Why are UTIs Dangerous for the Elderly?

In this episode, we are joined by Dr. Gerda Maissel, a board-certified physician and private patient advocate, for an in-depth conversation about urinary tract infections (UTIs) in older adults and why UTI's are dangerous for elderly. Drawing on her clinical expertise and advocacy background, Dr. Maissel explains why seniors are at higher risk for UTIs and what sets their experiences apart from those of younger people. She unpacks the physiological changes that come with aging, such as decreased immune function, the effects of medication, and prostate enlargement in men. She reveals how these factors increase susceptibility to infection.

Listeners gain practical insight into recognizing UTI symptoms, which often manifest differently in older adults, sometimes appearing as confusion or agitation rather than the classic burning or urgency. Dr. Maissel shares evidence-based prevention strategies, including the roles of hydration, cranberry products, estrogen cream for women, and regular evaluation of medications that might promote urinary retention. The episode also sheds light on how UTIs can complicate chronic conditions like dementia, why prompt testing and treatment are crucial, and when hospitalization may become necessary.

Tune in for actionable tips, myth-busting facts, and reassurance that UTIs are not just an unavoidable part of aging, but a treatable condition. 

Check out: https://www.mymdadvisor.com

 SeniorLivingGuide.com Podcast sponsored by:  TerraBella Senior Living & Tom Marks, Best Selling Author on Retirement

The background music is written, performed and produced exclusively by purple-planet.com.
https://www.purple-planet.com/

SeniorLivingGuide.com Webinars and Podcast represents the opinions and expertise of our guests. The content here is for informational and educational purposes. It does not necessarily represent the views, recommendations, opinions or advice of Fairfax Publishing/SeniorLivingGuide.com or its employees.

Transcript

Darleen Mahoney [00:00:02]:

Today we are joined by Dr. Gerda Maisel. She is a private patient advocate and board certified physician who is passionate about ensuring that people receive the best health care possible. She is dedicated to her work, her clients and helping people have better experiences with the healthcare system, which we all absolutely need. And she has recently been doing a lot of work with education on solo aging. She writes a monthly essay, sharing stories and offering tips on getting through our healthcare system. You can subscribe to her monthly free essay. It's called the Fog Light. It's on substack. To get there you can go to substack.com and search for the Fog Light or you can go directly there by going to the fog light. Foglight.substack.com thank you so much for joining us today, Dr. Maisel.

Dr. Gerda Maisel [00:01:01]:

My pleasure. Thank you for having me.

Darleen Mahoney [00:01:03]:

Absolutely. So I reached out to you to have you join the podcast because a subject we've never discussed on this podcast really tug at me because I had a dear friend, an older friend who was really, really struggling with UTIs. And I know that in my life experience I've always heard in this job and just seniors in general, it's been kind of a passing conversation. Oh, UTIs make sure if you're having memory issues that it's not a uti because that could be a contributor. And then that's really where it stopped, like dead stop, period. But with my friend, it was a huge conversation. She wasn't having memory issues, but she was in a lot of pain. It was reoccurring. And then she just shared a lot with me as far as the difficulties with older adults and UTIs and why they are so problematic. So I thought this is a big deal and we need to talk about it.

Dr. Gerda Maisel [00:02:10]:

Excellent.

Darleen Mahoney [00:02:11]:

Yes. So what is a UTI? Especially what's the difference between a UTI and a 20 and 30 year old where, you know, maybe they just drink some cranberry juice and call it a day. And then an older adult who has a uti.

Dr. Gerda Maisel [00:02:27]:

Well, so a UTI stands for urinary tract infection and it usually means an infection in the bladder. And it is typically a bacteria that is, I call it setup shop. Urine starts out sterile, but if bacteria get in there, it's a great place for them to have a party. They grow, they multiply, and then they make you sick.

Darleen Mahoney [00:02:50]:

Yeah. Yeah. So when and how does that bacteria get in there? Because I know that it can come from a couple different places, but like in an older adult, I mean, how does that just, it just how does that get in there?

