But not going to Dr. Google regularly. or looking,
406
00:20:25.079 --> 00:20:26.140
you know, Googling things.
407
00:20:26.160 --> 00:20:28.420
I think that's one of our biggest problems right now
408
00:20:28.500 --> 00:20:31.589
is the internet gives you so many different things and
409
00:20:31.619 --> 00:20:36.609
people are self-prescribing themselves with things that aren't really helping
410
00:20:36.670 --> 00:20:38.170
and could be making things worse.
411
00:20:38.509 --> 00:20:40.630
Possibly. I think that the internet can be a really
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great resource. And I actually like it when people go
413
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to the internet because then they've done some research and
414
00:20:46.410 --> 00:20:49.160
they're not just talking to their friends or their, you know,
415
00:20:49.180 --> 00:20:51.900
partners or whatever, that they actually are getting some other
416
00:20:52.509 --> 00:20:55.549
information out there. And sometimes it's helpful and sometimes it's not,
417
00:20:55.569 --> 00:20:58.190
but then we can have a conversation about what's scientifically
418
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appropriate and what's been found to be debunked and whatnot.
419
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We can go from there, but at least they have
420
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an idea. And when you're starting from ground zero and
421
00:21:04.890 --> 00:21:07.250
they haven't even heard of whatever it is that they're
422
00:21:07.269 --> 00:21:09.789
trying to solve, it can be really challenging. So I
423
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think the internet's a great tool when used appropriately, but
424
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if you don't get the right information, if it's just
425
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anecdotal thing like, hey, I think this works because I
426
00:21:20.720 --> 00:21:23.559
tried it and I liked it, that's not as helpful
427
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as going to say the Mayo Clinic website or a
428
00:21:26.339 --> 00:21:29.720
Cleveland Clinic website or something else that is sponsored by
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00:21:29.740 --> 00:21:34.240
a medical facility where they know whatever they're recommending is
430
00:21:34.440 --> 00:21:38.589
based in facts and science, not just someone else's experience.
431
00:21:38.970 --> 00:21:41.829
That's a great point, going to those medical homes and
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getting that information rather than just hitting Google.
433
00:21:45.509 --> 00:21:47.910
Or chat GPT or any of those other options that
434
00:21:47.930 --> 00:21:48.200
they have now?
435
00:21:48.210 --> 00:21:50.609
I have been misled by chat GPT before. I put
436
00:21:50.690 --> 00:21:52.569
in a question and I got an answer I know
437
00:21:52.630 --> 00:21:55.380
was wrong. And yeah, it hallucinates. So you have to
438
00:21:55.420 --> 00:21:56.660
be careful with that kind of thing.
439
00:21:57.960 --> 00:21:59.299
And people trust those things.
440
00:21:59.339 --> 00:22:02.039
So we have to make sure that they also trust
441
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our providers and physicians too.
442
00:22:03.900 --> 00:22:04.440
Absolutely.
443
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Yeah, it's got to be a balance, right?
444
00:22:05.799 --> 00:22:06.339
Absolutely.
445
00:22:07.269 --> 00:22:10.549
Are there particular conversations that you find patients are sometimes
446
00:22:10.670 --> 00:22:13.670
embarrassed or hesitant to have with their provider?
447
00:22:13.690 --> 00:22:13.769
Sure.
448
00:22:14.380 --> 00:22:17.819
I think for me, because I'm a woman and I'm
449
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only 51, if they're older and a man's having erectile dysfunction,
450
00:22:22.539 --> 00:22:26.529
they're really reluctant to have that discussion. Or when they do,
451
00:22:26.589 --> 00:22:30.470
you can see them really struggling to open up. I
452
00:22:30.509 --> 00:22:33.210
think that they're just afraid of being embarrassed or judged.
453
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And I understand it's a very sensitive topic, but I
454
00:22:39.089 --> 00:22:42.769
went to school for this. And I've heard a lot
455
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of stuff. So, you know, I don't judge people. I
456
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want them to be honest and straightforward with me so
457
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I know how to help them. And if they gloss
458
00:22:50.079 --> 00:22:52.940
over a subject or they don't tell me something, I
459
00:22:53.059 --> 00:22:54.579
may not have all the information I need to give
460
00:22:54.599 --> 00:22:56.420
them the best option available for them.
461
00:22:57.769 --> 00:23:00.549
I know that previously to you joining us, we did
462
00:23:00.609 --> 00:23:04.170
have a male urologist, and that was one of the
463
00:23:04.190 --> 00:23:06.309
first things when I found out that you were coming here.
464
00:23:06.329 --> 00:23:10.089
I was like, oh, Wendy is doing this. Okay, Dr.
465
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Nunez is a woman. And I thought the same thing.
466
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I thought, oh, will my husband be comfortable coming to her?
467
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And the more I've talked to you and got to
468
00:23:18.230 --> 00:23:21.230
know you, absolutely, you're an expert in your field. So
469
00:23:21.329 --> 00:23:23.369
I think that that's not really a barrier.
470
00:23:23.430 --> 00:23:25.990
So I hope more and more people feel comfortable with that.
471
00:23:26.289 --> 00:23:28.730
After doing this for this long, It takes a lot
472
00:23:28.769 --> 00:23:31.339
to embarrass me. And I come at it with a
473
00:23:31.390 --> 00:23:35.200
very clinical point of view. So I'm not not your friend.
474
00:23:35.579 --> 00:23:38.400
You know, I'm not your neighbor. I'm your physician. And
475
00:23:38.440 --> 00:23:42.099
the things that people are telling me have a basis
476
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in their body and medicine. And so once they kind
477
00:23:45.839 --> 00:23:48.779
of understand my point of view and my approach, then
478
00:23:48.799 --> 00:23:50.119
I think a lot of people will kind of loosen
479
00:23:50.140 --> 00:23:52.490
up and relax. I spent a lot of time during
480
00:23:52.509 --> 00:23:55.230
my training at the VA and the VA is like
481
00:23:55.230 --> 00:23:57.490
95% men. And a lot of them, at least in
482
00:23:57.509 --> 00:24:01.130
the San Antonio VA were skewed for the older population.
