บทถอดความฉบับเต็มของ Breaking Down Urologic Care with Dr. Wendy Nunes

and serving on hospital credentialing committees, she has a 34 00:02:10.479 --> 00:02:14.900 unique perspective on both the clinical and organizational. 35 00:02:14.240 --> 00:02:15.240 Sides of healthcare. 36 00:02:16.219 --> 00:02:19.210 Today, we're going to talk about urology, what patients should 37 00:02:19.270 --> 00:02:23.430 know about their urologic health, the importance of having specialty 38 00:02:23.469 --> 00:02:26.539 care available close to home, and what it means to 39 00:02:26.580 --> 00:02:30.919 provide high-quality specialty care in a rural community. Dr. Nunez, 40 00:02:31.080 --> 00:02:33.599 welcome to Redefining Rural Health Care. It's great to have 41 00:02:33.620 --> 00:02:34.039 you with us. 42 00:02:34.439 --> 00:02:35.490 Thank you. It's great to be here. 43 00:02:36.150 --> 00:02:39.430 Let's get started with your story. What originally drew you 44 00:02:39.550 --> 00:02:42.930 to medicine, and what ultimately led you to choose urology 45 00:02:43.030 --> 00:02:43.770 as your specialty? 46 00:02:44.490 --> 00:02:47.229 Well, it wasn't an obvious choice for me. Originally, I 47 00:02:47.550 --> 00:02:50.460 wanted to be a veterinarian, and I had worked in 48 00:02:50.500 --> 00:02:53.979 a vet clinic for small animals throughout most of high school. 49 00:02:54.500 --> 00:02:57.379 I would ride my bicycle from school to the clinic 50 00:02:57.419 --> 00:03:01.099 about three miles away and just got to see what 51 00:03:01.120 --> 00:03:03.060 it was like to be a veterinarian inside out for 52 00:03:03.099 --> 00:03:06.710 small animals. But it was a little boring. And when 53 00:03:06.750 --> 00:03:09.099 I got to college, I got exposed to large animals, 54 00:03:09.219 --> 00:03:13.250 but that's a pretty difficult lifestyle. You know, the animals 55 00:03:13.289 --> 00:03:15.849 can hurt you, step on you, kick you, etc. You know, 56 00:03:15.870 --> 00:03:19.069 you're going to them usually and That can be at 57 00:03:19.159 --> 00:03:21.759 all hours of the day and night and all kinds 58 00:03:21.819 --> 00:03:25.580 of weather and physically demanding as well. So it just 59 00:03:26.080 --> 00:03:27.740 didn't seem like it was a very good fit. And 60 00:03:27.759 --> 00:03:32.539 I wanted more interaction. Medicine and the scientific fields always 61 00:03:32.580 --> 00:03:35.139 really interested me, but there's very little that you can 62 00:03:35.180 --> 00:03:36.560 do for interaction with animals. 63 00:03:36.979 --> 00:03:39.000 They can't really tell you how they're feeling. 64 00:03:39.159 --> 00:03:42.879 No, they can't. So anyway, I decided to change my 65 00:03:42.919 --> 00:03:46.039 focus to human medicine and went to med school and 66 00:03:46.889 --> 00:03:49.669 Got exposed to urology as part of my medical school 67 00:03:49.750 --> 00:03:54.150 curriculum and didn't anticipate liking urology. I knew very little 68 00:03:54.169 --> 00:03:57.599 about it, probably like average people know very little about it. 69 00:03:58.289 --> 00:04:01.590 And just figured out it was a really neat aspect 70 00:04:01.650 --> 00:04:04.069 of medicine, the kinds of things that we care for 71 00:04:04.150 --> 00:04:07.949 for people that have urologic needs is unique. And it's 72 00:04:08.050 --> 00:04:13.310 both medical and procedural medicine. It covers all kinds of 73 00:04:13.449 --> 00:04:16.769 ages from birth all the way to the elderly and 74 00:04:16.810 --> 00:04:20.089 everything in between and men and women. So when I 75 00:04:20.350 --> 00:04:23.199 figured out that that kind of medicine really interested me 76 00:04:23.420 --> 00:04:26.220 and I liked the procedures and the kinds of things 77 00:04:26.240 --> 00:04:28.519 that I could offer for care, the kinds of things 78 00:04:28.560 --> 00:04:31.139 I could take care of, I realized it was also 79 00:04:31.160 --> 00:04:33.319 a great lifestyle because I wanted to have a life 80 00:04:33.439 --> 00:04:35.879 outside of medicine. I wanted to be fulfilled in and 81 00:04:35.939 --> 00:04:38.490 out of work. And urology allowed me to do that 82 00:04:38.529 --> 00:04:40.649 without spending every waking minute in the hospital. 