Water, UTIs, and Kidney Stones w/ Dr. Dana C. Rice

Episode Information

March 29, 2022

Urologist Dr. Dana C. Rice talks about misconceptions related to UTIs, developing her UTI Tracker App, Kidney Stones, and more.

Topics Include:

• Growing up on Cape Cod
• How sibling rivalry caused her to be extremely competitive
• Playing lots of different sports as a child and the importance of always being the best
• How she initially wanted to be the doctor that would save the world but how she discovered her interest in surgery and urology
• Her own childhood experiences with vesicoureteral reflux and her journey to becoming a urologist
• The app she created  (UTI Tracker)  and her partnership with UTIVA
• A bit about kidney stones and UTIS
• How with women, UTIs are thought of as being caused by sex, but how they are actually often caused by hormone-based change like pregnancy, periods and menopause
• How drinking enough water, losing weight (or maintaining a decent weight) and keeping fit can help to prevent kidney stones
• How kidney stones can be caused by not drinking enough water but also how they have a genetic component
• The similarity between pearls and kidney stones
• Why she likes Doctorpedia and how it will become a one stop website for all things medical

Highlights

• “When I was training at least, urology was really not a female area. And I usually tell people, ‘If men had children and coughed, sneezed and had incontinence and urinary tract infection every time they had a kid, that problem would’ve been fixed a hundred years ago.’ So as a female going into a sort of a male dominated profession, there was a lot of opportunity and a lot of ways to be involved and really help people.”
• “While there are still definitely people who die of prostate cancer and we have to do screenings, the pendulum has really swung to ‘People are survivors’. They may not necessarily be cured. They have to be followed for the rest of their lives just in case, but people do well. And those are all really good and hopeful things.”
• “Tides are changing. So with Google and with the ability to find all different kinds of data, people sometimes come in with a preconceived notion of what they want or how things need to go. And all I can say is the internet has tons of data and a lot of it is good. But the problem is it may be good for one person and doesn’t really apply to you. And people come in with, “This is what I’m expecting, because this is what my friend got, or this is what I’ve seen on an ad on TV so this has to be the miracle thing” … And that’s a hard factor. because it should be a dialogue and an open conversation, in my opinion, between a patient and a doctor, like, “Tell me what you need, want and have for symptoms. And I can tell you what I know and what I think might help. And then we can work together.””
• “You have to be real with your patients, your colleagues, and people. Not everything is a science experiment. If you don’t know the right word for something, I am a female urologist. If you can shock me, you tried hard, really hard.”
• “I apologize to all the moms out there but I had more time on my hands in my six weeks of maternity than I had at other points in time in my life. So I decided to create an app and put it all together. It was a pipe dream of mine. And what I did is I created an app for urinary tract infections so that people could be open about it, talk about it, women’s health, men’s health, that kind of thing. And for me, urinary tract infections have a really big stigma of that it’s always sexually transmitted. But there are lots of different ways that you can have urinary tract infections. And especially for women, when you first start getting your period, when you first start having sex, lots of women after they’ve had babies and then again at menopause, so they are associated with hormonal swings. So I think what ends up happening is for women, UTIs actually get labeled as a sexual problem, whereas it’s more physiologic hormone-based in my opinion.”
• “If you look at sort of generalized media shows, comedians, all that kind of stuff, it’s a lot funnier to talk about sex UTIs, or you did naughty things in Vegas with whoever and now your penis hurts. So those are where the jokes come from. And unfortunately for a lot of people, what ends up happening in the younger crowds is that they don’t necessarily want to tell their doctors because they don’t want their parents to know. And then we’ve gone down this dirty little secret, which is not necessarily where we needed to go.”
• “We definitely need to have more open conversations about health and in my opinion, about women’s health. I treat a lot of postmenopausal and menopausal women and they often will happen to have urinary tract infections or what feels like a urinary tract infection, but it’s really hormone related. And as far as I’m aware, pretty much every woman in their lifetime will go through menopause at some point. So why it isn’t an open thing that some women may have urinary tract infections more prevalent around menopause blows my mind. Like why is this not like a book somewhere like, “Hey, menopause sucks. This is everything you could expect from it. And here’s your 101 book.”
• “In my career I have seen people come in with home remedies or stories about, “I wanted to prevent my kidney stone. So I’ve been drinking water mixed with a box of baking soda for the last five days.” And all of a sudden they have all kinds of electrolyte problems and GI problems. Like you can imagine that if you drink a box of baking soda, that’s not good for you, but someone read it on the internet that it was possible.”
• “When you have obesity and diabetes and metabolic dysfunction, your body tends to try to excrete more waste material. And then you can have a higher build up of different things too, or a propensity to pass uric acid stones. So what I usually advise my stone patients to do is to drink water, water, water, water, water, make sure you’re urinated regularly. And then the best thing you can do is to keep the weight off and keep yourself exercising and nice and healthy. But there are also outliers too. Some people have some genetic components, older people with osteoporosis break down of bone, more calcium. You get more chances of stones. So there are other factors, but in general for most people, lots of water, healthy diet, try to watch the weight.”
• “Kidney stones are one of the few things in life that are amazing to look at for about two seconds. And then you think to yourself, “Oh, that little bugger looks painful.””
• “I like the way Doctorpedia seems to be lined up and [where it is] going, that it is a doctor information source that has been vetted for truthful, honest opinions where you’re getting something that makes sense.”
• “You need to have something to refer back to, because the fact of the matter is nobody listens the first time to anything really, that’s just human nature. So if you can refer back to a little video or a snippet of information or something that’s personalized and easy to get to, it takes a lot of the pressure away or anxiety away from the patient right there. There’s an easy way to get there, an easy way to navigate a trusted source. And hopefully if all of those parts come together, Doctorpedia should be able to do that for people.”

