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(Dr. Peter Salgo)
Welcome to Second Opinion where each week our healthcare team solves a real medical mystery. When we close this file in a half-an-hour from now you'll not only know the outcome of this week's case, you'll be better able to take charge of your own healthcare. I'm your host, Dr. Peter Salgo, and our story today concerns Phil. Now you've already met our special guests and we're joining Primary Care Physician, Lisa Harris, and Health Reporter, Kat Carney. No one on this team knows the case, its right here in the chart. So let's talk about Phil. Shall we? Phil is a 42-year-old production line worker in a packing plant in North Carolina. He is 5'7", 220 pounds and he has been brought to the emergency room by an ambulance. He is suffering from abdominal pain. Lisa there you are. You're up.
(Dr. Lisa Harris)
Wow. I mean I can think about 500 things that go into differential diagnosis.
(Peter)
You must have gone to medical school.
(Lisa)
Somewhere along the line.
(Peter)
Anything you want to know?
(Lisa)
Well where's his abdominal pain?
(Peter)
The abdominal pain is on the right side, its back here.
(Lisa)
Did it move anywhere?
(Peter)
It's radiating a bit down his right side towards his right testicle. And he is, by the way, having difficulty speaking. He was having waves of pain, that's the word he keeps using, down his right side. When he got to work this morning it got worse, so his co-workers called 911 and he was brought in by ambulance. What's wrong with this guy?
(Lisa)
Well there's a variety of things. You're talking about pain that's in the back that's radiating down towards the front, so you want to think about the kidneys. You want to think about the appendix. You can think about the gallbladder. I mean we have, we don't have enough information to really narrow down the diagnosis at this point.
(Peter)
Any other information you want? I got some here if you ask for it.
(Lisa)
Yeah. And when did this pain start for him?
(Dr. Peter Salgo)
It apparently just started that day. I got some vital signs.
(Dr. Lisa Harris)
All right.
(Peter)
I think you'd like those. His pulse is 124. His blood pressure is 150 over 70. His temperature is normal. There's no guarding. When you push on his abdomen it doesn't hurt when you release. His urinalysis shows some blood. And what else can I?
(Lisa)
Well his vital signs are telling us that he's in pain. So the elevation of his blood pressure and his rapid heart rate are telling me that this is a response, a pain response. The fact that he doesn't have guarding kind of takes you out of a surgical abdomen realm, so we don't need to grab surgery immediately. And it makes you think about other prosthesis. It may mean a retroperineal in the kidney.
(Peter)
His urine had 4+ blood in it. There's many RDC's microscopically and one to four white cells in the urine. What do you want to do?
(Lisa)
I would like to get an ultrasound or a CAT scan of the abdomen.
(Peter)
Well that's what they did. The CAT scan shows a stone in his right ureter. There's mild uretal dilatation on the right. The stone is radio dense; it means it shows up on x-ray. It's eight millimeters. And there's no hydronephrosis but the ureter itself is dilated. What does all this mean? You're the urologist here.
(Dr. Jean Joseph)
Well going back to the symptoms. Colicky or pain that comes in waves and the sudden onset of it quite characteristic of kidney stone. The stones typically are formed in the kidney. And they try to pass out of the body. The can get stuck along the way in the ureter, which is a tube that drains the kidney into the bladder. So a lot of stones pass on their own because they're small. Urologists don't see most stones where they pass on their own but this stone is eight millimeters. Most stones seven millimeters or above do not pass spontaneously.
(Peter)
So this is big enough to fit that category. And it sure sounds like Phil is in agony. So the question I have and I'm sure the question everybody has is what makes him hurt so bad. Why do they hurt?
(Jean)
The ureter is contracting, trying to pass the stone. And every time it contracts, that's the wave, the colicky pain that you have.
(Peter)
Now Steve, you've had kidney stones.
(Steve Jasinski)
Yes.