Dr. Gerda Maisel [00:03:05]:

Well, it generally climbs its way up. It crawls up, up on in, so to speak. So in other words, okay, women who have the tube that goes between your bladder and the outside is your urethra, so people get the terms confused. The tubes that go up to your kidneys are the ureters. So we're talking about the urethra specifically. In women, it's really short. There's not a lot of distance between the outside and the inside. In men, it's a little bit longer, but it's not like it's a foot long. It's still just a couple of inches long. And so bacteria that are on the outside can easily go up the urethra into the bladder. And there are many conditions that cause to make it more likely that the bacteria are going to set up shop and have a party in there. And we can talk about that a little bit if you want.

Darleen Mahoney [00:03:59]:

So is it more common for Women to get UTIs than it is men?

Dr. Gerda Maisel [00:04:02]:

Many more women, especially when they're younger, women get UTIs far more often than men. As we get older, we see more men experiencing their first UTIs.

Darleen Mahoney [00:04:13]:

Okay, so are there preventatives? If you're older and you don't typically get UTIs, but you listen to this podcast and think, you know what, maybe I should do some preventative measures. Is there like a. Maybe a specific cloth after you use the restroom that's maybe an antibacterial cloth or anything like that that would be more preventative?

Dr. Gerda Maisel [00:04:35]:

Well, it's a great question, and it's something that everybody who's experienced a UTI wants to not have one again. And some people get them over and over again. And as you mentioned, older people are far more likely to get a uti. There's quite a few reasons why older people are more likely to get a uti, and I'll talk about that, and then we can talk about prevention. When you're older, your immune system is not as robust. Your immune system doesn't fight off the bacteria as well. Older people tend to take more medications, and those medications that cause urinary retention can lead to UTIs. And it's something that people often don't think about. So it's a little bit prevention, a little bit cause here. So a common medicine that causes some urinary retention is Benadryl. Sleeping pills can cause UT can cause urinary retention. Anything. The medical term is anticholinergic. Anything that dries out your mouth may cause some urinary retention. And if you don't fully empty your bladder, then the bacteria, when they get in there, they can have a party. If your bladder is empty, there's not urine in there for them to multiply in, then you're less likely to have a uti. And as you get older, not only do you have these meds, but you also get situations like men have big prostates. If you're born with a prostate, it's going to keep growing unless you have it out over the many, many years. And as people get into their 70s, 80s, 90s, that prostate gets bigger and bigger and that can block the outflow of urine. Can't pee completely. You get urinary retention. Bacteria get in there. Uti.

Darleen Mahoney [00:06:27]:

Oh, wow. Okay. So are there some medications that maybe some people can take as an alternative to the medications that encourage a uti?

Dr. Gerda Maisel [00:06:38]:

Well, so yes and no. There are medications that people, you know, when I, we talk about people take sleeping pills, well, there's a, you know, that's a whole other conversation as to how to avoid taking a sleeping pill or how to avoid taking an antihistamine like Benadryl. Some of the newer antihistamines cause less urinary retention and not everybody gets urinary retention with these. But these are just things to look out for when it comes to preventing UTIs. One of the things that is done from a medication point of view is to acidify the urine. Bacteria won't party in there, they won't grow. If the urine is really as acidic. And you mentioned in the beginning, take some cranberry. Well, you know, it's been an old wives tale for a long time, but now the data supports that cranberry really does help. And cranberry will acidify the urine and make it a less hospitable place for those bacteria to grow. And there are some prescription urine acidifiers. D Mannose is one. I think that's prescription vitamin C some people use. There are different things that doctors will use to help that urine be more acidic and less hospitable.

Darleen Mahoney [00:07:54]:

Yeah. So if you are an older person and you do have concerns about, you don't want to get a UTI because UTIs are very painful and they're very difficult to get rid of. They can be very difficult to get rid of. So is it preventative? If you were to integrate cranberry juice on a daily basis, would that be helpful?