Relevant Links

• UTI Tracker App

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:23)
Hello and welcome to the Doctorpedia podcast. I’m your host, Daniel Lobell and it’s my great honor to welcome to the show today Dr. Dana Rice. How are you Dr. Rice?

Dr. Dana Rice: (00:34)
I’m doing great. Thank you for having me, Daniel.

Daniel Lobell: (00:37)
My pleasure. Where are you currently? Are you in Virginia?

Dr. Dana Rice: (00:42)
I am. I’m just outside of Washington, DC. It’s Northern Virginia,

Daniel Lobell: (00:46)
We just had a doctor on the podcast from Washington DC. Do you know Dr. Ira Rabin?

Dr. Dana Rice: (00:50)
I don’t know off the top of my head, but I will plead the fifth if I should a hundred percent know, because I am the worst with names in the whole wide world.

Daniel Lobell: (00:58)
Well, he is an internal medicine doctor and seems like a great guy. Maybe you’ll meet sometime at one of the doctor luncheons. Do you have doctor luncheons where all the doctors meet?

Dr. Dana Rice: (01:11)
Pre COVID, we had a lot more fun things. Nowadays, we get stuck in a room somewhere, but someday we’ll reemerge.

Daniel Lobell: (01:19)
Yeah. You know, those big secret doctor or meetings where all your doctors get together and you talk about us behind our backs.

Dr. Dana Rice: (01:27)
Yeah. You got it. We all know each other and we sit there and we say, “Guess what I saw in that guy?”

Daniel Lobell: (01:34)
[Chuckles.] Got pictures?

Dr. Dana Rice: (01:37)
What can we get away with? What won’t they know?

Daniel Lobell: (01:39)
[Laughs.] So did you grow up around Washington DC?

Dr. Dana Rice: (01:45)
I didn’t actually. I am from Massachusetts and I came down to DC for training for medical school. I went to George Washington University and then I matched into urology for residency actually at the same place. So I did my residency at GWU and I met my husband who is from Rockville, Maryland. If you’re familiar with the DC area at all, it’s a diamond shape and for all practical purposes, Maryland, Northern Virginia and DC are neighbors – it’s very close together.

Daniel Lobell: (02:22)
It has been argued that the smartest people marry people from Maryland. I married someone from Maryland too.

Dr. Dana Rice: (02:28)
[Laughs.] I was going to guess that, but then you never know.

Daniel Lobell: (02:33)
So what part of Massachusetts did you say you grew up in?

Dr. Dana Rice: (02:38)
Well, it depends. My childhood was on Cape Cod and that’s where I consider home in the heart. And then we moved to Worcester, Massachusetts before junior high, somewhere around fourth, fifth, sixth grade.

Daniel Lobell: (02:57)
I used to go to the Berkshires with my grandparents when I was a kid.

Dr. Dana Rice: (03:02)
Oh, beautiful music festivals?

Daniel Lobell: (03:04)
Well, they were members at Tanglewood. And we would go to all the concerts in the summer on the great lawn. And they were just really wonderful memories from my childhood. My grandfather also was an artist and he had worked with Norman Rockwell and he took me to the Norman Rockwell Museum and all these kind of cool things in Massachusetts that are just a whole other world.

Dr. Dana Rice: (03:33)
Well, that’s true for many reasons, but yeah, Tanglewood is beautiful. That whole area is beautiful. It sounds like you had quite an experience. We should talk about your childhood at some point.

Daniel Lobell: (03:42)
[Laughs.] I think I just did.

Dr. Dana Rice: (03:44)
It’s probably more interesting than mine. [Laughs.]

Daniel Lobell: (03:45)
I sneak it in. Tell me some interesting stuff from your childhood.

Dr. Dana Rice: (03:51)
Let’s see. I would say I had an all American childhood.

Daniel Lobell: (03:59)
Baseball? Apple pie? [Laughs.]

Dr. Dana Rice: (04:00)
Yeah, you got it. [Laughs.] I grew up playing every sport you could possibly imagine whenever I was given the opportunity. I have a brother who’s a year and a half older than me. And if you know anything about a lot of doctors, you may notice some of us are fairly competitive and that holds true with older siblings as well. So I learned to be fairly good at many different things from the strict playground rules of ‘I’m better than you are’ kind of sibling rivalry. And then life happened, friends and sports teams. And I am tone deaf. So I can honestly say, although I enjoy music, that was not a huge part of my childhood. But I am from the MTV generation. So I did like that kinda stuff.

