Transcription:
Dr. Amanda Pettibone-Pond Talks Urology

Scott Webb: We are here today with Dr. Amanda Pettibone-Pond, urologist with Outer Banks Urology. Dr. Pond has Been with the Outer Banks Hospital and Medical Group since June 2020. She does procedures in her office and surgeries at the Outer Banks Hospital.

This is Outer Banks Health. I'm Scott Webb. Dr. Pond, thanks so much for your time today. Great to have you on. Before we get rolling here, I want to have you tell us a little bit about yourself.

Dr. Pond: Yeah. I'm originally from Indiana. I was born and raised there. I went to Indiana University for undergrad and graduate school. From there, I started teaching anatomy and physiology. And that's really what kind of compelled me into going into medicine and surgical field. So I went to St. George's for medical school and completed my urology residency at University of Tennessee.

My first practice was with IU Health in Bloomington, Indiana, which was fabulous. Fabulous people. After four years, my family and I decided we wanted to live closer to the water and be at the beach. And so we found the Outer Banks and loved it, loved the people and made the move. So we've been here almost a year now. Loving it. Absolutely loving it. And I'm married and I have three children and we all just love to spend time outdoors.

Scott Webb: Well, it sounds like you definitely went to the right place if you wanted to be on the beach, near the beach, near the water. That's perfect. And I know you started at the Outer Banks during the pandemic, which must've been very interesting. So tell us a little bit about that. What challenges did you have to overcome as you started during such an interesting time?

Dr. Pond: I think the pandemic had been going on for a little bit and they had reopened clinics and elective surgeries. I honestly didn't see much of an impact, which I think is good. And once I had gotten my office, I'm a solo provider, so I don't have an office with multiple other providers with patients in the waiting room. So my waiting room is not packed with people and, you know, making it hard to socially distance. I have a nice lobby outside of my waiting room where people can wait.

But really we've tried to schedule patients accordingly, so we don't have too many people in the waiting room at one time. My staff and I have worn masks and have been very diligent about wiping everything down. And fortunately, I've still been able to do a lot of the vital office procedures, where we diagnose various types of cancer and really have had little impact on doing outpatient surgeries. So I've been fortunate. I don't know that all practices would say that. But we've just kind of paced where it's safe for everyone to come in and they don't have to worry about being around a bunch of other people.

And since I've been here, there really has not been a big push or demand or request for virtual visits, but certainly that's something we're, you know, more than willing to do and accommodate if people were interested.

Scott Webb: Yeah. And good to know they know that it's safe to come in and that you're following all the protocols. And it's nice that you have an office where there's not a lot of people bunched up and waiting and all that. So that's good. Good for you. Good for patients. And I know that Outer Banks has not had a urologist for a long time, so I'm sure they're happy to have you there. And I'm sure there's a big need. So tell us about that.

Dr. Pond: So many patients have really expressed gratitude to have somebody here full time. That they just were tired of making the drive either to Virginia Beach or Greenville and that I could see them for their general urologic health. So I feel like we've been a great resource for the area and saved a lot of people some miles and gas money. But it's been great. And I do feel so fortunate that I was able to get here when they needed me. And like I said, the patients have just been so grateful and it's just been a great experience so far.

Some urologic issues obviously are hard to live with like a kidney stone or not being able to urinate. But some of them, I think, unfortunately not having someone here, people may have put off a few things too, that maybe otherwise they would have addressed sooner. And so I think that it's good to be here and to be a resource for them, so that some of these important things don't get delayed.

Scott Webb: Yeah. I think we're all probably guilty on some level of, you know, living with some things we don't need to, whether it was the pandemic or just fear or laziness or the drive, whatever it might be. And so good to know that, you know, people do have these issues, overactive bladders, kidney stones, things we're going to talk about today. Before we get rolling into that though, what are the just sort of general types of issues that you've been dealing with and helping your patients with?