483
00:24:01.829 --> 00:24:04.150
And so a lot of them were just, you know,
484
00:24:04.269 --> 00:24:06.309
their minds were blown that I was a physician, not
485
00:24:06.349 --> 00:24:09.910
a nurse. And so it was a lot of education and,
486
00:24:10.079 --> 00:24:13.319
you know, persistence and whatnot. And I had a number
487
00:24:13.359 --> 00:24:15.039
of older men over the years from the VA say,
488
00:24:15.079 --> 00:24:17.819
you know what? I love having a female physician because
489
00:24:17.839 --> 00:24:20.960
they listen so well. And they give me time to
490
00:24:21.500 --> 00:24:25.039
have things explained to me. And I like that touch.
491
00:24:25.680 --> 00:24:26.819
I think that's wonderful.
492
00:24:27.440 --> 00:24:30.960
So how does the patient typically get connected with a urologist?
493
00:24:31.259 --> 00:24:32.759
Does it require a referral?
494
00:24:33.940 --> 00:24:36.549
That is really insurance driven. And so it's important to
495
00:24:36.569 --> 00:24:39.470
know your policy. So a lot of insurances do not
496
00:24:39.529 --> 00:24:43.630
require a referral from their other provider. They can just self-refer.
497
00:24:43.650 --> 00:24:47.299
I think Medicare typically is a self-referral. And I don't
498
00:24:47.359 --> 00:24:49.640
know about secondary insurances, though. So that's where it gets
499
00:24:49.680 --> 00:24:53.210
kind of tricky. And if they're not sure, they should
500
00:24:53.230 --> 00:24:56.569
call their insurance company and ask. But otherwise, they're in
501
00:24:56.609 --> 00:24:58.630
their visit with primary care and they say, hey, you
502
00:24:58.650 --> 00:25:02.569
know what? I've got problem X. And that provider says, well,
503
00:25:02.769 --> 00:25:05.549
I think you should go see Dr. Wendy because she
504
00:25:05.589 --> 00:25:07.710
is a urologist and she can handle that. They put
505
00:25:07.730 --> 00:25:10.319
a referral order in the computer and then we help
506
00:25:10.339 --> 00:25:11.660
them get the appointment arranged for them.
507
00:25:12.880 --> 00:25:13.599
Sounds great.
508
00:25:14.299 --> 00:25:16.319
What can somebody expect during their first visit?
509
00:25:17.359 --> 00:25:19.990
Well, it depends on why they're there, right? Yes. Yeah,
510
00:25:20.029 --> 00:25:24.950
so some things don't require examinations. Some things do. Sometimes
511
00:25:25.109 --> 00:25:28.569
I'll offer procedures if it's part of the problem that
512
00:25:28.589 --> 00:25:32.099
I'm trying to evaluate. Sometimes it requires further testing and
513
00:25:32.119 --> 00:25:34.230
they have to come back. Sometimes I offer them a
514
00:25:34.299 --> 00:25:35.859
treatment that I want them to come back and see
515
00:25:35.920 --> 00:25:39.339
if they're improving. Sometimes we get them set up for surgery.
516
00:25:39.480 --> 00:25:43.400
So I think the short answer is they should expect
517
00:25:43.420 --> 00:25:46.200
me to listen to them. and try to find a
518
00:25:46.220 --> 00:25:49.039
solution that will work well for them and that they
519
00:25:49.079 --> 00:25:51.619
have an input in and they feel like they're making
520
00:25:51.640 --> 00:25:53.210
a good decision with me at the end of the visit.
521
00:25:53.849 --> 00:25:54.089
Good.
522
00:25:54.250 --> 00:25:56.029
So they don't have to come with a full bladder.
523
00:25:57.049 --> 00:25:58.970
My nurse is really good at sorting out ahead of
524
00:25:59.009 --> 00:26:01.230
time based on the reason for visit, who needs to
525
00:26:01.250 --> 00:26:03.349
give me a urine sample. And they tend to be
526
00:26:04.069 --> 00:26:06.779
coming in the week before. So I have the results available.
527
00:26:06.799 --> 00:26:08.279
So we're not waiting for those during the visit.
528
00:26:09.180 --> 00:26:11.480
I think a lot of people hear the word urologist
529
00:26:11.539 --> 00:26:14.619
and immediately become nervous. What would you tell someone who
530
00:26:14.660 --> 00:26:17.619
has been referred to you that isn't sure what to expect?
531
00:26:18.460 --> 00:26:21.579
Expect to be given a lot of information and it
532
00:26:21.619 --> 00:26:25.660
may be overwhelming. I like to give a very detailed
533
00:26:25.740 --> 00:26:28.099
written report of the things we talk about so they
534
00:26:28.140 --> 00:26:30.539
don't have to take notes about the bladder irritants. They
535
00:26:30.559 --> 00:26:34.559
don't have to remember everything that we discussed. They'll have
536
00:26:34.579 --> 00:26:36.539
the gist of it and then they've got the report
537
00:26:36.559 --> 00:26:39.079
that I give them when they walk out. I think
538
00:26:39.099 --> 00:26:42.599
that you can expect to maybe be a little unsure
539
00:26:43.329 --> 00:26:45.470
And that can make some people uncomfortable just because they
540
00:26:45.490 --> 00:26:49.009
don't know what to expect. I think that no matter
541
00:26:49.109 --> 00:26:52.089
who you see or for what, you should feel, number one,
542
00:26:52.500 --> 00:26:55.259
immediately reassured that they know what they're doing, that they're well-trained,
543
00:26:55.279 --> 00:26:58.140
they're well-educated. And number two, that they're listening to you.