Daniel Lobell: (04:50)
I’m more tone deaf to social situations,

Dr. Dana Rice: (04:56)
[Laughs.] But that’s a difficult thing to be if you’re a urologist, because that would just be real awkward all around.

Daniel Lobell: (05:01)
[Laughs.] Yeah. I would imagine. So what did your parents do?

Dr. Dana Rice: (05:08)
So my dad was a stockbroker and he has since passed away and my mom is a teacher by training and then stayed home for a little bit and then ultimately went back to work with special needs kids. And I would have to ask the specifics, but I believe she was more of an aide in that situation, but she liked to work more hands on in a one on one setting. And now she is retired and spoiling her grandkids.

Daniel Lobell: (05:39)
Oh, sounds good. Do you think that is the medical connection in your family, do you think that’s what inspired you, your moms working with special needs kids or did it come from somewhere else?

Dr. Dana Rice: (05:52)
So it’s funny. I was thinking about this when I actually have done some other interviews all along and everyone says, “Why medicine, how medicine?” So the truth of the matter is I was a “sick” kid. So I actually had something called vesicoureteral reflux, which is a urology situation

Daniel Lobell: (06:14)
If I’m not mistaken, isn’t that an all American disease?

Dr. Dana Rice: (06:19)
[Laughs.] It kinda is. Basically what happens is you get urinary tract infections. And I actually had to have surgery when I was quite young. It does run in my family, some of it has a genetic component and some does not, but mine did. And I think it came naturally to me, just having been in at hospitals and the talk and all that. And then the party line I use about why I went into medicine is more of growing up on Cape Cod and my grandparents lived on Cape Cod. It’s not what you would consider hard living necessarily by any stretch of the imagination where we were. And my grandparents used to come home or go to Boston to get medical care. They didn’t necessarily always seek care where they lived because they just didn’t have the same opportunity.

Dr. Dana Rice: (07:12)
And I thought to myself, if my family is fortunate enough to be able to do this and still not get the greatest medical care everywhere, what’s happening in the world and society and all of that? So I actually thought when I went into medicine, which was a natural predisposition and when I went to college, it just was what I was good at. I thought I was going to medical school to save the world and I was going to be the internist that fought for every disadvantaged person everywhere. And then I realized once I got into medicine, “I don’t know if I have the backbone to pick that fight” and it turns out I am very good with my hands, which led me down the road to surgery. And then once I got into surgery, I was obviously familiar with urology, so it was always sort of on the back burner for me, I found general surgery and trauma surgery was fun for me for about five minutes of the trauma and everything after that was not the adrenaline part of it was not for me.

Daniel Lobell: (08:14)
Too traumatic?

Dr. Dana Rice: (08:15)
Traumatic sometimes – obviously it’s sad. There’s so much more that goes into trauma surgery than the 15 minutes of excitement and getting the patient stable. Like there’s so much social work and family things and stuff like that. So for me, I was all about wanting to fix things and make things better. Orthopedic surgery – you have to be a special soul for using saws and knives and things like that. That just wasn’t for me. So that weeded things out. And when I was training at least, urology was really not a female area. And I usually tell people, “If men had children and coughed, sneezed and had incontinence and urinary tract infection every time they had a kid, that problem would’ve been fixed a hundred years ago.” So as a female going into a sort of a male dominated profession, there were a lot of opportunities and a lot of ways to be involved and really help people. So although now I do quite a bit more cancer stuff just because I guess I’ve trained myself into the old person qualities – now I’m no longer the newbie on the block – but there’s so much opportunity in urology, both clinically, surgically, and then professionally for helping people that it’s just a really good avenue.

Daniel Lobell: (09:41)
When you work around cancer patients so often, do you start seeing the world in that way? Because like I remember I worked in rehabs and then with kids who had addiction and then if I’d meet any kid, I started to think, “Oh, they probably have an addiction”, which wasn’t true. But because that was what was so familiar to me, it became my world. Do you, is your mind always in cancer when you’re working with people with cancer, do you see it everywhere?

Dr. Dana Rice: (10:15)
So I would say that in points in my career, that has been true. Nothing has been more true than when I was in infectious disease class in medical school, and we studied worms and itching, I was itchy for six weeks, even though I never traveled to Sub-Saharan Africa in the last whatever years, but they’re a part of things. So when you say cancer in my world, it goes in waves where you really see a lot of sadness. And it’s really hard. Everybody who has a little complaint, you’re like, “Oh, you’re going to have cancer” and it gets a little anxiety provoking at times. But one of the nice things about urology is that there are a lot of cancers that we are very, very good at treating, unlike some of the other fields where those doctors are saints and constantly have to deal with death and giving people news that they’re not going to get better.

Dr. Dana Rice: (11:11)
There are a lot of times where I get to give this speech of, “This is like a no problem thing. We’ll have a lot of dates together and we’ll see each other and I’ll have to do a lot of surveillance, but this is not going to be the thing that kills you.” And those are the moments where you can really comfort patients. And it really feels good to be able to tell somebody, “Yeah, this is annoying and you’re going to have to deal with it, but this is not going to be the thing that takes your life.”

Daniel Lobell: (11:36)
Right. That’s good. That’s a good feeling to be able to say that.

Dr. Dana Rice: (11:40)
Yeah. Every time I get to say that it makes a good day.