Dr. Pond: I see all kinds of things. I think, you know, not everybody understands what a urologist does. There aren't very many of us around. But I see men and women. A lot of people associate urology with just men, but I probably see equal amounts of men and women. In both men and women, they have various urinary issues. You've mentioned overactive bladder, urinary incontinence, urinary retention, urinary tract infections, kidney stones. So those are men and women.

In urology, we also deal with various types of cancers that we diagnose and treat and manage, including prostate cancer, bladder cancer, kidney cancer, and some that are less common like penile and testicular cancer.

As far as men go, men sexual health, I also do vasectomies here and various other types of surgery. And for women, I see, you know, a lot of stress incontinence and that's more common in women. But certainly men and women have urinary issues and kidney stones, which are everywhere. And like I mentioned, diagnosing several different types of cancer.

Scott Webb: Oh, boy, Dr. Pond, you really have to be on your game. You are one-stop shopping there for everything that you help patients with, which is pretty amazing to have you in the area. So let's talk about specifically overactive bladders. What do you do? What do you offer? Anything special for people suffering from overactive bladders?

Dr. Pond: Right. So I really take the time in patients who come in with symptoms of frequency, urgency, getting up at night, which are the typical symptoms that we associate with overactive bladder. And sometimes it is a bladder and sometimes it's not. Sometimes it's some of our lifestyle, our behaviors like fluids or the type of fluids that we drink or even bowel issues. Oftentimes, it's other medical issues that we may have like diabetes or cardiovascular disease or various medications that we take.

So I really try to get the big picture with these patients, because if I don't and I just treat them for a bladder issue, you know, they may not get better. So I take all of those things into account and we really discuss a lot of behaviors that can be contributing to their urinary issues. So once we've kind of sorted all of those things out, if behavioral modifications aren't sufficient, there are certainly medications that we can try. There's at least probably half a dozen of those that I will try patients on.

There's also pelvic floor therapy, which is a nice option for people who really don't want medications or a procedure. And so fortunately, we have a wonderful pelvic floor physical therapist here as well. So I send some folks to her. And when all of those behavioral changes, medications, pelvic floor therapy fail, we talk about what's called third-line therapy.

And for our office, we offer Botox in the bladder, which we'd just inject in the bladder and that's nice. It's an outpatient procedure. And then we also offer what's called a InterStim, which is a type of sacral neuromodulation, which really kind of regulates the electrical activity that the brain receives. And it helps with overactive bladder and underactive bladder. And it's also FDA approved for patients with fecal incontinence. So that's kind of my algorithm for patients with overactive bladder.

Scott Webb: Yeah, it sounds like a lot of options, a lot of modalities, which is great for, you know, both doctors and patients to have options. Let's talk about kidney stones if we can. We know that kidney stones are painful, common, treatable. The only thing I really know about preventing them is I was told once to drink lots of fluids, especially in the summer, maybe mixing a little bit of lemon with the water would be helpful. But what are your thoughts about preventing kidney stones and treating them?

Dr. Pond: Well, absolutely a lot of people that get kidney stones don't like water or don't drink enough fluids. That is the most common cause of kidney stones. It's also genetic. So unfortunately, despite your best efforts, you may continue to get them, which isn't what anybody wants to hear. And kidney stones are everywhere. You know, this will be the third place I've practiced medicine. And you know, you think, "Oh goodness, Stones can't be nearly as bad in XYZ as they are here." But they are, they're everywhere. I don't think it's the water. There's no studies that show it's the water. And for stone formers, the recommendation is a hundred ounces, which is a lot of water, especially for people who really don't like to drink water.

But the things to really avoid are tea and dark colas as they tend to have more phosphoric acid, which can increase the risk. So if you can't just drink water, at least avoid those things for the most part. Also animal protein, the recommendation is six ounces or less of animal protein a day, which isn't much for people who like meat. Watching your sodium, watching how much you salt and kind of the processed foods that we eat.