(Dr. Peter Salgo)
How much did it hurt you?
(Steve)
Apparently I had small stones because they never really hurt me when I was passing them until I got in trouble.
(Peter)
But then it hurt.
(Steve)
I had several stones or bigger stones.
(Peter)
So if he didn't feel as much pain as Phil is feeling now, why is there variability here?
(Dr. Rebeca Monk)
I think it's partly due to the stone's type. Some stones are more sharp and spiny as they go down. Others are smoother. It also depends on the size, as it goes. Most.
(Steve)
Are not smooth.
(Rebeca)
That's right.
(Peter)
What on earth is a kidney stone?
(Jean)
Most kidney stones are a calcium stones and you have others, which are uric acid stone, cystine stone, and struvite stone. But 80 percent of kidney stones are made of calcium.
(Peter)
They're hard. They're sharp. And as I understand it, from what you told me, when that ureter, that duct leading out of the kidney squeezes down on that sharp angle, that hurts.
(Jean)
That hurts.
(Peter)
Well Phil is hurting. In fact he's screaming in pain. So what do you want to do for Phil right now in the emergency room?
(Lisa)
Call the urologist.
(Dr. Peter Salgo)
All right.
(Lisa)
No. We're going to start an IV, and we're going to give him some hydration. We're going to give him some analgesics to try to get the pain under control.
(Peter)
Jean what do you want to do with it?
(Jean)
Given the size of it and the severity of his pain, you will need something done. And first of all, controlling his pain, hydrating him.
(Peter)
Now is the pain control there to make him less painful or does it actually help a stone pass?
(Jean)
Well the pain control, number one. Make him comfortable. And there are other things we can use, non-steroidals can help a stone pass as well but the actual narcotic will not promote stone passage it itself.
(Peter)
Alga stones you see. Do most pass? Or do you have to intervene most of the time?
(Dr. Jean Joseph)
As an urologist, when the patient is referred to us it's typically because a stone that needs intervention. But most stones do pass.
(Kat Carney)
Well Peter I feel unclear to what typically causes kidney stones or is there any typical cause?
(Peter)
Is there a typical cause?
(Rebeca)
I think many patients are, there are familial predispositions to forming stones. Some patients have a family history of kidney stones. And then often not drinking enough.
(Kristina Penniston, Ph.D, R.D.)
It's a huge cause. And he lives in North Carolina, that's a hot climate and we tend to refer to the southern United States as the stone belt because.
(Peter)
I was wondering if somebody was going to mention it.
(Kristina)
People do tend to form stones more in dehydrated conditions. And he may be in a situation as you intimated in describing his work situation where he's not allowed to use the restroom or he's not, and so then he restricts the amount that he drinks. He self censures, or so to speak, so that he doesn't have to urinate as much. So yeah, I'm concerned about the hydration status, absolutely. But there's other nutritional factors as well.
(Dr. Peter Salgo)
But what you're implying, at least in part is, that because he gets dehydrated the urine gets concentrated.
(Kristina)
It gets super saturated. And that's the first step for crystallization.
(Peter)
I guess folks when they make rock candy with a string, that's the same sort of thing. The sugar crystallizes.
(Kristina)
Exactly.
(Peter)
And here you got rocks in your kidneys, in your ureter.
(Kristina)
Because urine has super saturated and crystals have been allowed to form. And then when they are retained in the kidney for any length of time, they can grow into larger stones.
(Peter)
Then they go down the ureter and they hurt and somebody calls you.
(Lisa)
I think its important again to point out that many stones pass on their own, and people may come in with abdominal pain, colicky, you know, what you call retro peritoneal flank pain that radiates towards the abdomen. We get a UA and you may see.
(Peter)
UA's an urinalysis.
(Dr. Lisa Harris)
Urinalysis. And you may see some blood in the urine and nothing else. And that's really the only clue that we may have that somebody may or may not have had a stone.