83 00:04:41.250 --> 00:04:45.459 Fascinating I'm sure you get to be on call sometimes 84 00:04:45.519 --> 00:04:48.839 and have some odd hours but with I know veterinary 85 00:04:48.899 --> 00:04:51.540 things I grew up on a farm and it always 86 00:04:51.600 --> 00:04:54.310 seemed like animals would get sick nights and weekends and 87 00:04:54.410 --> 00:04:56.250 you know having to go out on call and things 88 00:04:56.290 --> 00:04:59.230 so we're certainly glad that you're a urologist and that 89 00:04:59.250 --> 00:05:01.949 you've joined our team here me too what do you 90 00:05:02.009 --> 00:05:06.060 enjoy most about being a urologist today I love. 91 00:05:05.920 --> 00:05:09.850 The patient interactions. I love, especially when I get to 92 00:05:09.879 --> 00:05:13.069 know a patient and sometimes they're part of their family. 93 00:05:13.829 --> 00:05:17.750 It's something that is really close to home. It covers 94 00:05:17.810 --> 00:05:19.649 a lot of things that are very important to people 95 00:05:19.689 --> 00:05:22.189 and have a huge quality of life impact for their care. 96 00:05:22.209 --> 00:05:27.709 And there are some conditions where they need long-term follow-up 97 00:05:27.769 --> 00:05:30.170 and observation. And then I get to know those folks 98 00:05:30.209 --> 00:05:32.810 really well. I came to the St. Croix Valley in 99 00:05:32.810 --> 00:05:35.689 2007 and I was very pregnant with our first child. 100 00:05:36.350 --> 00:05:37.910 And so now I know exactly how long I've been 101 00:05:37.930 --> 00:05:40.329 here because I delivered right after I got here. And 102 00:05:40.389 --> 00:05:43.649 so 19 years later, I'm still here. And there are 103 00:05:43.769 --> 00:05:47.269 literally some patients I saw from nearly the first month.

104 00:05:47.889 --> 00:05:50.629 And so it's been really nice to have that kind 105 00:05:50.670 --> 00:05:54.050 of relationship, kind of like primary care, how you develop 106 00:05:54.089 --> 00:05:57.389 those relationships over time and care for multiple people in 107 00:05:57.430 --> 00:06:00.290 the family as well. But then I have the surgical 108 00:06:00.370 --> 00:06:04.160 aspect and have a very problem-focused relationship kind of care 109 00:06:04.180 --> 00:06:06.699 that I can offer. I'm not doing preventative or a 110 00:06:06.740 --> 00:06:08.800 lot of very broad topics. I'm very focused. 111 00:06:09.680 --> 00:06:11.050 That's incredibly interesting. 112 00:06:11.579 --> 00:06:14.430 So you grew up in Portland, Oregon, but you've now 113 00:06:14.509 --> 00:06:17.670 been in Northwestern Wisconsin for nearly 20 years. You said 114 00:06:17.689 --> 00:06:20.129 you gave birth to your daughter 17 years ago? 115 00:06:20.129 --> 00:06:20.879 19. 116 00:06:20.879 --> 00:06:24.379 19 years ago. And then what brought you to Wisconsin? 117 00:06:24.829 --> 00:06:28.759 So I went from Portland, Oregon, where I graduated high school, 118 00:06:29.449 --> 00:06:32.269 to Washington State University because I was going to be 119 00:06:32.310 --> 00:06:35.509 an early admission candidate for their veterinary college up there 120 00:06:36.089 --> 00:06:38.490 but changed my mind after my sophomore year in college 121 00:06:38.670 --> 00:06:41.350 and then my parents moved to Missouri so I went 122 00:06:41.370 --> 00:06:43.540 to Missouri and then down to San Antonio for training 123 00:06:44.060 --> 00:06:47.699 six years of residency training longer than most specialties except 124 00:06:47.720 --> 00:06:50.540 for neurosurgery neurosurgery seven but urology was six so you're 125 00:06:50.720 --> 00:06:52.980 very well trained when you come out of that and 126 00:06:53.019 --> 00:06:56.699 I met my husband down there And he got recruited 127 00:06:56.860 --> 00:07:01.569 to a critical access hospital in the area. And we 128 00:07:01.589 --> 00:07:04.069 went up and visited and absolutely fell in love with 129 00:07:04.089 --> 00:07:08.290 the St. Croix River Valley and love the topography, you know, 130 00:07:08.629 --> 00:07:12.259 the hills and the