544
00:26:58.779 --> 00:27:02.720
So that they're not being ignored and things that are
545
00:27:02.740 --> 00:27:05.710
of concern are being addressed. And that they have the
546
00:27:05.750 --> 00:27:10.410
right to say no. Just because I recommend something either
547
00:27:10.450 --> 00:27:13.250
a test or a procedure, they don't have to do it.
548
00:27:13.390 --> 00:27:15.750
It's their choice, but I'll explain to them why I
549
00:27:15.789 --> 00:27:18.410
think they need it and what may be the end
550
00:27:18.470 --> 00:27:20.730
result if they don't do it so they can make
551
00:27:20.779 --> 00:27:23.980
the best choice for themselves. But regardless, you know, we're,
552
00:27:24.039 --> 00:27:25.759
we're here to help you. You know, we don't want
553
00:27:25.799 --> 00:27:27.940
to embarrass you. We don't want to harm you or
554
00:27:27.980 --> 00:27:31.579
make you emotionally or physically uncomfortable, but you know, these
555
00:27:31.640 --> 00:27:34.559
are things that usually need to get taken care of.
556
00:27:34.559 --> 00:27:35.660
I agree.
557
00:27:35.680 --> 00:27:38.549
I agree. Are there things people can do throughout their
558
00:27:38.589 --> 00:27:41.549
lives to support their urinary and urologic health?
559
00:27:42.089 --> 00:27:44.309
The two biggest things I think that I've come across
560
00:27:44.349 --> 00:27:48.250
time and time again is number one, don't smoke, don't vape,
561
00:27:48.450 --> 00:27:51.829
don't smoke, don't chew. There are so many toxins in
562
00:27:51.869 --> 00:27:54.970
those products that really harm our body. And smoking in
563
00:27:55.059 --> 00:27:58.900
particular greatly increases a person's risk of developing urinary tract
564
00:27:58.920 --> 00:27:59.579
cancer in their life.
565
00:28:00.130 --> 00:28:01.589
I never would have correlated that.
566
00:28:01.769 --> 00:28:02.049
Yeah.
567
00:28:02.230 --> 00:28:04.430
And if they, if they quit smoking, their risk goes
568
00:28:04.470 --> 00:28:07.329
way down, not as low as if they had never smoked,
569
00:28:07.529 --> 00:28:10.589
but way down. The bummer in life is that there
570
00:28:10.609 --> 00:28:12.630
are a lot of environmental toxins that we may not
571
00:28:12.670 --> 00:28:15.710
know we're exposed to. And so I've seen plenty of
572
00:28:15.779 --> 00:28:18.819
non-smokers come to me with say bladder cancer, but the
573
00:28:18.880 --> 00:28:21.059
vast majority are those who do have a smoking history.
574
00:28:21.079 --> 00:28:24.420
So that's the first thing. Second thing is drink your water.
575
00:28:25.049 --> 00:28:26.589
You know, I think it's kind of comical now. When
576
00:28:26.630 --> 00:28:28.509
I was a kid, I never carried water with me.
577
00:28:28.589 --> 00:28:30.990
I never had anything in the car to drink. I
578
00:28:31.069 --> 00:28:33.509
never had a bottle of water near me. I drank
579
00:28:33.589 --> 00:28:35.349
at meals and maybe if I got thirsty or I
580
00:28:35.349 --> 00:28:37.710
was working out and that was it. Now I carry
581
00:28:37.750 --> 00:28:41.549
water with me everywhere. And the older we get, the
582
00:28:41.630 --> 00:28:44.019
more our bodies need water. So the biggest thing that
583
00:28:44.059 --> 00:28:47.420
I see in folks, Medicare age, shall we say, and
584
00:28:47.519 --> 00:28:50.519
older is that they don't drink enough water. So they
585
00:28:50.559 --> 00:28:55.970
get constipated. They maybe develop kidney stones. And then they
586
00:28:56.029 --> 00:28:58.309
also just don't function well in life. Their balance is
587
00:28:58.369 --> 00:29:01.609
not good. Their thinking is not clear. And they just
588
00:29:01.650 --> 00:29:04.190
kind of don't feel good. I mean, I've caught myself
589
00:29:04.210 --> 00:29:06.390
being dehydrated and didn't realize I was thirsty. And I
590
00:29:06.430 --> 00:29:08.589
just felt crabby and out of sorts and just not right.
591
00:29:08.670 --> 00:29:12.549
So the older we are, the less aware we are
592
00:29:12.569 --> 00:29:14.859
that we need that fluid. We don't have that thirst
593
00:29:14.910 --> 00:29:16.859
drive that kicks in as early as when we're younger.
594
00:29:17.539 --> 00:29:18.619
But the more important it is.
595
00:29:19.420 --> 00:29:22.640
Well, I know people who start to have problems with incontinence.
596
00:29:23.099 --> 00:29:25.059
it's the first thing they do is they stop drinking
597
00:29:25.220 --> 00:29:25.740
as much.
598
00:29:25.799 --> 00:29:28.680
Yeah. And if you're going out and about, totally do that.
599
00:29:28.960 --> 00:29:32.900
But otherwise, your body needs that fluid. It's really important.
600
00:29:33.349 --> 00:29:35.109
And come see me because maybe we can find a
601
00:29:35.130 --> 00:29:37.009
solution where you won't have to cut back on your fluid.
602
00:29:37.490 --> 00:29:38.289
Yes, I agree.
603
00:29:38.309 --> 00:29:41.039
One of the things we talk about frequently on this
604
00:29:41.079 --> 00:29:45.960
podcast is access to specialty care in rural communities. Why
605
00:29:46.000 --> 00:29:49.079
is it important for people in western Wisconsin to have
606
00:29:49.240 --> 00:29:51.079
access to urology care close to home?