Dr. Gerda Maisel [00:08:13]:

Well, sure.

Darleen Mahoney [00:08:13]:

Preventative, Yep.

Dr. Gerda Maisel [00:08:14]:

A lot of people do that. Cranberry juice is very popular. And you can eat cranberries. You know, you can make cranberry pie. You can do all sorts of things, but all of those things can help. There are other things that can help too. Well, first of all, you should go to the doctor if you haven't gone to the doctor to make sure that you aren't retaining urine. The retention of urine is something that a lot of people don't think about. And they think, well, okay, I'm, you know, I'm emptying my bladder, I pee regularly, so of course I'm not retaining urine. You can't tell by how much is coming out whether anything is left inside. So you need to see either a urologist or a urogynecologist. For women. I'm a big fan of urogynecologists. And they have a quick test they can do in the office. It's a bladder ultrasound or a bladder scan. And they, they have you pee, they have you urinate. Then you come back and they do a real quick and they check and they see if there's a lot left inside. If there's a lot left inside, then that leads to a whole other set of treatments. So first thing I suggest is make sure you don't have retention. Then it's things like, you know, in the hospital, people get catheters placed in their bladder. And we doctors used to give people urinary infections all the time and by leaving catheters in too long. So we're better at that now. But sometimes people have catheters in the outpatient world. And so keep being aware that catheters can lead to UTIs, is something to be aware of, is something to watch for. For women, estrogen cream can be incredibly helpful. It's a cream that you place in the vagina and it basically re. Rejuvenates the tissues. When you get older, the lack of estrogen can cause the. They call it vaginal atrophy. I hate that term, but that's what it's called. And they call it. It's actually atrophic vaginitis. But the tissues of the vagina and around the urethra shrink. It can lead to incontinence and it can lead to UTIs. So estrogen cream can make a big difference. And for men treating their prostates.

Darleen Mahoney [00:10:37]:

So is estrogen cream, is that a prescription or is that an over the counter prescription? Okay, so that would be a conversation with the doctor.

Dr. Gerda Maisel [00:10:46]:

Exactly.

Darleen Mahoney [00:10:47]:

Okay, so what are the common signs if you think you have a uti?

Dr. Gerda Maisel [00:10:53]:

Well, many people are aware of the confusion and agitation. That can be the first sign that somebody you don't always know when you're confused or agitated. But if a loved one or someone, you know, gets agitated and confused out of the blue and they were, you know, it's a clear change from their baseline. Often in an older person, especially in an older woman or in a man who is not continent who is wearing diapers, you think uti. The classic symptoms for UTI are urgency, which many people have anyway, but an increase in urgency, an increase in frequency burning. Sometimes people will run a fever. Older people don't always run a fever. I knew some aides who would tell, would pick up UTIs and they would say, her urine smells differently. So it can change in smell. And sometimes a person's just not feeling good combined with some change in the way that their bathroom habits. So all of those things, UTIs are so common, can lead you to. Lead you to ask for urine tests to be done.

Darleen Mahoney [00:12:04]:

Yeah, yeah. And that's such a simple test.

Dr. Gerda Maisel [00:12:07]:

Yeah, there's. There's two tests and I'll take two seconds to explain what is ordered because people often get them confused. We call it a UA and a urine or a UC and S, not N but and S. And it's. The UA is a urine analysis. And that's literally just taking the urine, looking at it under the microscope, seeing if there's white blood cells from infection, seeing if there's protein, which is a chemistry they do on it. But they do an analysis of the urine itself. That test comes back within hours or maybe a day. Then there's the urine culture and sensitivity, the C and S. The culture and sensitivity is when they take the urine and you remember those agar plates from chemistry, and they put it and they see what grows, if anything, from the urine. And then they put it up against all the different antibiotics. That's the sensitivity. And they see if something grew, what bacteria grew, what antibiotic is it sensitive to or not sensitive to. And the doctor uses the results of the urine C and S to tell to determine. Oh, I started them on drug A. Oh, it's not really sensitive drug A. Let me put them on drug B. Oh, wow.