landscapes and whatnot. And the people, 131 00:07:12.639 --> 00:07:17.009 the people are so warm and so genuine and likable 132 00:07:17.240 --> 00:07:20.379 and relatable. And that's something I felt was very common 133 00:07:21.180 --> 00:07:24.620 in the Northwest as well. That kind of mentality, you know, 134 00:07:24.639 --> 00:07:29.579 very down to earth, very honest, straightforward, kind people. So 135 00:07:29.759 --> 00:07:33.110 it felt like a home away from home. And I've 136 00:07:33.230 --> 00:07:36.689 now been in this area for longer than any other 137 00:07:36.730 --> 00:07:38.269 part of my life. And it's truly home. 138 00:07:39.259 --> 00:07:41.639 So when you were in school in San Antonio, it 139 00:07:41.699 --> 00:07:42.490 had to have been hot. 140 00:07:42.930 --> 00:07:43.569 Incredibly hot. 141 00:07:43.709 --> 00:07:43.949 Yes. 142 00:07:44.089 --> 00:07:45.529 For like four months of the year. 143 00:07:45.569 --> 00:07:47.889 Yes. I think that encouraged you to maybe go the 144 00:07:47.949 --> 00:07:50.810 polar opposite to where we have some frigid weather here 145 00:07:50.850 --> 00:07:51.129 in Wisconsin. 146 00:07:51.149 --> 00:07:51.829 You could say so. 147 00:07:52.470 --> 00:07:53.310 Yeah. 148 00:07:53.629 --> 00:07:57.519 Down there in the summertime, you literally go from air-conditioned 149 00:07:57.540 --> 00:07:59.779 environment to air-conditioned environment and you try to go as 150 00:07:59.839 --> 00:08:02.480 quickly as possible because otherwise you start sweating and you 151 00:08:02.500 --> 00:08:05.459 just are miserable. Even at night, it doesn't get very 152 00:08:05.540 --> 00:08:08.980 cool toward July and August and so you're not comfortable 153 00:08:09.040 --> 00:08:11.600 and you want to be indoors or in an air-conditioned car. 154 00:08:11.699 --> 00:08:15.689 And so when my husband and I came up to Wisconsin, 155 00:08:16.290 --> 00:08:19.550 we were warned the winters are cold. And we had 156 00:08:19.709 --> 00:08:23.250 no idea until our first winter. And we were walking 157 00:08:23.370 --> 00:08:26.089 from our car to the building together, and it was 158 00:08:26.230 --> 00:08:29.430 five degrees above zero. And my husband was rubbing his 159 00:08:29.470 --> 00:08:31.949 nose because he'd never had cold weather. He came from Brazil. 160 00:08:32.470 --> 00:08:34.690 He went from Brazil to Miami to San Antonio. So 161 00:08:34.710 --> 00:08:37.370 this was like a whole new ballgame. And he was 162 00:08:37.409 --> 00:08:39.250 rubbing his nose and saying, I feel like I've got 163 00:08:39.289 --> 00:08:41.909 something in there. What is going on? And I told him, 164 00:08:41.950 --> 00:08:45.029 I said, no, honey, the moisture that you're exhaling is 165 00:08:45.230 --> 00:08:49.009 freezing on your nose hairs. He looked at me just shocked. 166 00:08:49.049 --> 00:08:50.750 I'd blown his mind because he had no idea it 167 00:08:50.769 --> 00:08:53.690 was even possible because it's a whole new level of cold. But, 168 00:08:53.769 --> 00:08:55.750 but like in San Antonio in the winter, you go 169 00:08:55.850 --> 00:08:59.490 from heater to heater. So you just change a different extreme. 170 00:08:59.529 --> 00:08:59.889 That's all. 171 00:09:00.289 --> 00:09:03.309 And we, we love the winter. Even, even when it's cold, 172 00:09:03.330 --> 00:09:04.110 it's still really beautiful. 173 00:09:04.500 --> 00:09:04.929 Layer up. 174 00:09:05.230 --> 00:09:07.450 You can always put on more clothing and go from 175 00:09:07.490 --> 00:09:09.870 heat to heat and things like that. But sometime in 176 00:09:09.929 --> 00:09:11.649 the summer, it's really difficult. 177