607
00:29:52.079 --> 00:29:54.759
I think it's really important. I think it's such a
608
00:29:55.240 --> 00:29:57.279
feather in the cap of a facility to have a
609
00:29:57.380 --> 00:30:01.859
specialist that is there available to provide care and not
610
00:30:01.920 --> 00:30:05.359
have to drive into a large metro area. When I
611
00:30:05.400 --> 00:30:07.880
first came here, I was shopping for a home because
612
00:30:07.900 --> 00:30:09.349
I never had a house before. I always had really
613
00:30:09.390 --> 00:30:12.509
small apartments. So I needed a kitchen dining table and
614
00:30:12.549 --> 00:30:13.970
a new mattress and all that stuff. So I had
615
00:30:13.990 --> 00:30:15.910
to go to the city. So for me, driving down
616
00:30:16.029 --> 00:30:20.009
in urban traffic and navigating the freeway system and And,
617
00:30:20.109 --> 00:30:22.349
you know, city streets, no big deal. But for folks
618
00:30:22.390 --> 00:30:24.509
who don't do that often or for whatever reason makes
619
00:30:24.529 --> 00:30:27.089
them uncomfortable, it is a big deal. And so I've
620
00:30:27.210 --> 00:30:29.480
literally had patients over the years who said, yeah, I'm
621
00:30:29.519 --> 00:30:31.039
not going to go to the cities for that. I
622
00:30:31.059 --> 00:30:32.740
know you told me that you can't do whatever it
623
00:30:32.759 --> 00:30:33.900
is I need here, but I'm just not going to
624
00:30:33.920 --> 00:30:37.130
do it. I understand that now the older I get,
625
00:30:37.630 --> 00:30:40.789
the more relatable that is. But I think it's really
626
00:30:40.890 --> 00:30:46.660
great when you have that specialty nearby. Then you can
627
00:30:46.720 --> 00:30:52.259
get modern, state-of-the-art, urban-style care in your backyard. And you
628
00:30:52.279 --> 00:30:54.880
don't have to worry about getting a ride or worrying
629
00:30:54.900 --> 00:30:57.710
about parking or anything like that. And I think it
630
00:30:57.769 --> 00:31:01.559
also increases increases the trust that you have in your
631
00:31:02.099 --> 00:31:05.539
hometown hospital when you know that you can get so
632
00:31:05.599 --> 00:31:09.980
many services and treatments available because they're so well staffed
633
00:31:10.039 --> 00:31:10.859
and supported.
634
00:31:11.680 --> 00:31:14.710
That is just another reason I can't believe all the
635
00:31:14.750 --> 00:31:18.309
different things that you treat and how common probably people
636
00:31:18.349 --> 00:31:20.490
need to come in or how often they need to
637
00:31:20.549 --> 00:31:23.380
come in for this and to have somebody in your
638
00:31:23.500 --> 00:31:26.339
rural clinic to be able to talk to and solve
639
00:31:26.359 --> 00:31:28.890
these problems without going to a specialist, without driving into
640
00:31:28.930 --> 00:31:30.289
the cities is really important.
641
00:31:30.430 --> 00:31:34.150
Yeah, I think one of the really neatest things about
642
00:31:34.230 --> 00:31:37.950
Western Wisconsin Health is how many high technology things we
643
00:31:38.009 --> 00:31:41.289
have here that the common community member may not know about.
644
00:31:41.509 --> 00:31:44.200
So for example, we have a robot here, a surgical robot.
645
00:31:44.779 --> 00:31:46.640
And it's not like Star Trek where it operates on
646
00:31:46.680 --> 00:31:49.710
its own. I mean, the surgeon tells the machine what
647
00:31:49.730 --> 00:31:52.529
to do, but that is not common in smaller hospitals
648
00:31:52.549 --> 00:31:54.990
like this one. So for us to have it, I
649
00:31:55.009 --> 00:31:59.809
think that's huge. Surgical lasers. We have the ability to
650
00:31:59.930 --> 00:32:03.809
use surgical lasers for things like kidney stones. This inner
651
00:32:03.829 --> 00:32:05.650
stem procedure I was talking about where we have the
652
00:32:05.690 --> 00:32:08.710
nerve simulator for the bladder, those kinds of things, those
653
00:32:08.759 --> 00:32:12.460
are high technology. Those are Mayo Clinic level kinds of
654
00:32:13.700 --> 00:32:16.720
treatments and tools that we have right in our own backyard.
655
00:32:16.799 --> 00:32:17.460
It's really great.
656
00:32:18.450 --> 00:32:20.630
Do you use the surgical robot for any of the
657
00:32:20.670 --> 00:32:21.589
procedures that you do?
658
00:32:22.089 --> 00:32:26.029
I have in the past, but I typically don't. In
659
00:32:26.190 --> 00:32:28.910
the other facility I used to work, also a community
660
00:32:28.990 --> 00:32:32.990
access or critical access hospital, the things I need the
661
00:32:33.009 --> 00:32:35.589
robot for didn't pop up on my radar very often.
662
00:32:35.950 --> 00:32:38.470
And I'm a big believer of the more you do something,
663
00:32:38.589 --> 00:32:40.990
the better you get. So there are many things I'm
664
00:32:41.190 --> 00:32:44.509
very good at, but surgically removing a prostate for a
665
00:32:44.519 --> 00:32:46.599
man that has prostate cancer wasn't something I had the
666
00:32:46.640 --> 00:32:49.680
opportunity to do very much. And so as a result,
667
00:32:49.940 --> 00:32:51.980
I think it's better to have the patient go on
668
00:32:52.019 --> 00:32:55.559
to someone who does many, many of those. Specialties are
669
00:32:55.579 --> 00:32:59.180
kind of interesting because very few of us do the
670
00:32:59.319 --> 00:33:01.940
scope of what we can do, meaning I was trying
671
00:33:01.960 --> 00:33:04.630
to take someone's bladder out, surgically remove their bladder and
672
00:33:04.650 --> 00:33:08.490
their prostate and their kidneys and pelvic floor prolapse and
673
00:33:08.509 --> 00:33:11.710
all these things. But especially in bigger centers, you know,
674
00:33:11.730 --> 00:33:14.390
when you have, say, a practice that has 20-odd urologists,
675
00:33:15.049 --> 00:33:18.940
they subspecialize. You have... the prostate cancer guy or gal.