Darleen Mahoney [00:13:29]:

Okay. So it's not, it's less throwing spaghetti at the wall, so to speak.

Dr. Gerda Maisel [00:13:33]:

Right. And, and so that test takes three days. They take. They grow it for 72 hours before the final results come out. So sometimes people say, oh, I can't even get. I can't get any test results for four days. Well, the urinalysis should be done within a day. And you can tell, a doctor can tell by looking at the analysis of the urine, whether there's likely to be any bacteria, any infection going on. There's a variety of chemistries and cells that show up when you have an infection on the urinalysis.

Darleen Mahoney [00:14:09]:

So in the meantime, you're in pain, you're going frequently, and there's a good possibility that you have a uti. What are some. Other than drinking cranberry juice, One of the things that my friend described is the need to drink a lot more water and then really realizing she was trying to drink a lot of water, but she wasn't thirsty, even though she should be thirsty. And that was something that we really talked about because I drink tons and tons of water and she's just realizing she's just not as. She's just not as thirsty as she once was.

Dr. Gerda Maisel [00:14:53]:

Yeah, well, hydration in general really helps with bladder issues. And when we get older, people tend to cut back on what they're drinking because they have some degree of incontinence or urgency. And when they go out, they're afraid to. Of having an accident. So what you're saying is absolutely right. You do want to flush your system out. But if you are infected, you need an antibiotic, and especially when you're older and your body just can't fight off the infection. And so if you think it's likely you have an infection, yes, cranberry juice, drinking a lot of water, all are good things. But go see your doctor because you're going to need an antibiotic.

Darleen Mahoney [00:15:38]:

Right. But that's something to put together with the antibiotic. Or if you're waiting on your doctor to give you a prescription that might provide you some. A jump start to that.

Dr. Gerda Maisel [00:15:47]:

Agreed.

Darleen Mahoney [00:15:48]:

Yeah. Yeah. So she mentioned, and I'm just gonna just double check with you, that she didn't absorb. Even though she was drinking a lot, they didn't feel like she was absorbing. It wasn't hydrating her like it should be hydrating her. Is that something that makes sense to you or.

Dr. Gerda Maisel [00:16:05]:

Yeah, sorry, I'm not quite sure what that is.

Darleen Mahoney [00:16:08]:

All right.

Dr. Gerda Maisel [00:16:09]:

When you drink, you should absorb what you're drinking. But if it's hot and you're sweating a lot or it's just not enough, it might have caused an issue.

Darleen Mahoney [00:16:20]:

Okay. So maybe I misunderstood that. So I do apologize. So we covered some of the top causes of UTIs. So I did want to ask what. Because I don't really understand this part. So if you're interested in your 20s and your 30s and you get a UTI, it doesn't affect your Mental acuity. It doesn't, as far as I know, because I've known lots of people that have gotten UTIs as a younger person, and it just causes the discomfort and all of the things. Why does a UTI in an older adult, some of the very first symptoms may manifest itself in what could be, like, signs of Alzheimer's or dementia. And that's really sometimes like, one of the first signs of a UTI is where you suspect maybe someone has some cognitive issues.

Dr. Gerda Maisel [00:17:10]:

Well, our brains are just different when we get older. Not every older person with a UTI gets confused or agitated. So it's not that the UTI is always going to cause confusion and agitation, but a person, many of us, the older you get, the harder you have to work at things that your brain did easily in the past. And so sometimes when you're sick and when you have an infection, you just can't compensate as well.

Darleen Mahoney [00:17:43]:

Okay. Yeah. I just didn't understand the correlation of that because I know that when my dad had dementia, the very first thing when we took him into the neurologist is, we're going to check him for UTI before we do anything else.

Dr. Gerda Maisel [00:17:55]:

Yeah.

Darleen Mahoney [00:17:56]:

Yeah. And I thought, well, that's an interesting correlation.

Dr. Gerda Maisel [00:17:59]:

Yeah.