00:09:11.669 --> 00:09:13.629 You can always put on more clothes. You can't take 178 00:09:13.649 --> 00:09:15.269 them all off, especially not in public. 179 00:09:15.529 --> 00:09:15.870 I agree. 180 00:09:16.230 --> 00:09:16.549 I agree. 181 00:09:17.049 --> 00:09:19.549 When you tell someone you're a urologist, what is the 182 00:09:19.590 --> 00:09:22.950 most common reaction you get? Really? 183 00:09:22.970 --> 00:09:26.350 If they understand what it is. Or they think I 184 00:09:26.409 --> 00:09:29.409 say neurologist and I'm taking care of people with nerve 185 00:09:29.500 --> 00:09:32.600 problems or strokes or what have you. So when I say, no, 186 00:09:32.639 --> 00:09:36.059 I'm a urologist. they kind of go through a weird 187 00:09:36.100 --> 00:09:38.320 little calculation in their brain. They're not quite sure what 188 00:09:38.340 --> 00:09:42.259 to think about that. But yeah, it's something that's kind 189 00:09:42.279 --> 00:09:43.889 of interesting I get to tell people about once in 190 00:09:43.899 --> 00:09:44.139 a while. 191 00:09:44.529 --> 00:09:47.470 Right. So I think urology is one of those specialties 192 00:09:47.509 --> 00:09:51.330 where people sometimes aren't quite sure what falls under that umbrella. 193 00:09:52.149 --> 00:09:54.590 So can we talk a little bit about what you 194 00:09:54.690 --> 00:09:55.669 actually do today? 195 00:09:56.129 --> 00:09:56.490 Love to. 196 00:09:56.730 --> 00:09:59.909 So for someone who has never seen a urologist, what 197 00:09:59.929 --> 00:10:01.710 is exactly does a urologist treat? 198 00:10:02.529 --> 00:10:05.740 So urologists will treat the entire urinary tract from the 199 00:10:05.840 --> 00:10:09.000 kidneys down to the end of the urethra and everywhere 200 00:10:09.100 --> 00:10:12.299 in between. We also take care of the adrenal gland, 201 00:10:12.379 --> 00:10:14.440 which is where you get adrenaline from, and it sits 202 00:10:14.480 --> 00:10:17.889 on top of the kidneys. And then for urologists, we're 203 00:10:17.950 --> 00:10:21.620 kind of like the counterpart to an OBGYN. So OBGYNs 204 00:10:21.659 --> 00:10:25.159 take care of the female genital tract. Urologists will take 205 00:10:25.200 --> 00:10:28.440 care of the male genital tract. So that would include 206 00:10:28.539 --> 00:10:37.309 conditions like nodules of the adrenal gland, tumors of the kidneys, ureters, bladder, prostate, urethra, testicles, 207 00:10:38.169 --> 00:10:42.909 all of that, urinary tract stones, incontinence. That's a big 208 00:10:42.950 --> 00:10:45.879 thing that I treat that people may not realize can 209 00:10:46.360 --> 00:10:51.100 often be treatable. And then also difficulty amping the bladder, 210 00:10:51.139 --> 00:10:51.980 particularly for men. 211 00:10:53.100 --> 00:10:56.840 So let's make this practical for our listeners. What are 212 00:10:56.919 --> 00:11:00.340 some signs or symptoms that you should pay attention to 213 00:11:00.399 --> 00:11:03.500 that should prompt you to seek out care from a provider? 214 00:11:04.559 --> 00:11:07.399 Basically, if you notice your urinary tract and you're thinking, 215 00:11:07.419 --> 00:11:09.000 I don't know if I like this and maybe this 216 00:11:09.039 --> 00:11:12.899 isn't normal, that would be a good one. So difficulty 217 00:11:12.940 --> 00:11:16.769 holding the urine, getting up at night to pee, having 218 00:11:16.809 --> 00:11:19.529 that key and lock syndrome where the closer you get 219 00:11:19.549 --> 00:11:21.590 to your house and the bathroom, the more you have 220 00:11:21.629 --> 00:11:25.970 to go. Certainly pink or red urine is never normal. 221 00:11:27.029 --> 00:11:28.929 Back pain that's off to the side, so not in 222 00:11:28.950 --> 00:11:30.490 the center of the spine is, but off to the 223 00:11:30.529 --> 00:11:32.590 side where the kidneys live, that could be an indication 224 00:11:32.610 --> 00:11:36.029 of a concern. And basically anything that you're worried about, 225 00:11:36.049 --> 00:11:37.169 you should always get checked out. 226 00:11:38.289 --> 00:11:40.610 So you said that blood in the urine is never good. 227 00:11:40.889 --> 00:11:44.710 So that's one example that people might be tempted to ignore. 228 00:11:45.519 --> 00:11:48.240 or hope it goes away, but they should really come 229 00:11:48.259 --> 00:11:50.600 in immediately, would you say? 230 00:11:51.080 --> 00:11:52.799 Yeah, it's not an emergency. Like you go to the 231 00:11:52.899 --> 00:11:55.279 ER unless you are passing clots that are hard to 232 00:11:55.320 --> 00:11:58.299 get rid of or you're lightheaded. But typically that should be, 233 00:11:58.320 --> 00:12:00.779 you know, immediately call and make an appointment for your 234 00:12:00.820 --> 00:12:03.490 physician to get the process started. Okay. And there are 235 00:12:03.529 --> 00:12:05.830 two types of blood in the urine that I worry about. 