Daniel Lobell: (11:44)
Do you think there’s been notable progress made with regard to cancer treatment in the past five or 10 years?

Dr. Dana Rice: (11:55)
Oh yeah. Picture poison. The funny thing about medicine is that every time we get good at something, something else creeps up. I think nothing has taught us that as much as this pandemic probably. So medicine is definitely still an art in some ways, but the science of it, the technology of it, what we can do now with genetic markers and sequencing and things like that.

Daniel Lobell: (12:23)
What can you do? I’m curious, come on.[Laughs.]

Dr. Dana Rice: (12:27)
[Laughs.] Well, I am not in academic research medicine. So I get the fruit of the benefits of the people who put in a lot of bench work experience. But if you just look at the chemotherapies and immunotherapies, like the drug treatments for different types of cancer. Even in my career, when I was studying hematology, oncology to pass courses to get through med school, there was a finite amount of medicines that you had to learn or know about because that’s what there was. And now I have patients come back to me and it’s like, “I’m on some kinase inhibitor that just passed its trial through the NIH. And it does this, this and this.” And I’m like, “Oh, fabulous.” Okay, hold on. Yep. Let me work that one out. Thank God for oncologists.

Dr. Dana Rice: (13:17)
But we are definitely making strides in ways that are impressive. And then surgically with cancer, even if you look at roblox surgery, that’s something that we do a lot in urology for prostate cancers, kidney cancers, things like that. There used to be a time where if you had a kidney cancer, even if it was very small, pretty much everybody would take out the whole kidney. And now we’re very good at just taking out the tumor itself and leaving all the healthy kidney. So we have come a long way.

Daniel Lobell: (13:55)
Yeah. Do you give more positive prognoses these days when you have patients come in, is it a more hopeful thing for the most part?

Dr. Dana Rice: (14:07)
Yeah. Well, in urology, for me in particular, I am not oncology fellowship trained, which is a big thing now. So there are people who the buck stops with them and it’s kind of the last resort. If you’re getting sent to them, then no, their prognoses are not necessarily different, but diseases through time have changed. So in urology, in particular, there’s something called PSA, which is a prostate specific antigen. And in the nineties, it came out. And before then there were still a lot of people who would die of prostate cancer. And while there are still definitely people who die of prostate cancer and we have to do screenings and all that stuff, the pendulum has really swung to ‘People are survivors’. They may not necessarily be cured. They have to be followed for the rest of their life just in case, but people do well. And those are all really good and hopeful things.

Daniel Lobell: (15:04)
Yeah. That sounds good. And hopeful. So what would you say you wish your patients knew coming into you if there’s one thing that you could instill upon them?

Dr. Dana Rice: (15:22)
We are all human and we went into medicine to help you. So give every doctor everywhere, the benefit of the doubt that we are doing best to help you.

Daniel Lobell: (15:35)
Do you encounter a lot of skepticism when people come in?

Dr. Dana Rice: (15:39)
I can’t say skepticism as much as I can say, tides are changing. So with Google and with the ability to find all different kinds of data, as you can see in almost every aspect of life nowadays throughout the years, people sometimes come in with a preconceived notion of what they want or how things need to go. And all I can say is the internet has tons of data and a lot of it is good. But the problem is it may be good for one person and doesn’t really apply to you. And it’s not so much that people come in with skepticism, but people come in with, “This is what I’m expecting, because this is what my friend got, or this is what I’ve seen on an ad on TV so this has to be the miracle thing, that’s my problem.”

Dr. Dana Rice: (16:39)
And the nice thing is usually I just say, “Hey, how are you? What’s going on?” And we have a nice conversation. And people open up and, and they say why they’re there and what they’re looking for. But sometimes you’ll come in and somebody says, “I want X, Y, and Z”. And that’s a hard factor. because it should be a dialogue and an open conversation, in my opinion, between a patient and a doctor, like, “Tell me what you need, want and have for symptoms. And I can tell you what I know and what I think might help. And then we can work together.”

Dr. Dana Rice: (17:16)
Because in medicine, I don’t prejudge you, I would prefer you not to assume that I’m trying to charge you when I ask you to come back for another visit or I automatically assume because you’re X, Y, Z weight and height, that this is your problem. We’re just not really built that way. We do learn things in algorithms to help us figure out what common diseases may be and triggers or things like that. But at least for me, in my experience with myself and my friends and my colleagues, we really are open-minded and want to know what you think and want to partner with you for your health, because your body, your choice.

Daniel Lobell: (18:03)
What do you think are the most important facets of the doctor-patient relationship? I think you touched on it a minute ago with trust, but maybe you want to expand on that.

Dr. Dana Rice: (18:12)
I think trust and along with that is honesty. And then in my field where we’re talking about a lot of sexual behaviors or experiences or needs or wants or things that may be secondary, complications from sexual encounters, people are not as forthcoming [as they should be].

Daniel Lobell: (18:43)
Because they’re embarrassed.

Dr. Dana Rice: (18:46)
Or they are shy or society tells us that they really shouldn’t talk about it. Or that it may be offensive to me if they say what’s on their mind. I can’t tell you how many people look at me when, instead of saying scrotum, I say, “Your balls hurt?” And they look at me like, “She said that, right!?”