Darleen Mahoney [00:18:01]:

But of course, he didn't have one, and I pretty much knew he didn't have one. But, you know, you got to cover your basis for sure. So why would someone need to be hospitalized with the uti? I mean, is that something that you can get a UTI so. So severely?

Dr. Gerda Maisel [00:18:18]:

Yes.

Darleen Mahoney [00:18:19]:

Or repetitive UTIs, where you get rid of it and then it comes back that you just. It gets to that point.

Dr. Gerda Maisel [00:18:27]:

Well, as you know, older people are more. You know, it doesn't mean every older person, but there is more. Older people are more fragile. And if you are fragile, that UTI can overwhelm your immune system, and you can go from a simple UTI to an infection in the kidneys, which can be much more serious if that bacteria travel up the ureters to the kidneys. You can also, if you're really sick and you're not drinking, you can get severely dehydrated and require IV fluids. You can also just get really sick, and it can turn into urosepsis. That bacteria can work its way into your bloodstream, and then if you're septic and it's in your blood, then you're really at risk of including. Of death. People do die from. From UTIs that turn into urosepsis. And the other thing is that sometimes when an older person is just not well, and they go to the hospital, you're not 100% sure immediately what the cause is of their infection. It might be urine, it might be pneumonia, it might be a skin infection. And so sometimes doctors will admit and put on broad spectrum antibiotics. And until it becomes clearer exactly where the cause, what the causes of the infection.

Darleen Mahoney [00:19:52]:

Yeah. And definitely sometimes those antibiotics, they just don't work. What they're.

Dr. Gerda Maisel [00:19:57]:

Well, that the particular bacteria sensitive to the particular antibiotic, the antibiotic that was picked, or maybe they have a mild uti, but they also have pneumonia. It can get complicated. And so because the stakes are high, if somebody were to get a lot sicker, often older people are admitted for safety.

Darleen Mahoney [00:20:22]:

Yeah, yeah. It's tricky out there.

Dr. Gerda Maisel [00:20:26]:

Yes, it is.

Darleen Mahoney [00:20:27]:

It can be very, very tricky, especially as you get older, you know, identifying, you know, exactly what's going on in the body and making sure that you're targeting it. I know that with my mom, she had different things that were going on, and antibiotics would work, they didn't work. She'd go home and she'd be completely fine. They got rid of it, and then she'd have a relapse at home and then they'd, you know, she'd be back in the hospital. So, yeah, very tricky. And then something would work, and then all of a sudden she was good to go. I just. You just don't even know what's going on. But, yeah, so they definitely do their best. So with UTI preventions, we talked a little bit about that in the very beginning, really, you can do a lifestyle that helps with that, if that's a concern. Let me ask you this. With older adults, what are the percentage of older adults that are at risk for UTIs? Do you know what that might be?

Dr. Gerda Maisel [00:21:29]:

I don't want to give you a number that is wrong, but all I can. So I'm not going to quote you an exact number, but I can tell you that it's a very high percentage. You know, it is so common that it's something that everybody looks out for. And when I think about my patients and my clients as they age, it is the exception, not the rule, to meet somebody that never had a uti. They're very, very common.

Darleen Mahoney [00:21:57]:

Okay. Okay. So is that something that when patients come in for just a regular visit, you look for, like, as a standard practice?

Dr. Gerda Maisel [00:22:06]:

Well, so depends on. That's a broad question. In the sense, it depends on which doctor you're seeing. So some primary care doctors, that's something they pay a lot of attention to. Sometimes they have urology or the urogynecologist manage it. Sometimes geriatricians pay a lot of attention to it. Sometimes they're more focused on different symptoms. What? Now, I work as a private patient advocate, and part of what I help people know is which, under their circumstances, which doctors do they bring which questions to? Because what you just asked is really tricky. It is hard to know who you talk to about what and how you ask the question in a way that's going to actually get you the information you want to get to.