(Steve)
That's how I knew that I had my first stone. I had blood in my urine.
(Peter)
Well let's tell you what happens to Phil. Because Phil is in the emergency room. They gave him some hydration. They gave him some powerful analgesics to make the pain go away, and then they sent him home. They gave him a filter and wanted him to pee into a filter to catch the stone that sounds familiar to you?
(Steve)
Yes.
(Dr. Peter Salgo)
That's what they told you to do?
(Steve)
Yeah.
(Rebeca)
I think that stones just too big.
(Lisa)
You're not going to pass that.
(Rebeca)
That's what worries me.
(Peter)
They told him to come back and see his primary care physician
(Lisa)
Of course.
(Peter)
in a week. So does this make you unhappy or does this make you happy?
(Lisa)
Yeah. I mean I would have tried to set up the urology consult while he was in the emergency room and not waited a week for him to see his primary care doctor. To then call the urologist another week later.
(Peter)
Is that what you would have done, or would you have admitted him?
(Jean)
Well I would try and control his pain. If it's controlled with P or pain medication, we can delay treatment a couple of days or see how he does. If he's not showing sign of or he's like in sepsis or infection then you can still manage him conservatively at first.
(Peter)
Well let's pause for a second and sum up where we are. For most individuals the acute onset of kidney stones occurs when the stone enters the ureter and causes severe pain. Now surprisingly the initial treatment can be simply water, hydration, and analgesics. That's what they did for Phil. Well guess what. It's a week later, what do you think? Phil's back in his PCP's office. That would be someone like you. And he's still on medication. Still drinking water and he's still has some colicky pain. Now clearly it's not the same kind of agonizing pain that brought him in the first time. Does this mean that he still has a stone?
(Lisa)
It doesn't necessarily mean, he can still have a stone. He could have passed the stone and still have some dilatation or dysfunction of the ureter. He may have some hydro nephrosis. He may have a new stone that is formed. And he would need a repeat study done to see what's going on.
(Peter)
What do you think is going on? Does he still have a stone? He's still having some pain?
(Jean)
Most likely.
(Peter)
Let me be the devil's advocate here. Phil's feeling okay. He's on his meds. He's taking some fluids. If you wait too long, with this stone that's still there. You think it may still be there. What's he risking with that stone in his ureter?
(Rebeca)
Well if that stone does end up blocking the flow of urine through the ureter then that could case obstruction of all the flow of urine through, out of his kidney and it might lead to some damage in his kidney but probably you have, you can buy some time if he's not having severe pain and if its not blocked right now.
(Dr. Peter Salgo)
Well he already had a distended ureter, right?
(Dr. Rebeca Monk)
Right.
(Peter)
So what causes the kidney damage from the stone, if it's obstructing the ureter?
(Rebeca)
Back up of flow, reduces the kidney function, at least temporarily. If you have very large stones that really block for a long period of time, you can have reduced kidney function long term.
(Peter)
Well I can tell you what happened with Phil. His primary care physician said, this is a job for an urologist.
(Lisa)
Perfect.
(Peter)
You get the phone call. He comes into your office. And he says, look I've been taking my fluid. I've been taking my powerful analgesics. I'm still having this kind of crampy pain. What are you going to do for Phil?
(Jean)
At this point recurrent pain and Phil wants something done.
(Peter)
Yep.
(Jean)
And the option of observation is no longer warranted at this point.
(Peter)
So you're going to do some urology here?
(Jean)
Absolutely.
(Dr. Peter Salgo)
What does that involve?
(Dr. Jean Joseph)
I would give him the options. For a stone this small, again what we would do is most likely break the stone using shock waves.
(Peter)
Back when I was in medical school, and shortly thereafter, somebody had a stone like this and we were talking kind of big time surgery. I mean you were going to cut him open. Find the stone. Take it out. And sew him back up.
(Jean)
Those days are long gone.
(Rebeca)
They're long gone.