236 00:12:06.169 --> 00:12:08.450 There's the kind that you can see and the kind 237 00:12:08.470 --> 00:12:10.490 that your doctor tells you or your provider tells you 238 00:12:10.509 --> 00:12:14.070 is on your lab test. And those are both important 239 00:12:14.169 --> 00:12:17.370 because they can both be red flags that something is amiss. 240 00:12:18.070 --> 00:12:20.330 And it can be something as simple as a urinary 241 00:12:20.370 --> 00:12:24.269 tract infection that needs treatment or a kidney stone that 242 00:12:24.309 --> 00:12:27.710 hasn't started passing and causing you pain yet. And then 243 00:12:27.730 --> 00:12:30.350 there's the sinister kind where it can actually be a tumor, 244 00:12:30.590 --> 00:12:33.200 but the first sign is blood and you don't feel 245 00:12:33.240 --> 00:12:35.539 any difference yet. And you want to catch that as 246 00:12:35.620 --> 00:12:38.460 early as possible, which is why you should never ignore blood. 247 00:12:38.340 --> 00:12:41.179 In the urine. Sounds incredibly important to come in

as 248 00:12:41.220 --> 00:12:44.899 soon as you need to. What are some misconceptions about 249 00:12:45.019 --> 00:12:48.399 urologic health that you wish people would stop believing? 250 00:12:48.419 --> 00:12:51.440 I think one of the things that's really caught my 251 00:12:51.460 --> 00:12:54.279 attention is that usually by the time someone sees me 252 00:12:54.379 --> 00:12:57.580 for urinary symptoms, they've already been treated by somebody else 253 00:12:58.139 --> 00:13:00.600 and they're not happy. They haven't gotten the result they 254 00:13:00.639 --> 00:13:02.450 wanted or they wouldn't have come to see me in 255 00:13:02.490 --> 00:13:05.049 the first place. But they come with a little bit 256 00:13:05.070 --> 00:13:08.570 of a sense of frustration or like they're defeated, like 257 00:13:08.610 --> 00:13:11.070 they don't expect that there's anything else that can be done. 258 00:13:11.090 --> 00:13:16.450 And as a urologic specialist, I have things that I 259 00:13:16.490 --> 00:13:20.850 can offer that primary care are not trained to do. 260 00:13:21.240 --> 00:13:24.600 They do a great job on starting things and getting 261 00:13:24.639 --> 00:13:27.019 the ball rolling and doing some conservative treatments. But if 262 00:13:27.059 --> 00:13:29.379 someone needs something a little bit more advanced, that's where 263 00:13:29.519 --> 00:13:31.200 urologists can possibly help them. 264 00:13:31.740 --> 00:13:34.970 So many people think that urology is just a men's 265 00:13:35.009 --> 00:13:39.009 health specialty, when in fact urologists treat many conditions that 266 00:13:39.090 --> 00:13:41.990 women struggle with as well. Can you share with our 267 00:13:42.029 --> 00:13:44.340 listeners what conditions you treat for women? 268 00:13:45.200 --> 00:13:49.360 Yeah, so kidney stones and cancer don't discriminate. Men and 269 00:13:49.419 --> 00:13:51.480 women both get them. Men tend to get them more 270 00:13:51.600 --> 00:13:55.279 often for both situations, but still women do as well. 271 00:13:56.190 --> 00:13:58.720 And then bladder control. That's the biggest thing I see 272 00:13:59.039 --> 00:14:04.169 for women. They don't know that a urologist can necessarily 273 00:14:04.210 --> 00:14:06.190 help them as well. They think it's usually older men 274 00:14:06.210 --> 00:14:08.809 with their prostates, but there are quite a few treatments 275 00:14:08.830 --> 00:14:10.830 that women can undergo for leakage as well. 276 00:14:11.549 --> 00:14:15.210 I know that previously we've talked with some OBGYNs about 277 00:14:15.269 --> 00:14:19.190 bladder control. Is the surgery that they would perform for 278 00:14:19.250 --> 00:14:22.429 some of those issues the same as what a urologist does, 279 00:14:22.529 --> 00:14:24.240 or is there a difference between that? 280 00:14:24.830 --> 00:14:28.350 There is some overlap for sure. Any physician or provider 281 00:14:28.409 --> 00:14:31.509 can prescribe a bladder medication,