Darleen Mahoney [00:22:56]:

Yeah. And as we know, you have to advocate for yourself. So as you're seeing potentially multiple doctors. I'm at a time in my life right now I see one doctor. But we know some of our older folks are seeing multiple doctors, but making sure, hey, you know, uti, it's something I want to, like, stay on top of. Maybe I get checked once a year or whatever, just to run a quick course, culture or whatever. If that's something that they want to do, they may have to ask for it.

Dr. Gerda Maisel [00:23:28]:

They don't. Just so you know, we don't generally do surveillance, urinalysis or cultures.

Darleen Mahoney [00:23:37]:

Okay, that is good to know.

Dr. Gerda Maisel [00:23:39]:

The reason for that is that the bacteria that you have in your body can change over time. Actually, it's one of the reasons why women, as they get older, get more UTI is because as the. The their bacteria that are hanging out in their vagina change because the vagina becomes less acidic after menopause. So the good bacteria aren't necessarily there as much. But. So, no, we don't generally do a routine culture because the bacteria that's hanging out on Monday might not be the bacteria that's causing you to be sick two weeks from now. And hopefully, if we were to do a culture, you're not growing anything anyway. Your urine should be sterile. The only time it's going to grow something on a culture and sensitivity is if you have an infection.

Darleen Mahoney [00:24:35]:

Okay, so that would be the trigger for.

Dr. Gerda Maisel [00:24:38]:

Yeah, it's when you have symptoms. Yeah, no, no, it's a good thought. It's reasonable.

Darleen Mahoney [00:24:43]:

Hey, I live in the world. If I can prevent it before I get it, I am good to go with that. And I do know in the healthcare system, sometimes you have to advocate for yourself and you have to say, this is, you know, my mom died of ovarian cancer, so I'm going to advocate for myself to get that BRC test and make sure that I get it because no one else is going to do that for me. And all of those different Things. So that's just the other thing is I very much. And who. No one wants a uti. So if you can get a test once a year to see if you have a disposition for it, you know, I'm all in. But, yeah. So clearly it's something that, as you mentioned, that makes complete sense that especially in that area of your body, it's just changing all the time, so you really don't know what's, you know, one day to the next if you're. If you're going to be susceptible to a bacteria infection in that area.

Dr. Gerda Maisel [00:25:39]:

Yeah. So, I mean, to sort of summarize, the best thing you can do to prevent UTIs is to be hydrated to, you know, because the more you run water through the system, so to speak, the more likely you are to flush things out, deal with and prevent urinary retention. So address prostate issues and address, you know, if there is a problem, make sure you're checked for that. For women, it's use of estrogen cream. And then it's things like being careful with the medicines you're taking so you don't get urinary retention and getting catheters out early if one went in. And then, of course, as we talked about in the beginning, cranberry or other urine acidifiers can help prevent UTIs.

Darleen Mahoney [00:26:31]:

Yeah. Now, one thing I wanted to ask you, and this is a very basic question, and I know that I was talking to a friend of mine the other day that we were going to be doing this podcast, and I was excited about having this conversation. And she detests water, which. Yes. And so I don't get it because I live off of it. I have coffee in the morning, one cup. And then I am. Which I used to drink a lot of coffee. I've scaled way back, so I feel like I need a gold star. But now I drink a lot of water all day long, and the thought of drinking pretty much anything else I don't have an appreciation for. I mean, I did in my 20s and maybe early 30s. The Diet Coke thing, I was all in. But now the idea of that is just revolting. It's like cough syrup. So I don't get it. I don't get it. But for someone that doesn't appreciate just water, can you put different things that hydrate? Because I know there's all these little powders and all these different things that are supposed to help with hydration. Are those something that you recommend or. No.