(Peter)
They're long gone. Notice the way he says long gone.
(laughter)
(Jean)
No. I don't believe anyone in training now is doing any surgery for stones disease. Anyone at all, at least open surgery.
(Peter)
No more open surgery. Now the first thing you mentioned is this sound wave stuff. What is that all about?
(Jean)
New technology that came around in the '80s. We position the patient on the table and using x-rays or phoroscopy we can visualize the stone and direct shock waves at the stone.
(Peter)
These aren't electrical shocks right?
(Jean)
No, no.
(Peter)
These are pounding water hammer sound waves?
(Jean)
Correct.
(Dr. Peter Salgo)
Okay. Then what happens?
(Dr. Jean Joseph)
And the stones get pulverized.
(Lisa)
Called super sonar.
(Peter)
Super Sonar.
(Dr. Lisa Harris)
Uh huh.
(Jean)
It gets pulverized and it passes in the urine. It's a same day type procedure in and out. They will give anesthesia, put him on the table, and nowadays the machine we use you don't have to go in a tub like people used to, have to be in a tub.
(Peter)
You used to be in a big bathtub.
(Jean)
In a big bathtub, so it's a gel interface that's put next to the people's skin. And through that the shock waves are sent to the stone after the stone is localized.
(Peter)
So it's like a sledgehammer banging on your back?
(Jean)
(laughs)
Well it can be perceived as you do hear it as such. And the end, the person may see some bruises on the skin as well.
(Peter)
Now see that's what you had. What was that whole procedures like from the patient's prospective?
(Steve Jasinski)
It was fine while I was asleep.
(laughter)
(Steve)
When I was in the recovery room I experienced a lot of pain.
(Peter)
A lot of pain.
(Steve)
They left one of the stints in and I apparently, the sludge or whatever was coming down from my ureter and it was just incredibly intense pain.
(Dr. Peter Salgo)
On a scale of one to ten?
(Steve)
Ten or an eleven.
(Peter)
Okay. What are the options?
(Jean)
If the stone is close to the bladder an option will be to put the person to sleep and go in with a tiny little scope, which has a light at the end of it fiber optics and actually use a grasper and pull the stone out. Somehow we can use all the types of energy to break the stone in small fragments so we can pull it out first.
(Peter)
You make it sound so simple. Let me see if I can delineate what you're talking about. When you say you go up there to get the stone, you're going through the urethra, which is where the urine comes out. Up into the ureter, that small tube, with a very small thing. And go wiggle it up as far as you can until you hit the stone and then you take a basket and grab it and yank. All right.
(Jean)
Correct.
(Peter)
Correct!
(Jean)
We can do that.
(Peter)
Urologists make it sound so easy as it is.
(Dr. Jean Joseph)
Well we have a small instrument and they are routine procedures nowadays.
(Kat)
Well in this situation, both of the patients are male. Do kidney stones present differently, does the experience present differently in women? Is the treatment different?
(Rebeca)
It effects men more frequently then women, usually at a ratio of two to four to one, men to women. So men tend to get them more often then women. But women do get them also.
(Kat)
But would a woman have shown up with the same amount of pain, with the same type of symptoms?
(Kristina)
Yes. But I think that's a great question because the incidence of stones is rising in women, faster then it is in men. And so I think we should get a handle on recognizing the pain and treating it appropriately.
(Kat)
Why is it going higher? Faster?
(Kristina Penniston, Ph.D, R.D.)
We're not sure. We're not sure but we think that dietary concerns and lifestyles has a lot to do with it. Because genetics can't influence change.
(Lisa)
Holding your urine because you're working all day long. Not hydrating yourself and I mean there are a lot of things that can affect them.
(Dr. Peter Salgo)
I want to go back, if we can, to something that's confusing me about your particular case. All that pain, you said was in the left. After you had your lithotripsy. In the experience of the docs here, all of us here, is that typical? Its not what I've seen with lithotripsy, is it what you've seen?