Daniel Lobell: (19:09)
[Chuckles.]

Dr. Dana Rice: (19:09)
But people don’t walk around all the time saying, “My scrotum is uncomfortable.” You have to be real with your patients, your colleagues, and people. Not everything is a science experiment. If you don’t know the right word for something, I am a female urologist. If you can shock me, you tried hard, really hard.

Dr. Dana Rice: (19:33)
[Laughs.]

Dr. Dana Rice: (19:33)
So call it whatever you want to call it. Let’s just get on the table and we will figure out how to fix it.

Daniel Lobell: (19:40)
I love that attitude. Are most urinary tract infections sexual in origin? Is that how they mostly come about?

Dr. Dana Rice: (19:49)
Yeah. So this is a little bit of a soap opera for me. And it’s probably a good thing to touch on. I apologize to all the moms out there but I had more time on my hands in my six weeks of maternity than I had at other points in time in my life. So I decided to create an app and put it all together. It was a pipe dream of mine. And what I did is I created an app for urinary tract infections so that people could be open about it, talk about it, women’s health, men’s health, that kind of thing. And for me, urinary tract infections have a really big stigma of that it’s always sexually transmitted. But like I said at the beginning of the podcast, I had urinary tract infections before I was nine months old. And I can promise you, they were not sexually transmitted. So there are lots of different ways that you can have urinary tract infections. And I think that while there are whole groups of people that do have sexually triggered urinary tract infections, it is not just because of that. And I do think, especially for women, when you first start getting your period, when you first start having sex, lots of women after they’ve had babies and then again at menopause, so they are associated with hormonal swings. So I think what ends up happening is for women, UTIs actually get labeled as a sexual problem, whereas it’s more physiologic hormone-based in my opinion.

Daniel Lobell: (21:38)
So I think it is very stigmatized because I’m coming from the world of comedians, but when you hear about UTIs, it’s generally the comedian about to make some kind of sex jokes. It sounds to me like we don’t know why UTIs happen. Are there conclusive findings or reasons why they occur?

Dr. Dana Rice: (22:06)
Well, yes and no. If you were on a honeymoon weekend and had sex six times in one day, and then you have a urinary tract infection, like ding, ding – we probably know where that came from. So there are reasons why you can have them, but, for instance, lots of times kidney stones will have bacteria growing on them. And people will present with an infected kidney stone, which is a urinary track infection, because it’s urine that is infected. But you’re right. If you look at generalized media shows, comedians, all that kind of stuff, it’s a lot funnier to talk about sex UTIs, or you did naughty things in Vegas with whoever and now your penis hurts. So those are where the jokes come from.

Dr. Dana Rice: (22:59)
And unfortunately for a lot of people, what ends up happening in the younger crowds is that they don’t necessarily want to tell their physicians or their doctors because they don’t want their parents to know. And then we’ve gone down this dirty little secret, which is not necessarily where we needed to go. We definitely need to have more open conversations about health and in my opinion, about women’s health. I treat a lot of postmenopausal and menopausal women and they often will happen to have urinary tract infections or what feels like a urinary tract infection, but it’s really hormone related. But a lot of those women don’t necessarily want to talk to just anybody about their sexual activity. They don’t know whether they should see their gynecologist or someone else. And as far as I’m aware, pretty much every woman in their lifetime will go through menopause at some point. So why it isn’t an open thing that some women may have urinary tract infections more prevalent around menopause blows my mind. Like why is this not like a book somewhere like, “Hey, menopause sucks. This is everything you could expect from it. And here’s your 101 book.”

Daniel Lobell: (24:21)
I once saw a musical called Menopause the Musical. Have you ever seen that one?

Dr. Dana Rice: (24:27)
I haven’t but now I’m curious.

Daniel Lobell: (24:29)
Yeah. Well in New York down the block from where I used to live on the Upper East Side was a little theater with something called ‘Menopause The Musical’. And I used to pass it all the time. And one day they were like, “Hey, do you want to come in and see Menopause The Musical?” I said, “Okay.” I was curious what ‘Menopause The Musical’ was like. Now I can’t remember much about it because it was about 15 years ago, but it was a bunch of people singing about menopause. And I think it’s still around. So Google it ‘Menopause The Musical’.

Dr. Dana Rice: (25:01)
I’m going to have to. I love everything in New York and depending on who is performing, it may have been even more interesting.

Daniel Lobell: (25:08)
You mentioned you built this UTI app. What does the app do? What’s it called? Who should get it? Where can people find it?

Dr. Dana Rice: (25:17)
UTI tracker is the name of the app and it has its own website, utitracker.com. And I actually not too long ago partnered with a supplement company which is UTIVA. There’s a lot of supplements that go around with urinary tract prevention, cranberry supplements and D-Mannose. And we can get into the medical side of that if you want in a little bit. But basically what I found with the app is that I had thought about doing this back in residency when I realized that so many people had recurrent urinary tract infections and we would ask, “Well, what was your last infection?” And people would look at you like, “I have no idea. The doctor just gave me antibiotics.”