676
00:33:18.960 --> 00:33:21.799
You've got the endoscopic one that takes out the stones.
677
00:33:21.819 --> 00:33:24.039
You've got this, that, that. They kind of have their
678
00:33:24.119 --> 00:33:28.180
own niche. For me, I don't do everything that I
679
00:33:28.220 --> 00:33:30.940
was trying to do. I've narrowed it down more. And
680
00:33:31.009 --> 00:33:33.430
so when I need something big, I know who to
681
00:33:33.470 --> 00:33:36.069
send my patients to because I have relationships and some
682
00:33:36.109 --> 00:33:38.750
trust that I've developed there. But what I can keep here,
683
00:33:38.789 --> 00:33:40.710
what I can do here, I'm very proud to do
684
00:33:40.750 --> 00:33:41.529
and I think I do well.
685
00:33:42.269 --> 00:33:45.559
Good. Well, we won't send as many people off unless...
686
00:33:45.900 --> 00:33:48.869
more major than what we can handle so I appreciate that.
687
00:33:48.869 --> 00:33:51.170
And you mentioned call a while back and yeah I
688
00:33:51.170 --> 00:33:54.410
do take call here and so it's it's a great
689
00:33:54.450 --> 00:33:56.390
feeling to know that when you come to your local
690
00:33:56.529 --> 00:33:58.410
ER that there are a lot of things that you
691
00:33:58.430 --> 00:34:00.109
don't need to get sent to the cities for cities
692
00:34:00.150 --> 00:34:01.549
anymore we can take care of it here.
693
00:34:01.430 --> 00:34:05.450
I really appreciate that because we just didn't have that
694
00:34:05.490 --> 00:34:08.570
coverage here before so now we do and I think
695
00:34:08.590 --> 00:34:10.800
we'll be able to keep so many more people here
696
00:34:11.199 --> 00:34:13.980
in you know the Baldwin area as much as possible
697
00:34:14.159 --> 00:34:16.730
which will really help on everyone That's my absolute goal too.
698
00:34:18.110 --> 00:34:22.269
You've seen healthcare from both the physician and organizational perspectives.
699
00:34:22.820 --> 00:34:25.420
What do you think people outside of healthcare might not
700
00:34:25.500 --> 00:34:29.159
realize about what goes into making sure patients receive safe,
701
00:34:29.340 --> 00:34:30.219
high quality care?
702
00:34:31.760 --> 00:34:35.860
There's a lot of continued medical education. So just because
703
00:34:35.900 --> 00:34:38.530
you get your medical license and you get credentialed in
704
00:34:38.550 --> 00:34:42.789
the hospital and you're trained from your residency, your job
705
00:34:42.829 --> 00:34:45.809
doesn't end with the learning. You still have to keep
706
00:34:45.869 --> 00:34:50.010
your certification up. There's a very rigorous process in place,
707
00:34:50.050 --> 00:34:52.769
not only for the state licensing board, but also for
708
00:34:52.809 --> 00:34:56.719
your own medical board. So Mine is the American Board
709
00:34:56.739 --> 00:34:59.599
of Urology and they're very rigorous in making sure that
710
00:34:59.760 --> 00:35:02.559
every couple of years you're on task with proving that
711
00:35:02.599 --> 00:35:04.949
you're staying up to date on the latest. So whether
712
00:35:04.989 --> 00:35:08.630
you get your care in Baldwin, Wisconsin or New York,
713
00:35:08.650 --> 00:35:12.230
New York, you're getting the same level of quality care
714
00:35:12.289 --> 00:35:15.929
that you need to solve your problem. So that's one thing.
715
00:35:16.909 --> 00:35:19.230
There's the credentialing committee that I mentioned earlier. We make
716
00:35:19.269 --> 00:35:21.630
sure people are qualified. And if there's a new procedure
717
00:35:21.650 --> 00:35:24.369
they want to offer, that they're getting extra training in that.
718
00:35:24.469 --> 00:35:27.369
So it's not just, oh, it sounds cool, let's do it.
719
00:35:27.429 --> 00:35:31.809
They're being determined to be safe and qualified to offer
720
00:35:31.849 --> 00:35:35.750
that care at their facility. And there's a lot of
721
00:35:35.789 --> 00:35:37.929
things that go on behind the scenes that patients don't
722
00:35:37.969 --> 00:35:40.179
know about. They don't know about all the phone calls
723
00:35:40.219 --> 00:35:43.010
we make to their pharmacy to make sure that our
724
00:35:43.070 --> 00:35:46.400
medical list is correct and that when we're prescribing something
725
00:35:46.440 --> 00:35:48.039
new for them, it's not going to have an interaction
726
00:35:48.780 --> 00:35:53.039
or we are going to battle basically with their insurance
727
00:35:53.079 --> 00:35:56.889
company to explain why we think a certain procedure or
728
00:35:56.949 --> 00:36:01.389
treatment is not only necessary, but appropriate and ideal for them.
729
00:36:02.230 --> 00:36:04.389
And it's, it's a lot of things are off the
730
00:36:04.429 --> 00:36:06.630
clock and not in front of the patient. And we're,
731
00:36:06.690 --> 00:36:09.139
we're always, we're always trying to be the patient's advocate.
732
00:36:10.489 --> 00:36:15.050
It's sometimes challenging when they don't take a physician's note.
733
00:36:15.869 --> 00:36:19.050
I'm prescribing this medication, they need that medication, and then
734
00:36:19.090 --> 00:36:21.369
they ask you to prove it. That's got to be
735
00:36:21.409 --> 00:36:24.949
frustrating for a physician to spend extra time making sure
736
00:36:24.969 --> 00:36:27.909
that that patient is getting the medication or the treatment
737
00:36:27.949 --> 00:36:28.570
that they need.
