The Unfettered Urologist What I Never Had Time to Tell You
in a Fifteen Minute Office Visit
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—Susan Jones Kalota, M.D.
“Just as Dr. Boone beautifully captured the essence of life as an intern at
Charity Hospital in New Orleans in The Big Free (I was there), The
Unfettered Urologist captures the virtues of old-school doctoring together
with state-of-the-art urology. This unique work offers her vast wealth of
knowledge and personal experience, creating a must-read for urology
patients and the doctors who treat them.”
—Frank N. Deus, M.D., FACS, MMM Urologist and Healthcare
Administrator
“Urology problems? Stop searching Dr Google or WebMD and check out
Dr. Martha Boone’s The Unfettered Urologist. It is incredibly informative,
clear, and a must-read for anyone who urinates. This profoundly helpful
resource combines 35 years of experience in urology to answer your most
‘burning’ questions.”
—Vishal Bhalani, M.D.
“I’ve been a primary care physician for 30 years and wish I had had this
book to refer to. It would have made me look like a star and saved my
patients time, unnecessary visits to specialists, and money. Dr. Boone
provides invaluable guidance that not only helps doctors but enables
patients to take better care of themselves! This book will be my ‘go to’ for
common urological issues.”
—Frenesa K. Hall, M.D. Medical Director Carolina Pain Relief Center
“Packed with years of experience and memorable patient situations, Dr.
Boone’s The Unfettered Urologist is the ultimate teaching tool for both
residents and advanced urologists.”
—Martha K. Terris, M.D. Witherington Distinguished Professor and
Chair Medical College of Georgia
“If you are a primary care doctor or a patient with a urologic problem, I
highly recommend two books. The first is The Unfettered Urologist, and I
suggest you read it twice!”
—Neil Baum, M.D. Professor, Clinical Urology Tulane Medical School
“Dr. Boone offers an honest and rare look into the daily practice of urology.
A career’s worth of wisdom and humor are distilled into practical
recommendations, vignettes, and checklists for patients and clinicians.”
—Catherine R. deVries, M.D. Professor, University of Utah
“I’ve known Dr. Boone for almost 30 years of her career. Martha has an
exceptional bedside manner and rapport with her patients. This book will
help all current and future patients navigate their health.”
—Vahan Kassabian, M.D. Director, Prostate Center and Advanced
Therapeutics Advanced Urology Institute of Georgia
“I worked with Dr. Boone for years to treat patients with kidney stones. Be
sure to take advantage of her wealth of medical and practical knowledge.
Patients and providers will both find The Unfettered Urologist a great help.”
—Shaun Conlon, M.D. Atlanta Nephrology Associates
“In The Unfettered Urologist, Dr. Boone uses her many years of experience
to manage over a dozen common urologic problems with a no-nonsense
approach. It will aid practitioners and patients alike!”
—Ken Sinervo, M.D. Medical Director The Center for Endometriosis
Care
“The Unfettered Urologist is a beautifully woven book, part memoir and
part medical resource guide. Author Martha Boone conveys her knowledge
and expertise with humor and empathy. Her deep wisdom will guide me in
my focus on prevention and wellness. And seeing healthcare from the
physician’s vantage point will make me a more empathetic and prepared
patient.”
—Jeanie P Duncan Author, Choosing Me: The Journey Home to My
True Self President, Raven Group
“Like a conductor directing an orchestra, Dr Boone uses her 35 years of
experience to combine the elements of urology into a masterpiece of patient
management. Clean, concise, and filled with advice that only a master could
provide.”
—Carla Roberts, M.D., PhD Founding Partner, Reproductive Surgical
Specialists
“The genital / urinary tract system is one of the most important pillars of the
body. Dr. Boone is unique in using a whole-body approach to keep the
system healthy and functioning. I always admired her for providing the best
care. Her book for physicians, providers, and patients is a rare example of
“paying it forward.” Ultimately, we will see more patients benefit from the
wisdom and knowledge of one of the most dedicated urologists I have
known.”