but that works only on 282 00:14:31.710 --> 00:14:34.610 overactive bladder. So I like to explain to my patients 283 00:14:34.629 --> 00:14:37.970 there are two reasons why women leak. The first one 284 00:14:38.169 --> 00:14:41.399 is called stress incontinence, and that is not a bladder problem. 285 00:14:41.440 --> 00:14:44.899 That's an outlet issue, meaning the pelvic floor muscles and 286 00:14:44.940 --> 00:14:47.139 the sphincter in particular are not strong enough to hold 287 00:14:47.159 --> 00:14:49.960 the urine in place when we do activities that increase 288 00:14:50.100 --> 00:14:53.799 pressure inside the abdomen like coughing, sneezing, jumping, laughing. 289 00:14:54.590 --> 00:14:55.549 Running. Running. 290 00:14:55.710 --> 00:14:58.090 Oh, yeah. And getting out of a low chair sometimes 291 00:14:58.110 --> 00:15:02.330 doesn't have to cause some women leakage. So that condition 292 00:15:02.730 --> 00:15:06.070 isn't treated by medication because, again, it's not the bladder 293 00:15:06.090 --> 00:15:08.090 that's the problem. It's what medications work on. It's an 294 00:15:08.250 --> 00:15:12.190 outlet issue. So conservative things like physical therapy, weight loss 295 00:15:12.230 --> 00:15:15.509 for those of us who are overweight, those are usually 296 00:15:15.529 --> 00:15:18.870 the mainstay for conservative treatment. And then there are surgical 297 00:15:18.909 --> 00:15:22.429 procedures like a sling, and that's where some OBGYNs do 298 00:15:22.509 --> 00:15:26.179 a sling procedure. And that's basically where a piece of 299 00:15:26.350 --> 00:15:28.470 permanent mesh is put under the vaginal skin to help 300 00:15:28.509 --> 00:15:33.490 support the urethra during those times of activities that provoke leakage. 301 00:15:33.570 --> 00:15:35.809 But it's not put in place so it can't let 302 00:15:35.830 --> 00:15:38.629 you urinate like normal. And then the other kind of 303 00:15:38.669 --> 00:15:41.029 leakage is urge incontinence. And that is where the bladder 304 00:15:41.289 --> 00:15:43.700 is the problem. And the bladder, for whatever reason, is 305 00:15:43.740 --> 00:15:46.639 not storing urine appropriately and it's trying to empty on you. 306 00:15:47.159 --> 00:15:49.000 And usually people say, oh my gosh, I get the 307 00:15:49.039 --> 00:15:50.980 strong need to pee and I just can't hold it. 308 00:15:51.879 --> 00:15:55.539 So medication, sometimes diet change to avoid things we call 309 00:15:55.559 --> 00:15:58.659 bladder irritants, those things can be helpful. Physical therapy can 310 00:15:58.700 --> 00:16:02.600 help some patients with retraining their bladder. And then beyond that, 311 00:16:02.700 --> 00:16:06.379 there are surgical options like injecting the bladder muscle with Botox, 312 00:16:06.440 --> 00:16:08.379 which I actually do in the office and people do 313 00:16:08.480 --> 00:16:11.039 really well with that wide awake. And then there's a 314 00:16:11.080 --> 00:16:13.899 nerve stimulator procedure, which I'm really excited to bring to 315 00:16:13.940 --> 00:16:16.899 Western Wisconsin Health. It's a brand new procedure for us, 316 00:16:17.360 --> 00:16:19.519 but I've been doing for 20 years. And it's basically 317 00:16:19.559 --> 00:16:22.740 like a bladder nerve pacemaker. where I insert a device 318 00:16:22.779 --> 00:16:25.679 surgically while the patient's asleep to help the letter kind 319 00:16:25.700 --> 00:16:30.019 of reset and stop misbehaving. So there's some really exciting 320 00:16:30.100 --> 00:16:32.350 options out there that most patients are not aware of. 321 00:16:33.490 --> 00:16:35.889 I haven't heard of most of those, so I'm intrigued 322 00:16:35.929 --> 00:16:37.870 with this and actually want to get some friends and 323 00:16:37.909 --> 00:16:40.700 family educated about what their options are. 324 00:16:40.919 --> 00:16:42.779 So filling up your schedule should be. 325 00:16:43.250 --> 00:16:46.029 Easy. I'll be happy to help. It's, it's, it's so 326 00:16:46.129 --> 