738
00:36:28.590 --> 00:36:32.739
Yeah. I'd like to give people at insurance companies the
739
00:36:32.780 --> 00:36:35.440
benefit of the doubt and You know, the reviewers are
740
00:36:35.500 --> 00:36:37.320
looking at to make sure that they're not getting a
741
00:36:37.360 --> 00:36:41.170
treatment that's not indicated or that the physician is not
742
00:36:41.250 --> 00:36:43.510
appropriate to deliver. But, you know, there are a lot
743
00:36:43.530 --> 00:36:45.989
of inefficiencies like with any big system. And so it
744
00:36:46.530 --> 00:36:49.750
can take an incredible amount of time out of your
745
00:36:49.769 --> 00:36:52.469
day when you're already taking care of patients and writing
746
00:36:52.510 --> 00:36:54.630
notes and rounding and whatever else you have to do
747
00:36:55.050 --> 00:36:56.780
to sit down and get a hold of someone on
748
00:36:56.800 --> 00:37:00.360
the insurance line and try to explain to them why
749
00:37:00.380 --> 00:37:02.519
you're doing one thing instead of another they want you
750
00:37:02.539 --> 00:37:02.699
to do.
751
00:37:03.519 --> 00:37:06.179
And people might be surprised that that's the actual physician
752
00:37:06.219 --> 00:37:08.519
that's making that phone call and not somebody else.
753
00:37:08.880 --> 00:37:12.139
Yeah, there's something called peer-to-peer. Only physicians or nurse protectors
754
00:37:12.219 --> 00:37:14.840
or PAs can do. You can't have your nursing staff
755
00:37:14.860 --> 00:37:17.179
or administrative staff do it for you. And I think
756
00:37:17.199 --> 00:37:20.610
that's a good idea because we know best what we're offering,
757
00:37:20.630 --> 00:37:23.630
what we're talking about. I can explain to my support
758
00:37:23.650 --> 00:37:27.070
staff what I need to have communicated, but they don't
759
00:37:27.090 --> 00:37:29.289
have the same background I do. And so I completely
760
00:37:29.309 --> 00:37:31.150
understand why they want me to do it and not
761
00:37:31.190 --> 00:37:34.070
somebody else. it's just there are other barriers in place
762
00:37:34.090 --> 00:37:35.429
that just make it really challenging.
763
00:37:36.150 --> 00:37:38.710
It's taxing on the system to have you sitting on
764
00:37:38.789 --> 00:37:41.610
hold waiting to clear something up when maybe a patient
765
00:37:41.670 --> 00:37:43.429
is waiting in a room or something.
766
00:37:43.130 --> 00:37:45.780
Like that too. So it just backs everything up a
767
00:37:45.800 --> 00:37:46.219
little bit.
768
00:37:46.239 --> 00:37:48.480
We try to schedule it. It's just the times that
769
00:37:48.500 --> 00:37:50.639
they're available may not be the best times that we're
770
00:37:50.659 --> 00:37:54.420
also available. So I mean, it all ends up, it
771
00:37:54.480 --> 00:37:56.969
works in the end. It has a lot of inefficiencies
772
00:37:57.030 --> 00:38:00.250
and can add a layer of complexity to medical practice.
773
00:38:00.369 --> 00:38:04.969
But it's something that all of us do because we
774
00:38:05.010 --> 00:38:06.670
want the patient to get the care that we need.
775
00:38:07.690 --> 00:38:09.309
We don't have to call the insurance company. We can
776
00:38:09.349 --> 00:38:11.289
just say, yeah, they didn't cover it. It's your problem.
777
00:38:11.550 --> 00:38:13.300
We don't do that. We go to battle for our
778
00:38:13.320 --> 00:38:15.000
patients to make sure that they get what we think
779
00:38:15.019 --> 00:38:15.320
they need.
780
00:38:16.280 --> 00:38:18.760
And this is not something unique for urology. This is
781
00:38:18.800 --> 00:38:23.139
something across the board that physicians struggle with in any
782
00:38:23.239 --> 00:38:24.800
different specialty or department.
783
00:38:25.039 --> 00:38:26.000
Absolutely, yeah.
784
00:38:27.250 --> 00:38:30.050
What is something you wish your patients would ask you
785
00:38:30.110 --> 00:38:30.889
more often?
786
00:38:32.489 --> 00:38:35.070
Whatever it is they're embarrassed about, whatever it is that
787
00:38:35.090 --> 00:38:38.909
they're worried about, something that they wish they could fix
788
00:38:39.289 --> 00:38:42.760
or improve and they've tried something and it didn't work
789
00:38:42.820 --> 00:38:43.880
and so they've kind of given up.
790
00:38:44.639 --> 00:38:47.260
What is the most rewarding part of being a physician
791
00:38:47.320 --> 00:38:47.619
for you?
792
00:38:48.409 --> 00:38:51.230
You know, I said to someone earlier, it's not my
793
00:38:51.269 --> 00:38:54.530
job to make someone happy. It's my job to provide
794
00:38:54.550 --> 00:38:56.550
the kind of care I would be proud to receive.
795
00:38:57.429 --> 00:38:59.949
So I guess I'm going to kind of go against
796
00:38:59.989 --> 00:39:02.500
myself and say that I like making people happy. I
797
00:39:03.179 --> 00:39:06.360
like having them walk away from me and feel like
798
00:39:06.400 --> 00:39:09.659
they've been listened to, like they're getting a great game plan,
799
00:39:09.699 --> 00:39:13.239
that they have the potential for being helped or fixed or,
800
00:39:13.460 --> 00:39:17.760
or cured, whatever the situation is. Um, I like making
801
00:39:17.800 --> 00:39:22.250
that connection with people where I feel it click that they,
802
00:39:22.570 --> 00:39:25.929
they understand that I'm on their side and then I'm well-trained,
803
00:39:25.969 --> 00:39:30.130
well-qualified and they trust me. You know, I, we you
804
00:39:30.170 --> 00:39:34.349
go to a provider, you put your life in their hands,
805
00:39:34.590 --> 00:39:37.849
you know, you're telling them very embarrassing, very intimate details
806
00:39:37.909 --> 00:39:41.300
about your life and hope that you can get a solution.