(Kristina)
The patients that I hear don't complain of that type of pain after extra corporal shock waves in particular. They describe the pain at minimal at best. And it's uncommon in my experience.
(Rebeca)
But it is important to say not all stone types crush as well as others. Some stones, calcium oxalate, monohydrate type stones, certain types of stones are harder to crush and they may fragment as completely.
(Kristina)
So people's response to pain is highly individual and we know that ureters are of different sizes and there are anatomical concerns so some of that may have played into his relatively pronounced pain.
(Lisa)
You know the ureter wasn't meant to be stretched. And there are nerve fibers that are connected to that. So if you're stretching it, it does hurt. From someone's who's also had kidney stones and childbirth, I can tell you the stones are worse.
(laughter)
(Peter)
I'll tell you what Phil has. Phil's lithotripsy went fine. He did not have this kind of postoperative pain, the kind that you had, and that's good for Phil, I'm sure. They tell him that his stone is gone. He feels better in a few days. And so let's take a moment here to sum up where we are and then we'll go forward from there. If a kidney stone does not pass on its own, it must be removed mechanically to avoid kidney damage. It's just straightforward. And there are lots of ways of doing it. You can grasp it. You can put it in a basket. You can break it up with a lithotripsy. So Phil is feeling better but his urologist decides that its time for a closer look at Phil, not just his kidney, but Phil, and Phil's entire body is sent to the nephrologist. Why would they do that?
(Rebeca)
Well they want to know what Phil did to cause the stone. And it's important to do a metabolic evaluation of his blood and his urine to try to figure out why he's forming these stones. So one thing you want to know is if it is a calcium stone, since can see the stone on an x-ray, it may be a calcium stone. Either calcium mixed with some other substance.
(Peter)
I do know this because they did an analysis on the stone.
(Dr. Rebeca Monk)
Okay. Oh what kind of a stone is it?
(Peter)
They tell me that it was, in the chart it says it was calcium oxalate stone. So you guessed right.
(Rebeca)
Okay. It's a calcium oxalate stone. And you want to know, is his does his blood level of calcium high, anything that raises your own calcium level in your blood will make you excrete more calcium into the urine? So you want to rule out certain things that might cause stones in his medical condition.
(Peter)
Well let me give you some numbers here, if you'd like, because as I understand it, what you're looking for is those things in his body that would predispose him to make stones. His vitamin D level was borderline high. His calcium is borderline high. His urinary sodium was high. Absolutely high.
(Kristina)
Was that 24 hour urine excretion or?
(Peter)
Yeah. Of sodium, and his total 24-hour volume of urine was about a liter-and-a-half. 1.6 liters. I can tell you the actual number for his urinary sodium is six grams a day. What does all this tell you?
(Rebeca)
Wow.
(Dr. Peter Salgo)
Is that high?
(Rebeca)
That's very high.
(Peter)
When you said, wow. I mean when a doctor says wow it generally gets my attention.
(Rebeca)
But it's probably not that abnormal for most people in the United States so they eat a very high sodium diet. Yeah.
(Kristina)
I think that's typical.
(Rebeca)
Yeah.
(Kristina)
That's the typical American intake of sodium. And the reason why we know that there's approximately his intake is because 24 hour urinary sodium is about 95-99% reflective of intake. Because our bodies need so little sodium that the kidneys basically excrete all that we eat. So that's an excellent measure of his dietary intake and it is too high and it will cause hypercalcuria.
(Peter Salgo)
Was it too much calcium in his urine?
(Kristina Penniston, Ph.D, R.D.)
Right. It could be a contributing cause. He could have other causes for the hypercalcuria.
(Peter)
Now wait, I thought you were talking about sodium?
(Kristina)
Well we are. But sodium.
(Peter)
So why does that cause increased calcium?