—Ceana Nezhat, M.D. Editor, Endometriosis in Adolescents
“Kindness. Compassion. Caring. These are the characteristics Martha
Boone brought to her pelvic pain patients. In this book, she provides a
treasure trove of insights that will help patients understand their condition,
work with their caregivers, and select the most effective therapies. We are
blessed that after her retirement, she is sharing this hard-earned wisdom.”
—Jill H. Osborne, MA Founder, Interstitial Cystitis Network
“Bladder control problems, urinary infections, and sexual difficulties affect
many of us and can cause so much heartache and confusion! Dr. Boone has
created a guide to healing that is as accessible as it is accurate. Bravo, Dr.
Boone!”
—Jenelle E. Foote, M.D., FACS Clinical Assistant Professor of
Gynecology, Morehouse School of Medicine Clinical Assistant
Professor of Family Practice, E mory School of Medicine
The
UNFETTERED
Urologist
WHAT I NEVER HAD TIME TO TELL YOU
IN A FIFTEEN-MINUTE OFFICE VISIT
Martha B. Boone, M.D.
NEW YORK
LONDON • NASHVILLE • MELBOURNE • VANCOUVER
The UNFETTERED Urologist
What I Never Had Time to Tell You in a Fifteen Minute Office Visit
© 2023 Martha Boone, M.D.
All rights reserved. No portion of this book may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means—electronic, mechanical, photocopy, recording, scanning, or
other—except for brief quotations in critical reviews or articles, without the prior written permission
of the publisher.
Published in New York, New York, by Morgan James Publishing. Morgan James is a trademark of
Morgan James, LLC. www.MorganJamesPublishing.com
This book contains the opinions and ideas of the author. The book intends to give primary care
providers, patients, and their families the author’s opinions of how our medical system works and
what they can do independently before seeking medical advice from a urologist.
The book does not provide medical services. The book is not intended to replace the advice of your
medical professional who is familiar with your specific case.
Throughout the book, several companies, health care providers, and products are mentioned. The
author has no current financial arrangement with any of these entities.
The author and publisher disclaim all responsibility for any liability or risk incurred by consequence
of using any of the content in this book. Any and all advice should be approved by your professional
medical advisor.
Proudly distributed by Ingram Publisher Services.
ISBN 9781636980720 paperback
ISBN 9781636980737 ebook
Library of Congress Control Number:
2022947814
Cover Design by:
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Interior Design by:
Chris Treccani
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Front Cover Photo by:
Karen Burns
Author Photo by:
Jesse Boone
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Partners in building since 2006.
Get involved today! Visit: www.morgan-james-publishing.com/giving-back
Dedication
If you have a great hospital, it’s because you have great nurses.
This book is dedicated to the unsung heroes: the amazing nurses and
technicians at Charity Hospital in New Orleans, Tulane Medical Center,
Ochsner Clinic, University of California-Davis, the Veterans
Administration, The Medical College of Georgia, and the nurses in the
Northside Hospital network in Atlanta, Alpharetta, and Cumming, who
helped me and my patients for my entire career. You know who you are.
I could never have been successful without great nurses assisting me every
step of the way.
CONTENTS
I Never Enough Time
II Three Doctors in One
III “Doc, my urine is red!”
IV Interstitial Cystitis, Bladder Pain, and Prostatodynia
V Urinary Tract Infection
VI Urinary Incontinence
VII How Low Is Your T?
VIII Erectile Dysfunction is No Laughing Matter
IX The Kidney Stone Always Wins!
X Kidney Stone Surgery
XI Prostate Cancer
XII Bladder Cancer
XIII Be Your Own Health Care Manager
XIV Meditation and Mind Management
XV Toxins
XVI Intuition
XVII The Future Is Bright
Acknowledgments
About the Author
“There lives more faith in honest doubt, believe me,
than in half the creeds.”
-ALFRED LORD TENNYSON
Chapter I
Never Enough Time
“The two most powerful warriors are patience and time.”
- LEO TOLSTOY
Why would I quit my job as a very successful surgeon and spend my time
writing about what I never had time to tell my patients in the office?
After thirty-five years as a urologist, over nine-thousand surgeries, over
one hundred and seventy-five thousand patient visits, and six jobs in four
cities, my biggest frustration was not having enough time with my patients.