And then another thing is people think, "Oh gosh, I have calcium stones. I can't eat calcium, or I should avoid calcium," but that's not the case. In fact, you need calcium to bind to the oxalate in the gut. So you need about a 1000 milligrams of calcium daily. So the wrong thing is to stop eating calcium because you think it's worsening your kidney stones.

We can also do a 24-hour urine on patients with recurrent stones and just see if there's any abnormalities to address like high levels of calcium or uric acid. We look at the urine pH. We look at the oxalate levels. So there's various things we can look at in a 24-hour urine collection too to help pinpoint certain factors that we can target to help prevent stones. And that's not always diagnostic, but sometimes certainly can be helpful.

Most stones are calcium oxalate stones. And often people think, "Well, can't I just dissolve those?" But unfortunately, those can't be dissolved. There are some medications that can be prescribed to help prevent stones. There's some thiazide diuretics and potassium citrate.

So there are medications that can be prescribed to help stones as well. But watching your fluids and your calcium and sodium and animal protein, those are all kind of the dietary measures that we discussed. In the end, there are some medications that can help slow them down.

As far as treatment goes, we generally either do a shockwave lithotripsy, which can be done here at the hospital. We shock the stone from the outside, or we physically laser the stone from the inside. So both of them break up the stone and we can do both of those here at the hospital.

Scott Webb: That's great. Maybe it's just the kid in me, but anytime I hear that lasers are being used, I definitely appreciate that. As we get close to wrapping up here, let's talk about enlarged prostates. You know, we're talking about men here, particularly. What are you doing in terms of treatment options and helping folks with that?

Dr. Pond: Well, I just can't help but educate people again, you know, I have similar discussion about some lifestyle changes, just to eliminate those as a cause of some of their symptoms. But generally, men who have an enlarged prostate, it takes them a minute to get their stream started. Once they do, it's slow. It's intermittent. They may have a little dribbling. They feel like they don't empty. They void frequently urgently and they get up at night. Those are all kind of the constellation of symptoms that we see in men who have an enlarged prostate. And sometimes that starts at about age 50.

Certainly, there are medications. There aren't any really new ones. But there are a few medications that we can try to help improve those symptoms. And when the medication and lifestyle changes aren't adequate, there's procedures that can be done to kind of open the channel from the inside. There's the gold standard, which is done under anesthesia. We call that a TURP and men do great after that.

But some men are a candidate for a less invasive procedure called a UroLift. A UroLift is a minimally invasive procedure that we can do in the office, which is great. It doesn't require anesthesia. It takes about 10 minutes to do. Most men, they say 30%, but I think it's much less, will go home with a catheter. So they'll void and just go home and go on with their day. And it doesn't affect your sexual function either, which is good for a lot of men. And most men can come off of a lot of their prostate medications as well.

So the UroLift I think it has been a great tool to add to that toolbox. Not everybody is a candidate, but for anybody who is, it's just a great minimally invasive procedure. The symptoms get better in two to four weeks. Like I said, it's done in the office and it takes about 10 minutes. So I've really enjoyed doing those procedures and offering that in the office here.

Scott Webb: So doctor, this has been so fun today, educational, informational. As we wrap up here, anything else you want to tell people about their urological issues, needs, diagnosis, treatment, your time there, what they can expect when they meet with you? Anything else?

Dr. Pond: We're happy to be here. We're happy to take care of patients. Like I said, as far as I know, nobody has tracked any COVID back to our office, so it's safe. We're open. And like I said, taking the necessary precautions and we'd love to see anyone with a urologic problem.

Scott Webb: Doctor, thanks so much for your time, expertise and passion today, and you stay well.

Dr. Pond: All right. Thank you.

Scott Webb: Outer Banks Urology is located at 103 East Mall Drive Studio A in Nags Head, North Carolina. To make an appointment, please call (252) 449-5965. And further information can be found at theobh.com. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics of interest.

This is the Outer Banks Health. I'm Scott Webb. Stay well.