00:16:49.009 rewarding when, when someone comes to me really unhappy, they're 327 00:16:49.129 --> 00:16:53.139 not jogging because they're leaking through a pad or they're 328 00:16:53.179 --> 00:16:55.340 worried about having an accident out in public. And so 329 00:16:55.360 --> 00:16:58.840 they're curtailing their social activities. It is so rewarding to 330 00:16:58.899 --> 00:17:01.639 help those folks because they feel like, you know, a 331 00:17:01.659 --> 00:17:03.039 lot of times they just have given up and that's 332 00:17:03.059 --> 00:17:06.000 just the way life is. And they're not happy. And, 333 00:17:06.140 --> 00:17:10.009 and some things are so severe that they're difficult to manage, 334 00:17:10.109 --> 00:17:11.970 but a lot of things are very treatable. 335 00:17:12.720 --> 00:17:16.160 You had mentioned previously, too, that sometimes changing your diet 336 00:17:16.299 --> 00:17:20.019 can be a solution and removing certain things. Are there 337 00:17:20.140 --> 00:17:23.220 foods that our listeners should watch out for that you 338 00:17:23.259 --> 00:17:25.160 can share with us? Sure. Yeah. 339 00:17:25.259 --> 00:17:29.259 If they have overactive bladder, then avoiding the bladder irritants 340 00:17:29.319 --> 00:17:32.309 may be helpful. So it's any food or drink, usually drinks, 341 00:17:33.150 --> 00:17:37.660 any food or drink that is acidic, spicy, caffeinated, carbonated, 342 00:17:37.980 --> 00:17:41.910 or alcoholic. So acidic would be tomatoes. And I get 343 00:17:41.950 --> 00:17:43.769 a lot of groans from patients. I tell them to 344 00:17:43.789 --> 00:17:46.329 avoid tomatoes because when they're growing their home tomatoes, they're 345 00:17:46.369 --> 00:17:49.970 really looking forward to eating them. Or citrus fruits, that 346 00:17:49.990 --> 00:17:53.029 kind of thing would be under the acidic category. Vinegar-based 347 00:17:53.069 --> 00:17:57.490 salad dressings, you

know, anything with bubbles, anything with caffeine, 348 00:17:57.809 --> 00:17:59.569 that kind of thing. And I tell people to cut 349 00:17:59.609 --> 00:18:01.329 those out for a week and see if they notice 350 00:18:01.369 --> 00:18:03.099 a difference. And if they do, great, there's a trigger 351 00:18:03.119 --> 00:18:05.099 in there somewhere. you can kind of slowly add the 352 00:18:05.119 --> 00:18:07.200 things back that you've cut out to see if you 353 00:18:07.240 --> 00:18:09.680 can find a trigger. And if you find out, yeah, 354 00:18:09.700 --> 00:18:12.049 your garden tomatoes are a problem, well, maybe just eat 355 00:18:12.069 --> 00:18:13.329 the tomatoes and you're not going to go anywhere. 356 00:18:13.349 --> 00:18:17.569 I think that being garden season right now, that's probably 357 00:18:17.609 --> 00:18:20.950 not going to make a few people happy, but I ultimately, yeah, 358 00:18:20.990 --> 00:18:24.309 I think that people really want to be more comfortable 359 00:18:24.349 --> 00:18:27.279 though too, because these things can be very embarrassing. And 360 00:18:27.319 --> 00:18:29.940 I have some family members that do not go to 361 00:18:30.000 --> 00:18:33.549 things because they have incontinence issues. So knowing that there's 362 00:18:33.589 --> 00:18:36.430 a solution out there that can help, well, I hope, 363 00:18:36.589 --> 00:18:37.849 improve their quality of life. 364 00:18:38.410 --> 00:18:41.559 I've had some patients say, I'm not giving up my coffee, 365 00:18:41.619 --> 00:18:46.160 for example. That's okay. They don't have to. Incontinence has 366 00:18:46.220 --> 00:18:48.980 a major quality of life impact on people, but it's 367 00:18:49.019 --> 00:18:50.839 not going to kill you. And it may give you 368 00:18:50.859 --> 00:18:53.769 a rash if you're wet and having trouble staying dry. 369 00:18:53.849 --> 00:18:57.670 But otherwise, do what you want. Do what you think 370 00:18:57.730 --> 00:19:00.150 is right for you. My job is not to force 371 00:19:00.170 --> 00:19:02.390 you to not to have your coffee or your tomatoes, 372 00:19:02.470 --> 00:19:04.420 but to give you the knowledge so you can make 373 00:19:04.440 --> 00:19:06.900 those choices for yourself and, and see what works and 374 00:19:06.920 --> 00:19:07.299 what doesn't. 375 00:19:07.319 --> 00:19:10.009 I think that's the biggest thing is partnering with your 376 00:19:10.200 --> 00:19:13.509 physician to know what things to try. And then you 377 00:19:13.529 --> 00:19:16.029 can make your choice from there, which thing you would 378 00:19:16.089 --> 00:19:17.869 rather not have or rather have. 379 00:19:17.990 --> 00:19:18.230 Right. 