I often left the exam room craving more time to share non-medical and non-
science information. I regretted not having adequate time to listen to
everything the patient wanted to say. I was disappointed at having only an
average of fifteen minutes with each person.
For many years I felt crushed under the burden of ever-increasing
regulation from outside entities that left me feeling a sense of emptiness and
inadequacy. I always gave my best scientific and medical advice. I stuck
strictly with the script of what was known from medical science about a
patient’s disease. I diligently studied every X-ray and blood test. I carefully
examined each part of the body involved in the patient’s problem. I kept up
with all the latest technology and took regular courses to keep my
knowledge up to date.
Year after year I won the TOP DOC contests for my excellent patient
care. Yet, I had so much more to give my patients, but no time. It was my
duty to make sure they knew the scientific opinion. It was my greatest
desire to give them my practical knowledge, my intuition, and my opinion
from extensive experience.
Many patients feel great frustration when interfacing with our medical
system, but don’t realize why. Doctors in America are paid by something
called work relative value unit (RVU), which means we are expected to
produce a certain amount of work in a short period of time. If we don’t
produce enough relative value units, we can’t pay our office bills. The cost
of practicing medicine goes up every year. Every year, the amount of time
all medical professionals spend documenting information for the
government and insurance payors increases. The time spent documenting is
taken away from the time we’d spend listening and talking to the patient.
We feel the pressure. The system is not always conducive to assisting in
your best health. My own and my patients’ frustration grew over the years.
In 2020, I’d been a medical doctor since 1985. I decided to leave my
practice to take a yearlong sabbatical in hopes of curing my frustration. I
wanted to fulfill one of my lifetime goals—to travel the world while my
husband and I were able. I had watched close friends and colleagues suffer
unexpected diseases that made their retirement miserable.
One of the reasons I love being a doctor is that I love studying people. I
want to see where they live, what they eat, how they work and raise their
families. I want to understand their spiritual beliefs. I want to hear as many
languages, eat as many different types of food, hear as many types of music,
and see as much art as possible. We mapped out a full year of traveling the
globe to experience the many varieties of the human condition. One month
after we started our sabbatical, Covid-19 hit and our plans evaporated.
Leaving my patients had been bittersweet. I wanted to write a love letter
to them. I wanted to thank them for trusting me and being my patient. So I
decided that since it was deemed not safe to travel, to write some of the
things I always wanted to say, but never had the time.
Please know that I’m not offering medical advice in this book. Every
chapter is my opinion. Much of it is not supported by the strictest science.
Nothing here should replace sound medical advice from a doctor who
knows your particular situation. Nor does anything here represent the
opinions of any organization with which I have ever been affiliated. At
some junctures, I actually go against the advice of my previous governing
agencies.
This book embodies the opinions and practical knowledge of a woman
who has devoted forty-four years of her life to science and thirty-five years
to medicine. Many have called me a trailblazer for being among the first
one hundred women to be board certified in urology. I define myself as a
nerdy little bookworm who loves science, loves people, and was blessed
enough to find a job allowing me to serve both passions.
I hope to provide information on how to think about illness and help
yourself in our medical system, and to offer tools for self-care. There are
many means of healing that won’t be found in the average doctor’s office. If
you take nothing else from this book, please do not ignore blood in your
urine and DO NOT SMOKE.
I hope you find something in this book to help you, or at least a story to
make you laugh or cry.
Chapter II
Three Doctors in One
“Make the most of yourself, for that is all there is of you.”
- RALPH WALDO EMERSON
I’m not sure exactly when it happened. But sometime between 1996 and
2010, it became necessary for me to be three varieties of the doctor.
For the first eleven years of my practicing medicine, I was one type of
doctor: the expert. I was a highly educated professional scientist to whom
you brought your medical problems and trusted your deepest secrets. You
took my advice, most of the time, and usually got better. The relationship
was simple.
And then, everything started to shift. I blame the internet.
Young people without a firm grasp of eighth-grade biology brought
inch-thick stacks of paper copied from the internet to their office visits.