Dr. Dana Rice: (26:14)
But if you know the type of bacteria, you can find a trend, you can figure out how to prevent it. So it was really good information. So what I did in the app is I put together an information section using guideline research and then a way to track the actual lab values, the antibiotics you had been prescribed and then almost based it on like a period tracker type of thing. So you could keep a calendar for your triggers because some people’s urinary tract infections are hormonal so it can track your periods. It can track if you’re constipated, it can track when you have sex, it can track all different kinds of things that may trigger urinary tract infection or feelings of urinary tract infection. And once you really start journaling and taking control of what your triggers your symptoms, I think it really helps patients take control of what’s going on with their bodies, because like so many other things in life, once you understand it and can manage it, then the anxiety behind it starts to fade a little bit and then you can really get ahead of the problem.

Dr. Dana Rice: (27:17)
So anyways, the reason why I mentioned the supplement company is because technically they have the rights to the app and everything now. So although I did create it, design it, my face is on it – They are marketing it for me because there’s one thing that I have learned: I am a much better doctor than I am someone who tries to figure out the business side of things. Although I thought it was great and interesting, people would come to me with questions like, “So what’s your five year goal for revenue per whatever?” And I would just look at them like, “My five year goal is for this to help people”. I just didn’t have that mental capacity.

Daniel Lobell: (28:01)
Yeah.

Dr. Dana Rice: (28:04)
Actually, when I was reading your bio and I saw that you gave a TEDx talk, I was like, “I don’t fully understand these TEDx talks. I’m going to go into these in more detail”. Because in medicine, we have academic talks and research and journals and all those kind of things, but there’s a whole different world out there that we miss sometimes when we’re in medicine.

Daniel Lobell: (28:29)
Yeah. The TEDxs are pretty cool. I got asked to do it. And then I didn’t know much about it until I did it. But yeah, there’s all different topics. People from all walks of life discussing different things. Mine was about raising chickens in a backyard in Brooklyn. So yeah, I think it’s worth exploring. There was a lot there,

Dr. Dana Rice: (28:55)
But you must have been popular with your neighbors having chickens in Brooklyn.

Daniel Lobell: (28:58)
[Laughs.] It’s discussed in the talk.

Dr. Dana Rice: (29:05)
As someone who lived in New York for a little while – although I lived in the city, not in the borough – I still can’t imagine having chickens in Brooklyn and not having a creative description from your neighbors.

Daniel Lobell: (29:20)
Yeah. Some good material came out of it. I’ll put it like that.

Dr. Dana Rice: (29:26)
All right. Fair enough.

Daniel Lobell: (29:30)
You brought up kidney stones. What are kidney stones and how do people get them? And can you prevent them?

Dr. Dana Rice: (29:44)
So the answer is yes. Kidney stones are essentially deposits. Some are calcium, some are uric acid. So your kidney’s job is to filter the blood and excrete out things your body doesn’t need or wastes. And that’s how you urinate. So that’s the basic premises. And the way I tell people to think about kidney stones is if you had orange juice that had pulp, and you constantly were shaking, stirring and pouring, that pulp would kind of just pee out and you’re nice and hydrated and you thin it out and everything looks good. If you’re somebody who excretes too much pulp or too much deposits, you can start to form little piles or little calcifications if they’re calcium stones, things like that, which basically form into stones. And everyone thinks this is like a boulder the size of the Taj Mahal but the ureter, which is the tube that connects the kidney down to the bladder, is only the size of spaghetti. So you need the tiniest little pebble size thing to hurt you.

Dr. Dana Rice: (30:53)
So what I usually tell people is kidney stones or deposits or build up of minerals prevents the urine from draining in some way. And that’s when it hurts. If urine can drain around a kidney stone, that’s when you don’t necessarily have pain. But preventing them can depend on what type of stones you have. What I usually tell people and the literature supports is the number one thing is keep yourself good and hydrated. Just like the orange juice. If you thin it out, you’re going to be able to pass out more pulp. And lots of times the way your kidney physiology works, you won’t be as prone to kidney stones.

Dr. Dana Rice: (31:44)
The other thing in the American diet, that’s really pretty important in my opinion. And there’s more and more data coming out about obesity. So for every 15 pounds or so overweight, I think there was one statistic one time that said as much [a person has] as [much as] a 10% risk of stones in the next five years. And don’t hold me to that. But that’s what stuck in my head from an article I read somewhere. And the idea behind that is that when you have obesity, diabetes and metabolic dysfunction, your body tends to try to excrete more waste material. And then you can have higher build up of different things too, a propensity to pass uric acid stones. So what I usually tell my stone holders is water, water, water, water, water, make sure you’re urinating regularly. And then the best thing you can do is to keep the weight off and keep yourself exercising and nice and healthy. But there are also outliers too. Some people have some genetic components, older people have osteoporosis, break down of bone, more calcium – you get more chances of stones. So there are other factors, but in general for most people, lots of water, healthy diet, try to watch the weight.

Daniel Lobell: (33:03)
You almost never hear about obesity being a positive thing, except this week, I heard about a study that showed that obese people have a lesser rate of injury when they fall because of the obesity, because of the padding. So while obesity is certainly dangerous, in other ways, it has shown that it’s caused less people having to go in for broken bones.