(Kristina)
Because the concern for sodium with kidney stones is that sodium increases the amount of volume that the kidneys have to handle and it sort of flushes out calcium as an innocent bystander. So its calcium that really the kidney should be reabsorbing and putting back into his bloodstream to be put back into bone but because we have to work so hard to get rid of the sodium, the calcium is flushed out as well. And that of course forms stones.
(Kat)
Wouldn't he have been sent home with any nutritional information or any nutritional guidance after this first incident?
(Jean)
The usual advice, I tell patients three things that cause a stone to form, your not drinking enough fluid, you're not drinking enough fluid, and you're not drinking enough fluid.
(Peter)
When I said he only had about a liter-and-a-half of urine per day, you perked up. You perked up. Is that too small?
(Kristina)
Yeah.
(Dr. Peter Salgo)
Does that mean he's not drinking enough fluids?
(Lisa)
Yeah, probably.
(Rebeca)
Usually you want to have at least two liter, two, two-and-a-half liters so its not that bad. We see a lot of people who don't drink. Who drink a lot less and make less, less urine.
(Peter)
Given all this information, what's in Phil's future? Is he likely to form more stones or is this is?
(Kristina)
The recurrence rate is very high, 50% within the first five years and 80% within the ten year, so his chances are quite good that he'll form another stone.
(Peter)
You know, Phil has, with many patients is out there in the ozone on the Internet. As they all do these things. And Phil has read about this calcium problem and he says that calcium comes from dairy. So Phil, on his own has cut down the dairy from his diet. Does that protect him from kidney stones?
(Rebeca)
No it does not.
(Peter)
That's a myth?
(Kristina)
It's probably increasing his risk for kidney stones.
(Peter)
But calcium causes stones, you told me.
(Kristina Penniston, Ph.D, R.D.)
But you have to have appropriate calcium in a diet to (a) to maintain calcium balance and bone status, but also to bind oxalate in a GI track.
(Kat)
Would someone had, you know, had a consultation with him about what his diet should have been so that he just wasn't sent of to get on the internet and figure it out on his own. I mean you know.
(Kristina)
But the question is pertinent, is she's asking would he have been given this advice. And unfortunately I don't think as many people who form stones get nutritional advice as needs it. And I think there are many nephrologists and urologists actually who do work with nutritionists or recommend to seeing a nutritionist but I don't think that's the norm.
(Peter)
But that implies that nutrition information is useful if you can do something. So what would you advise Phil to do?
(Kristina)
He should have appropriate amount of calcium. He should eat plenty of fruits and vegetable that provide potassium to maintain an alkaline environment in his body to prevent hypercalcuria. And he should eat as little sodium as possible.
(Peter)
But you need to say is that vegetables can give you oxalate.
(Kristina)
They can.
(Dr. Peter Salgo)
Which vegetables?
(Kristina)
Well there are only a few vegetables that are known to cause high urinary excretion of oxalate. These are primary spinach; beets, both the roots and the greens; tea, black tea and green tea actually; chocolate; and rhubarb; which everybody eats a whole lot of. And also nuts and nut butters, like peanut butter. And we find that people can still enjoy these foods and they're healthy foods, let's face it. Who are we telling not to eat spinach to these days? But they can still enjoy those foods if they're sure to have calcium with every meal.
(Peter)
Steve, did you change your diet? What happened?
(Steve)
I did. I reduced my sodium intake.
(Peter)
Okay.
(Steve)
And started drinking a lot more water.
(Peter)
Any strawberry rhubarb pie in your future here.
(Steve)
When I finally had this big problem I got a list of foods that were high in calcium oxalate or oxalate and reduced my intake of those.
(Peter)
Would you like to know what's happening with Phil? Phil went home and was given the dietary advice, in fact that you got Steve. And he did his best to keep to it. Went to see his nephrologist who checked his 24-hour urine collection for sodium and calcium, no change. Nothing different. Does that surprise you?