They argued and told me of their diagnoses as determined by them and
Google. If I didn’t seem to know every line of what was gleaned from their
internet search, I was deemed inadequate and they moved on to the next
doctor. As they stomped out of the office refusing to pay their co-pay, they’d
walk right past my wall of impressive diplomas without giving them a
glance, then sit in their cars and write scathing internet reviews to let the
world know of my idiocy.
At first, I found these interactions amusing. Then I was incredulous.
Finally, I fought to hide my anger. The under-thirty crowd became a mystery
to me. To be their doctor, I had to constantly do battle with their internet
searches. Unbeknownst to me, Google was god to them. I was hurt, lost, and
confused. How could they trust an unknown entity but distrust a real human,
with advanced education they could easily validate, sitting right in front of
them?
At the same time, the patients from 30 to 65 years old sought a partner in
health care. This was my own age group and I related best to them. They
respected my education. They knew I knew more than they did. But it was
their body and nobody was going to tell them to do anything that did not
sound correct.
This kind of patient wanted a coach or a trusted advisor, like the person
who did their finances. Most listened respectfully, asked a mile-long list of
questions, and went home to consider my advice and decide what they
would or would not do. If we could not come to a mutually agreed-upon
course of action, I’d suggest a second opinion and they’d accept that idea.
This age group mostly wanted time to discuss everything they had read and
have me explain basic science, biology, and medicine to them, so that they
could buy into my mostly trusted advice. Nearly all of these patients came
back to see me and followed my suggestions. Occasionally, one decided the
second opinion doctor was more to their liking, but the interaction was civil,
honest, and straightforward.
Again at this same time, I treated the over-65 crowd much as I always
had. I loved my older patients best, though they were often irascible or even
mean. They’d seen it all and weren’t impressed with much. They had
survived wars, depressions, and deaths of loved ones, financial gains and
losses. They were in the last phase of life, trying to keep their dying bodies
going, and had no time for fancy words. They came with a list of complaints
and expected solutions.
Usually their primary care physician had discovered something with
which they needed help. They respectfully relayed their stories and expected
me to respond like a great oracle and tell them what to do. Recognizing the
personal nature of the doctor-patient relationship, they wanted me to know
about their grandson’s baseball expertise as well as their kidney stone attack.
This group didn’t argue with me, but they expected an answer. They rarely
asked for another opinion. If their primary care doctor told them I was the
one to solve their problem, they trusted that doctor, if not me. They didn’t
hop from one doctor to another. But, by God, they expected me to figure
things out.
Before I’d fully realized my need to be three doctors in one, I had a few
shocks. One day I was performing a vaginal exam on a 22-year-old who
clutched her phone as I explained what was going to happen. I don’t know
when everyone began clutching their phones. But, I was familiar with the
behavior. It reminded me of a pediatric patient holding their favorite doll or
bear for comfort. People her age held tight to their phones at all times. I
thought nothing of it.
When I was sure she was comfortable with the planned pelvic exam, I
moved to my rolling stool to position myself between her legs. My nurse
made ready the ubiquitous K-Y jelly. I was gloved, sitting at eye level with
the entrance to her vagina, and completely focused on discovering the cause
of her urethral pain.
I explained what I was doing before I did it and she seemed relaxed
about the experience. As I pulled my gloved fingers out of her vagina, her
crotch exclaimed, “What did you find, doctor?”
Entranced in my deep focus on the source of her problem, I imagined
her vagina was talking to me! I was so startled that I pushed back quickly,
jammed my rolling stool against the wall behind me and slammed my head
into the wall.
As my head bobbed back into position, the vagina continued to talk as if
nothing strange had occurred. When I gained my composure, I realized this
young woman had me on facetime with her mother. Her mother had been
watching me perform a pelvic exam on her daughter.
I was speechless. I felt disrespected and violated. I was no longer the
trusted expert. Without realizing it, I had become a new kind of doctor, and
the expectations of me were nothing I understood.
No matter your age, I advise the following to improve your interactions
with our medical system and your doctor:
Come prepared for your visit by reading a trusted medical site. Many
doctors have information on their websites about the conditions they treat.
Spend time reading that information if it pertains to your problem. There
is much information that is incorrect on the web. Avoid any site that is not