Dr. Gerda Maisel [00:27:41]:

So the whole. I'll make two comments on that. One is electrolyte drinks. Electrolyte drinks are something that were developed for in the setting of, say, a professional football team that was exercising like crazy, running around, sweating in the heat. Those folks need electrolyte replacements. If you're unlucky enough and you have a lot of diarrhea or some other GI distress, you might need electrolyte replacement. Other than that, medically, you don't need to spend your money on neon colored electrolyte drinks. You enjoy drinking them. That's up to you. You want the food coloring and the calories, that's up to you. You, you know, the thing is about drinking, and this is something that is, is tricky in that one of the things that, that really bother women, especially as they age, and it happens to men too, is the symptom of urinary urgency. The I gotta go. You know, when you gotta go, you gotta go. And it can sometimes result in loss of control and it often causes people to really cut back. And I mention it because many of the things that we drink actually, as you get older and I'm taught, you know, can, can cause the bladder to become irritated. And then people out there get diagnosed with overactive bladder without somebody telling them, you know, it might be what you're eating and drinking that's irritating your bladder. You should give a try to cut back on coffee or tea or. I had one, one guy, actually a client of mine, recently loved lemon water. Sounds like the best thing in the world. And one of the things as we were talking that he had been telling me about was that he doesn't even want to leave the house because he has so much sense that he needs to go. When he, when he goes out, he pees. Right before he leaves, he goes somewhere, he sits near the bathroom because he's so afraid of losing control of his bladder. Well, as we talked through things and I realized how much lemon water plus soda he was drinking. When he was able to wean that down, he switched to herbal teas and got rid of the soda and just uses a lemon water now a little bit more dilute. And just as a treat, the urgency went away because in his case, he was experiencing a lot of bladder irritation. So that's why I say water, because water won't irritate the bladder. But most of us don't like drinking just plain water. And for anybody that's experiencing urinary urgency, you do have to think about whether the tea, coffee, or acidic beverage you're drinking is actually irritating your bladder, making it less likely you're going to Drink, making it more likely you're going to get a uti.

Darleen Mahoney [00:30:49]:

I do think if you start the habit of drinking it, you'll start to.

Dr. Gerda Maisel [00:30:52]:

Really like it works for some people.

Darleen Mahoney [00:30:56]:

I mean, I really do because I was not a water drinker, but now I'm just. I crave it. So I crave it immediately when I get up in the morning before I even have coffee. So I think that you can develop a habit for it. So I mean, at least give it a whirl.

Dr. Gerda Maisel [00:31:11]:

Habit is powerful and water is the best thing to drink if you can.

Darleen Mahoney [00:31:16]:

Yeah, yeah, absolutely. Absolutely. Well, before we sign off, is there anything else that we haven't chatted about regarding UTIs that you think our audience would be. Would find helpful?

Dr. Gerda Maisel [00:31:28]:

The only, the last comment I leave people with is you don't have to suffer repeated UTIs. The vast majority of people if they go to see a doctor. And again, I'm going to advise women, go see if you can find a urogynecologist. They tend to be a little more comprehensive and more attuned to female problems. But whether you see a urologist or urogynecologist or your family doctor, don't just live with it, try to get it treated. It's not something that's just the way it is when you get older. It can be addressed and the frequency can be. You can diminish the frequency.

Darleen Mahoney [00:32:09]:

Yeah, no, I love that. I appreciate that. I so appreciate you coming on the podcast and sharing some of these insights. It's such a much needed conversation that I don't think people really talk about. So I'm glad that we were able to discuss it today on the podcast.

Dr. Gerda Maisel [00:32:25]:

My pleasure.

Darleen Mahoney [00:32:27]:

Yeah, absolutely. And as I mentioned, we're going to include the links to both the sub stack to the monthly essay and it is free, as Dr. Maisel mentioned. So there is that. And then also she has a website where you can learn more about her. It's called My MD Advisor and it can be found at www.mymdadvisor.com. we'll include that link as well. Again, it's mymdadvisor.com and you can get to know Dr. Mazo a little bit more at that link. And I think that that's it for this podcast. If you enjoyed listening to this podcast, you can listen and find us anywhere you enjoy music or podcast. We have over 115 episodes available with all kinds of different subjects.

Dr. Gerda Maisel [00:33:25]:

Thanks for listening.