(Rebeca)
Not really. Some people continue to form, that excrete a lot of calcium despite the diet and some people just can't follow the diet, I think. So then there's medications that can be used to reduce the amount of calcium that comes out in the urine as well.
(Peter)
There are medications, like what?
(Rebeca)
Simple diuretics, Chlorthalidone, hydrochlorothiazide. There are blood pressure medicines diuretics that can very dramatically reduce the amount of calcium that comes out.
(Steve Jasinski)
That's another thing that I did. I started taking HTD.
(Kristina)
But he still needs to reduce his sodium, let's say.
You can maximize the efficacy of that drug with a low sodium diet. But he still needs, it's a challenge, it's not a barrier. We shouldn't say Phil is, you just can't follow the diet. We should try harder. And so he needs to meet again with the dietician and he needs to be counseled specifically in how to reduce the sodium.
(Peter)
Well with all this laboratory, do you think Phil had another stone?
(Lisa)
Yep.
(Dr. Peter Salgo)
Yes indeed. Phil came back in pain again with another stone. And this time, his doctor said maybe you're not doing this diet right and Phil said, well maybe I'll try harder. And that seems to have done it for Phil. He didn't have another stone, at least in so far as I can see in the chart. Now Steve, you did change your diet.
(Steve)
Yeah.
(Peter)
Did that affect the number of stones you've had and then the frequency with which they've occurred.
(Steve)
I've been stone free for three years.
(Peter)
Simply by diet changes?
(Steve)
Yeah.
(Peter)
No medications.
(Peter)
Oh, you're on hydrochlorthidine?
(Steve)
Yes.
(Peter)
And that's all it took? Diet change and a diuretic?
(Steve)
I changed my geographic location.
(Dr. Peter Salgo)
But you moved.
(laughter)
(Peter)
You moved from the Pacific Northwest into the stone belt.
(Steve Jasinski)
Stone belt. Yeah.
(Peter)
So if anything it should have gotten worse.
(Rebeca)
Are you drinking more?
(Steve)
I'm drinking more water because I'm in a tropical environment.
(Rebeca)
Tropical yes.
(Peter)
A tropic. I'm sure the folks in Tuscaloosa will love to be called tropical. So let's pause for just a second. I want to follow up on that but I do want to sort of sum up what we've been assessing for the past few moments. Long-term prevention of kidney stones is possible for most patients if they stick to a prescribed diet. For starters, you need to drink a lot of fluid. You got to follow a low sodium and a normal calcium diet. That makes sense. Now you're doing better. Tell me about what your life is like now. Do you miss the diets you used to be on?
(Steve)
No, not at all. In fact I'm on a better diet now then I was before.
(Peter)
You're feeling healthier?
(Steve)
Absolutely.
(Peter)
I want to thank all of you for being here. Thank you so much for sharing with us. I know that urologic problems are not the most comfortable things to discuss with a large television audience but again; it was kind of you to be here. Thank you all. Let's cover up a number of things that we spoke about today and summed them all up. A couple of key things to remember, for most individuals the active onset of kidney stones occurs when the stones enter the urine. Initial treatment, includes water and analgesics, maybe the stone will pass. If the stone does not pass on its own, it must be removed mechanically to avoid kidney damage. Long-term prevention of kidney stones is possible for most patients. For starters, you got to drink a lot of water. You should follow a low sodium, normal calcium diet. You should talk to a dietician if you can. And of course, our final message is always this. Taking charge of your health means being informed and having quality communications with your doctor. I'm Dr. Peter Salgo and I'll see you next time for another Second Opinion.
Fe(Announcer) Search for health information and learn more about doctor patient communication on the Second Opinion website. The address is pbs.org.
(Announcer)
Major funding for Second Opinion is provided by the Blue Cross and Blue Shield Association, an association of independent blue plans, committed to better knowledge leading to better, more affordable healthcare for consumers.
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