Dr. Dana Rice: (33:41)
I will believe you on that one. I don’t know. I mean, from a layman’s standpoint, I guess that I can wrap my head around that.

Daniel Lobell: (33:49)
Like it’s one of the only positive obesity studies I’ve ever heard. [Laughs.].

Dr. Dana Rice: (33:51)
[Laughs.]

Daniel Lobell: (33:51)
As someone who struggles with their weight, It’s nice to find a good one every once in a while.

Dr. Dana Rice: (34:01)
Well, [there are] upsides of everything.

Daniel Lobell: (34:03)
I didn’t even know there were different kinds of kidney stones you could pass.

Dr. Dana Rice: (34:09)
Yeah.

Daniel Lobell: (34:10)
Are any of them valuable? – None of them are like a pearl?

Dr. Dana Rice: (34:11)
Let’s see.

Daniel Lobell: (34:13)
Isn’t that how a pearl is formed, like an agitation inside?

Dr. Dana Rice: (34:17)
Yeah. Essentially it’s a similar concept – there’s a little sand granule in an oyster, and then it builds up material because the oyster’s trying to spit it out. So it is essentially the same kind of thing. A random kidney stone fact is Dalmatian dogs get kidney stones.

Dr. Dana Rice: (34:34)
I know it’s one of those random questions that periodically show up on tests. And I always think to myself, “This is dumb. Why is this a relevant question?”

Daniel Lobell: (34:43)
It’s an interesting point. You wouldn’t think like one breed of dogs specifically [would get kidney stones]?

Dr. Dana Rice: (34:49)
I don’t know. I’m obviously not a vet, so maybe there are a whole bunch of dogs that get kidney stones.

Daniel Lobell: (34:53)
I wonder if those are like oysters, “Oh, what’s this one? This one is a Dalmatian kidney stone. It’s worth $1.7 million.”

Dr. Dana Rice: (35:06)
Yeah. I would tell you that kidney stones are one of the few things in life that are amazing to look at for about two seconds. And then you think to yourself, “Oh, that little bugger looks painful.”

Daniel Lobell: (35:18)
Maybe that’s why people don’t pay for them. So you brought this point up earlier that people are now going on the internet and coming in with information or misinformation that they got online. And it was a perfect lead-in for me to talk about Doctorpedia. So I know that you’re involved with Doctorpedia, and we’re conducting this interview on behalf of Doctorpedia. So what attracted you to Doctorpedia? And in what capacity are you working with Doctorpedia?

Dr. Dana Rice: (36:00)
Yeah. So the truthful answer is I don’t exactly remember what took me down this road. I think because I had done the app and I had been the people who are making moves or trying to make medicine sort of more acceptable or reliable for the masses. I believe what had happened was one of the founding partners had LinkedIn messaged me and said, “Hey, I know you’ve done the app. Take a look at this, see what’s going on, tell me what you think.” And I’m not sure if you’ve talked to her, but Hala Sabry has a Facebook group for women physicians [called ‘Physician Moms Group’]. It’s a group that she’s collaborated on and grown over the years, and it’s a really great resource for mommy docs, especially for those of us that are juggling 50,000 hats and I said, “Tell me a little bit more about this.”

Dr. Dana Rice: (37:11)
And then she had given me a rundown and I had talked to Jeremy and I am a firm believer that too much information is overwhelming and confusing and too little information can be dangerous because you could hear only one side of a story and be fixated on that. And that may not be the right treatment. And I think for me in my career I have seen people come in with home remedies or stories about, “I wanted to prevent my kidney stone. So I’ve been drinking water mixed with a box of baking soda for the last five days.” And all of a sudden they have all kinds of electrolyte problems and GI problems.

Dr. Dana Rice: (38:01)
You can imagine that if you drink a box of baking soda, that’s not good for you, but someone read it on the internet that it was possible. So one thing that I like about the way Doctorpedia seems to be lined up and going is that it is a doctor information source that has been vetted for truthful, honest opinions where you’re getting something that makes sense. And I believe, and I don’t know if you should quote me here, but I believe they’re going to be doing the guidelines, science-based type vetting to make sure that the information on all their videos and things like that really pass the test. And then it’ll be sort of a one stop shop for patients to have information. And then ultimately I think they’re trying to make it so doctors can put out their own information on their personal portion of the website so that their patients can get good information quickly to that doctor.

Dr. Dana Rice: (39:16)
So just like when I made my app, the goal was to tell patients, “Hey, this is not a problem that necessarily needs a urologic surgeon. This is something that lots of doctors can do. You just need to be trained how to do it.” And then you need to have the “buy-in” that this works and this it is. So you need to have something to refer back to, because the fact of the matter is nobody listens the first time to anything really, that’s just human nature So if you can refer back to a little video or a snippet of information or something that’s personalized and easy to get to, it takes a lot of the pressure away or anxiety away from the patient, right there. There’s an easy way to get there, an easy way to navigate in a trusted source. And hopefully if all of those parts kind of come together, Doctorpedia should be able to do that for people.

Daniel Lobell: (40:11)
What’s the biggest compliment a patient can give you?