807
00:39:41.400 --> 00:39:44.639
And so trust is so key. So when you gain that,
808
00:39:45.340 --> 00:39:47.960
You know, especially if someone's been, you know, burned before.
809
00:39:47.980 --> 00:39:49.320
I think that's wonderful.
810
00:39:50.199 --> 00:39:51.090
I couldn't agree more.
811
00:39:52.150 --> 00:39:55.329
When you hear the phrase redefining rural health care, what
812
00:39:55.349 --> 00:39:55.829
does that.
813
00:39:55.750 --> 00:39:56.269
Mean to you?
814
00:39:57.309 --> 00:39:58.630
I think it goes back to what we were talking
815
00:39:58.650 --> 00:40:03.989
about earlier with just high quality personalized care that you
816
00:40:04.050 --> 00:40:06.690
could get in the cities, but you wouldn't get to
817
00:40:06.730 --> 00:40:09.849
the same level because you're well known here. This is
818
00:40:09.869 --> 00:40:14.150
your home here and you know your doctor or your provider.
819
00:40:14.690 --> 00:40:17.449
You trust them and you know that you're going to
820
00:40:17.489 --> 00:40:19.530
get the best of whatever it is that you need.
821
00:40:20.239 --> 00:40:24.860
So I think that it's pretty revolutionary when you can
822
00:40:24.940 --> 00:40:29.480
have all these different specialists come here and provide that
823
00:40:29.519 --> 00:40:32.900
care and then also primary care. Primary care is so
824
00:40:33.019 --> 00:40:36.840
critical for everyone to be happy and healthy and if
825
00:40:36.880 --> 00:40:40.670
they don't go that that's really, you know, tying your
826
00:40:40.710 --> 00:40:42.610
arm behind your back in terms of staying healthy and
827
00:40:42.659 --> 00:40:45.199
living a long life, because there's so many things that
828
00:40:45.219 --> 00:40:48.440
they can provide. And then they're also the springboard to
829
00:40:48.559 --> 00:40:51.539
getting to a specialist if that's needed. They know, okay,
830
00:40:51.579 --> 00:40:53.880
if I have this problem, okay, you don't need that
831
00:40:53.920 --> 00:40:55.340
kind of doctor, you need this kind of doctor, and
832
00:40:55.360 --> 00:40:58.099
that's who they send you to. So it's a real
833
00:40:58.139 --> 00:41:01.849
nice team, I think. And in a smaller facility, you
834
00:41:01.929 --> 00:41:05.190
have a more cohesive, a tighter team, because I can
835
00:41:05.210 --> 00:41:06.909
walk down the hall and I can talk to my
836
00:41:06.969 --> 00:41:09.199
other colleagues and You know, let them know what I'm
837
00:41:09.239 --> 00:41:13.019
thinking about patient Sally, you know, and we can make
838
00:41:13.059 --> 00:41:15.000
a plan together where if you're in a big facility,
839
00:41:15.159 --> 00:41:17.300
you know, you may never see that other provider or
840
00:41:17.320 --> 00:41:20.579
their other colleague because they're just a different wing. So
841
00:41:20.739 --> 00:41:25.469
I think that it's rural care is not only high quality,
842
00:41:25.530 --> 00:41:27.139
but it's also highly personalized.
843
00:41:28.590 --> 00:41:31.510
We've come to the end of our professional questions today,
844
00:41:31.550 --> 00:41:34.230
but we always like to wrap up with a personal question.
845
00:41:34.670 --> 00:41:36.449
What brings you joy in your personal life?
846
00:41:37.429 --> 00:41:40.260
I love my family. I have a 19 year old
847
00:41:40.320 --> 00:41:43.360
at University of Minnesota Twin Cities and I have a
848
00:41:43.340 --> 00:41:47.469
16 year old high schooler and my husband is a
849
00:41:47.469 --> 00:41:50.099
general surgeon here at Western Wisconsin Health and so And
850
00:41:50.119 --> 00:41:53.099
the four of us together, that's the best time. Beyond that,
851
00:41:53.119 --> 00:41:56.980
I like to read. I love to bake sourdough. In fact,
852
00:41:57.000 --> 00:41:59.219
I've got bread rising on my counter at home right now.
853
00:41:59.260 --> 00:42:02.760
I love to bake. I love to get out and
854
00:42:02.780 --> 00:42:04.699
get my hands dirty in the garden and the woods.
855
00:42:04.719 --> 00:42:09.820
Some of those tomatoes? You know, I tried. I have
856
00:42:09.860 --> 00:42:12.019
a really hard, I don't have a fenced in garden
857
00:42:12.039 --> 00:42:14.420
and I live in the woods. And so the deer
858
00:42:14.539 --> 00:42:18.280
are just, the deer are kind of my own problem
859
00:42:18.440 --> 00:42:22.099
of creation because You know, I like to have them
860
00:42:22.139 --> 00:42:24.320
come in and eat the seed off the ground from
861
00:42:24.340 --> 00:42:26.949
my bird feeders, which also brings in bears, by the way.