380 00:19:18.410 --> 00:19:18.690 Yeah. 381 00:19:18.710 --> 00:19:20.410 That's one of the things I love about the medical 382 00:19:20.450 --> 00:19:23.470 field right now, you know, back a generation or two ago, 383 00:19:23.490 --> 00:19:25.690 it was very paternalistic. You know, you did what your

384 00:19:25.730 --> 00:19:29.049 doctor said. And I remember my grandmother telling me that 385 00:19:29.089 --> 00:19:31.329 her doctor told her ex and she didn't want to 386 00:19:31.369 --> 00:19:32.549 do X, but she was going to do it anyway. 387 00:19:32.569 --> 00:19:34.640 I said, well, Why don't you tell them you don't 388 00:19:34.660 --> 00:19:36.019 want to do that and see what else you can 389 00:19:36.299 --> 00:19:38.359 do instead? And oh, no, he said I had to 390 00:19:38.400 --> 00:19:41.369 do it. There was just no questioning it. And then 391 00:19:41.480 --> 00:19:44.630 we swung the pendulum the other far direction where the 392 00:19:44.690 --> 00:19:48.650 patient is the customer and it's about customer service. But 393 00:19:48.690 --> 00:19:51.210 medicine is not customer service. I mean, yes, we want 394 00:19:51.269 --> 00:19:53.869 people to feel happy and healthy and like they've been 395 00:19:53.930 --> 00:19:57.890 given great care. But that's not something that we do. 396 00:19:58.579 --> 00:20:01.660 You know, the patient sometimes thinks they need something that 397 00:20:01.740 --> 00:20:03.579 maybe is not the best option for them. And so 398 00:20:03.660 --> 00:20:05.579 trying to get them off of that option and onto 399 00:20:05.599 --> 00:20:08.960 another one with education, make a shared decision together, that's 400 00:20:09.019 --> 00:20:11.049 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 402 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 412 00:20:40.670 --> 00:20:43.309 great resource. And I actually like it when people go 413 00:20:43.369 --> 00:20:46.369 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 00:20:58.230 --> 00:21:01.269 appropriate and what's been found to be debunked and whatnot. 419 00:21:01.309 --> 00:21:02.569 We can go from there, but at least they have 420 00:21:02.609 --> 00:21:04.869 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 00:21:10.730 --> 00:21:13.660 think the internet's a great tool when used appropriately, but 424 00:21:13.700 --> 00:21:16.299 if you don't get the right information, if it's just 425 00:21:17.119 --> 00:21:20.680 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 00:21:23.619 --> 00:21:26.299 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 429 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 432 00:21:41.849 --> 00:21:44.509 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 00:22:02.059 --> 00:22:03.859 our providers and physicians too. 442 00:22:03.900 --> 00:22:04.440 Absolutely. 443 00:22:04.460 --> 00:22:05.480 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 00:22:17.940 --> 00:22:22.460 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 00:22:33.650 --> 00:22:39.049 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

00:22:42.809 --> 00:22:45.819 of stuff. So, you know, I don't judge people. I 456 00:22:45.859 --> 00:22:47.700 want them to be honest and straightforward with me so 457 00:22:47.740 --> 00:22:50.019 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 00:23:10.150 --> 00:23:12.670 Nunez is a woman. And I thought the same thing. 466 00:23:12.710 --> 00:23:16.009 I thought, oh, will my husband be comfortable coming to her? 467 00:23:16.630 --> 00:23:18.190 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 00:23:42.119 --> 00:23:45.740 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.