Dr. Dana Rice: (40:28)
Well, I jokingly think the best comment that I’ve gotten, I got about three days ago when a patient asked me, “Are you in your thirties yet?” I said, “I love you. You’re my favorite patient forever.” [Laughs].

Daniel Lobell: (40:41)
[Laughs].

Dr. Dana Rice: (40:41)
However ego aside, I think realistically the best compliment I get is something along the lines of “Thank you for listening.” Or “I feel like you heard me” because a lot of times I’ll get patients that come to me and say, “I’ve been to X amount of doctors with the same problem and nobody really listened.” And for me, I don’t come from a family of doctors. I didn’t have a lot of experience in this world, in medicine prior to going to medical school. And that’s what I’m there for, to take what I’ve learned and help people.

Daniel Lobell: (41:35)
You were going to save the world if I recall correctly.

Dr. Dana Rice: (41:39)
I was going to save the world, but I try not to speak to patients in a way that some other physicians do. I don’t know exactly how to explain it, but if I’m talking about kidney stones and I’m like, well, you know, you produce too much uric acid based on your calcium channels. And if you have this, then this [will happen …] I just don’t really do that. I try to break it down as if I was explaining it to my mom or my brother or something like that.

Daniel Lobell: (42:12)
I thought you did a great job it to me.

Dr. Dana Rice: (42:16)
Well, thank you. But I think what’s important is being able to relate to your patients on a level at which they understand.

Daniel Lobell: (42:26)
My only feeling otherwise is, “Why is she talking to me like I’m her mom?” [Laughs.]

Dr. Dana Rice: (42:31)
[Laughs.] Well, if I did that, I’d say, “Get back in your room.” [Laughs.] Actually, I’d probably be saying, “Don’t give him any more chocolate. No more.”

Daniel Lobell: (42:43)
[Laughs.] Yeah. It’s the other way around with my mom, anytime she sees me giving my daughter chocolate, she says , “Don’t give her anymore chocolate.” I’m like, “She’s my kid.” [Laughs.]

Dr. Dana Rice: (42:50)
[Laughs.] I was going to say, “Do you want to trade for a minute?” We call my mom Nana. She lives in my house and she says, “Don’t tell your mom, here’s your 700th M&M of the day.” Or, “Don’t tell your mom, here you go.” My kids know where to go when they want something.

Daniel Lobell: (43:10)
Yeah. Well, I mean, see if you traded, you’d think you’d be better off, but the grass is always greener. You’ll probably get the same feeling either way.

Dr. Dana Rice: (43:19)
No, that’s true about everything in life. Everybody always thinks it’s greener on the other side until they get it.

Daniel Lobell: (43:23)
Unless you go to Scotland or Ireland, in which case it really is.

Dr. Dana Rice: (43:28)
And I’m on a plane tomorrow. Although only if I can have the beer, you know … when in Rome …

Daniel Lobell: (43:35)
There’s no shortage, believe me. It’s been a lot of fun talking to you. And I’ve very much enjoyed this interview. I’m going to wrap up asking you the question I always wrap these with, which is what do you do to stay healthy?

Dr. Dana Rice: (43:52)
It depends on the time you hit me. So my ideal situation to stay healthy is I like doing those little video things and I mix them up because I can’t stick with one for the 60 or 90 days, but I like to challenge myself with a little bit of abuse from beach body on demand or insanity or something like that. However, unfortunately I got COVID at the end of January and I have been a little bit sidelined. But I am hoping I’m going to get back into it. I used to be a big runner. However, that mid forties thing and knees has started to catch up with me a little bit. So I’ll get there eventually.

Daniel Lobell: (44:32)
Somebody has to invent something for those knees. A lot of runners lose their run because of the knee pain happen, it to my wife.

Dr. Dana Rice: (44:44)
I will tell you that the other thing that I think you need to warn people about if you ever are in the position is ,”Don’t be a catcher in softball.”

Daniel Lobell: (44:53)
Ooh, I think that it’s gotta be bad.

Dr. Dana Rice: (44:55)
I didn’t think it was when I was in high school. I’ll tell you that. But my 40 year old self is cranking and creaking and popping in a way that it should not when I go into a catcher’s crouch.

Daniel Lobell: (45:08)
You see, you were too competitive as a kid with your brother and now it’s coming back. [Laughs.]

Dr. Dana Rice: (45:15)
[Laughs.] No one has ever denied that fact. Never, not ever. Every scar on my body/ concussion/ whatever else happened to me was sheer rivalry.

Daniel Lobell: (45:25)
You could’ve just relaxed and enjoyed Cape Cod, but you had to get competitive. [Laughs.]

Dr. Dana Rice: (45:32)
[Laughs.] Well, you can’t let somebody box you out. That’s just unheard of. You gotta be in there. [Laughs.]

Daniel Lobell: (45:37)
I agree. That’s good advice. [Laughs.]. Dr. Dana Rice, thank you so much.

Dr. Dana Rice: (45:46)
Thank you for having me. It’s been great.

Daniel Lobell: (45:48)
All right. We’ll look forward to hearing more from you on Doctorpedia and perhaps again on this show sometime

Dr. Dana Rice: (45:55)
Anytime. Thank you so much. It was a pleasure

Daniel Lobell: (45:58)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any