862
00:42:27.010 --> 00:42:29.269
But anyway, you know, so they get attracted by the
863
00:42:29.289 --> 00:42:32.150
bird seed that falls. And then I get a trip
864
00:42:32.190 --> 00:42:34.389
out of seeing them from my kitchen window. But then
865
00:42:34.409 --> 00:42:38.550
they eat my plants, including my tomatoes. So, yeah, I
866
00:42:38.590 --> 00:42:40.250
wish I could do more of that. But it's a
867
00:42:40.269 --> 00:42:42.590
good tradeoff, I guess. I had an albino deer come
868
00:42:42.630 --> 00:42:44.949
to my window a couple of years ago. It was
869
00:42:44.969 --> 00:42:47.070
a little buck. It was really cool. Do you know
870
00:42:47.130 --> 00:42:49.289
it's illegal to shoot them? In Wisconsin?
871
00:42:49.309 --> 00:42:50.429
I think I did know that.
872
00:42:50.530 --> 00:42:51.309
Yeah.
873
00:42:51.610 --> 00:42:54.210
I think it's like one in 30,000 or something are albino.
874
00:42:54.349 --> 00:42:59.139
And so they're protected. And so you can't shoot them. Interesting.
875
00:42:59.460 --> 00:43:00.739
That's one of the things I love about living up
876
00:43:00.780 --> 00:43:03.630
here is all the nature. I at least live in
877
00:43:03.670 --> 00:43:05.170
a very wooded area.
878
00:43:05.190 --> 00:43:05.679
Sounds like it.
879
00:43:05.969 --> 00:43:09.329
Yeah, yeah. So if y'all are ever curious, go Google
880
00:43:09.449 --> 00:43:12.789
Nunes bear. I've got a few videos on YouTube. Okay.
881
00:43:12.929 --> 00:43:15.880
One of them is a huge male bear that broke
882
00:43:15.929 --> 00:43:18.440
the fencing or the railing from my front porch.
883
00:43:18.460 --> 00:43:19.159
Okay.
884
00:43:19.719 --> 00:43:22.739
Another one is him pulling himself up on my windowsill
885
00:43:22.760 --> 00:43:24.110
trying to look in the kitchen window. Hmm.
886
00:43:25.300 --> 00:43:28.260
Yeah. Maybe he's trying to see a physician about a
887
00:43:28.260 --> 00:43:29.500
neurological issue. Yeah.
888
00:43:30.710 --> 00:43:32.690
Well, we have, I live in St. Croix Falls and
889
00:43:32.710 --> 00:43:34.989
we have Fonda Rosa just right down the street.
890
00:43:35.309 --> 00:43:35.610
Oh, okay.
891
00:43:35.650 --> 00:43:38.010
It's a great outdoor animal park if you ever want
892
00:43:38.030 --> 00:43:40.960
to take family there. It's really a neat experience and
893
00:43:41.400 --> 00:43:43.500
wonderful people that work there. But anyway, I don't have
894
00:43:43.539 --> 00:43:45.519
to go there because I've got that in my own backyard.
895
00:43:45.579 --> 00:43:47.820
I've got the deer and the squirrels and the birds
896
00:43:47.920 --> 00:43:50.420
and the bears and the turkeys and all that kind
897
00:43:50.440 --> 00:43:52.469
of stuff. So it's really, it's one of the best
898
00:43:52.510 --> 00:43:54.690
things about living here is that, you know, it's so beautiful.
899
00:43:55.030 --> 00:43:56.190
It does sound wonderful.
900
00:43:56.230 --> 00:43:56.309
Yeah.
901
00:43:56.769 --> 00:43:59.190
Thank you for joining us today and for giving our
902
00:43:59.250 --> 00:44:01.429
listeners a better understanding of urology.
903
00:44:01.449 --> 00:44:03.630
It's my pleasure. Please come see me. I hope I
904
00:44:03.650 --> 00:44:04.769
can help you. Yes.
905
00:44:05.369 --> 00:44:08.150
You can schedule an appointment with Dr. Nunez by simply
906
00:44:08.190 --> 00:44:15.389
calling 715-684-1111. And you may need a provider's referral, but
907
00:44:15.409 --> 00:44:17.230
I think you might be able to schedule directly.
908
00:44:17.269 --> 00:44:19.469
It depends on your insurance, it sounds like, from an
909
00:44:19.530 --> 00:44:20.309
earlier question.
910
00:44:20.969 --> 00:44:23.889
I think one of the biggest takeaways from our conversation
911
00:44:24.030 --> 00:44:27.900
is that healthcare isn't just about treating an illness when
912
00:44:27.940 --> 00:44:32.280
something goes wrong. It's also about recognizing symptoms, asking questions,
913
00:44:32.480 --> 00:44:35.099
and feeling comfortable enough to seek care when you need it.
914
00:44:35.860 --> 00:44:37.969
And that's really at the heart of what we mean
915
00:44:38.070 --> 00:44:41.489
when we talk about redefining rural health care. Making sure
916
00:44:41.530 --> 00:44:45.469
people in rural communities have access to care, expertise, and
917
00:44:45.510 --> 00:44:48.760
relationships that they need close to home. Thank you for
918
00:44:48.820 --> 00:44:51.619
listening to Redefining Rural Health Care from Western Wisconsin Health.
919
00:44:52.130 --> 00:44:55.579
Please join us next time as I interview OBGYN Dr.
920
00:44:55.699 --> 00:44:56.699
Kara Seif.
921
00:44:57.440 --> 00:45:00.800
If you enjoyed today's conversation, be sure to subscribe and
922
00:45:00.860 --> 00:45:04.059
share this episode with someone who you think might find
923
00:45:04.099 --> 00:45:07.840
it helpful. Until next time, take care of yourself, take
924
00:45:07.880 --> 00:45:11.159
care of each other, and remember, your health is your wealth.
925
00:45:13.010 --> 00:45:15.530
Thank you for listening and be sure to subscribe so
926
00:45:15.570 --> 00:45:18.570
you don't miss one minute of this important health information.
927
00:45:19.050 --> 00:45:23.099
Visit www.health.org to learn more about all of the services
928
00:45:23.159 --> 00:45:26.219
we offer. Thanks for joining us through this journey and
929
00:45:26.300 --> 00:45:29.659
helping us redefine rural health care. Till next time.