and good evening.

>> Thank you so much for watching HealthLine here on PBS Fort Wayne.

I'm your host Mark Evans tonight we'll be talking about kidney stones rather common ailment but sometimes we don't know if we have those.

We need to know some of the symptoms so we can have those checked out because they can cause some problems in your health and our very special guest tonight who is a concurrent guest you keep coming back and we always have great shows when you're on Dr. Scott Palmer.

He's a urologist and we always have very interesting shows when he's on he's a very candid speaker and he'll address your problems, your concerns and we'll appreciate a phone call at two six 866- (969) 27 two zero.

We'll take your calls throughout the entire half hour.

Of course we don't stop down for commercials because we are a public television and we keep those calls coming in as I go ahead and get the the the show rolling.

Certainly not a rolling Stone but kidney stone.

>> Dr. Palmer, can you explain I'm sure you can want a kidney stone is well basically it's if you think back to high school chemistry, it's basically assault.

So you're combining a positive charge structure with the negative charge structure they combine to form a solid and they crystallize and and then over time they roll and ironically kidney is going to sit in your kidney for years without even being aware of it.

And then just one day they'll try to pass and you start a lot of pain or other issues like blood and urine but they're basically a type of salt, OK?

>> And I know too from a little of the research I did before the show starts and I didn't know this but there's more than one type of kidney stone there are the vast majority of kidney stones are a calcium based about 80 percent between 80 and 85 percent are calcium based.

But that isn't to imply that calcium is the primary cause of kidney stones but that they are primarily calcium based.

But there are other ones that are based in other types of chemicals such as what's called uric acid.

There's also maybe sometimes referred to as infection base stones.

So there are different types of stones out there.

There's a rare type called Testin Stone which is based on a genetic abnormality but there are multiple kinds of stones.

>> So when you say genetic abnormality that means it runs in the family?

>> Yes, it's inherited through the family.

It's quite rare.

It only represents about one percent of kidney stones but it's actually a genetic defect within the kidney itself.

>> All right.

And how common are kidney stones?

I've heard of people throughout my life who have had them off and on but how common are they among are people very common really as a man about one in seven men their lifetime will get a kidney stone and about one in ten women.

Although the gap is starting to narrow, we're starting to see more stones in women in the past few years they represent about half a million E.R.

visits a year.

So there there's significant health hazards with kidney stones and represent a large portion of our Medicare dollars in treatment.

>> So is it age related?

Well, we know that the Internet does increase as you age.

>> We know that the peak incidence is typically middle age, OK?

And from the American Medical Association I happen to come across an article today I thought was very interesting and says the prevalence of kidney stones in the United States increased from three point eight percent in the late 70s to eight point eight percent in the late 2000s.

The prevalence of kidney stones was 10 percent during 2013 and 14 and the risk of kidney stones is about 11 percent.

I think you mentioned that a nine percent in men.

My question is is are they growing the number of cases growing because of the population in GRRL is growing or is it because of eating habits?

>> How do you attribute that?

You know, that's a good question.

I'm not sure we totally know we know that worldwide the incidence of kidney stones is going up and there are theories as to why that is.

Some people believe it's just because as a population we're becoming unhealthier.

We're seeing higher levels of diabetes and obesity in other risk factors for kidney stones but no one knows for sure.

But the worldwide incidence is increasing and particularly among women and also non Caucasian ethnic groups.

>> I don't you find it amazing this is a little bit off track.

I don't even have this in my series of questions.

But with all of the knowledge we've gained especially I'd say in the last couple of decades all the research that's been done on how to take care of your body, things to do and things not to do, why are these constantly being risen these numbers I mean aren't people listening or are they taking the easy way out as far as nutrition and eating the best types of foods?

>> I mean really well, I think that's a question you could apply to our entire health care system, correct?

I mean it's it's one of those things where as as researchers and clinicians you can constantly try to talk to people about what they should do as far as their health .

But it's always a challenge and unfortunately know a lot of people will tend to lean towards easy lifestyles and not always take care of themselves and you start to see the instance of all kinds of diseases increasing and kidney stones is one of them.

Yeah, but as far as exactly why that is is it hard to say?

>> It's just amazing to me and we do shows like this to educate people but we keep seeing those numbers go up.

>> Yeah.

All right.

Well well there ought to be some research on that.

It's probably will be all right.

We talked about some of the the risk factors of the people involved in those risk factors.

But how about children?

>> Are they common in children?

No, not real common in children.

Typically they do occur in children.

There's going to be some kind of metabolic issue that you're not aware of or some kind of familial passage of some kind of problem.

>> But really in children in our practice we see it but it's not a real common thing.

OK, I noticed some hospitals even have a special ward for children in the pediatrics area for kidney stones and I believe that was attributed also to nutrition if it was an inherited well I mean nutrition is always a factor and I do get questions quite a bit from patients.

>> I'll say well I can't believe I'm getting a kidney stone because I'm eating a really healthy diet.

But ironically some of the healthier foods can be implicated more in kidney stones and unhealthy foods.

But in general though, people that are unhealthy as far as being heavy a diabetic and things like that do have a higher risk.

But eating a healthy diet in and of itself is not a guarantee for preventing kidney stones.

>> All right.

If you're just tuning in, we're talking to Dr. Scott Palmer who's a urologist.

>> We're talking about kidney stones tonight here on Health HealthLine.

Let's move on to the next question here you went over this a little bit, but I want to get into this a little bit deeper so that our viewers can perhaps maybe reduce their chance of getting kidney stones.

>> But what causes kidney stones?

Well, it's a it's a fairly open question really.

We talked about diet and health and genetics and so there's multiple causes and you know, we've been doing research on kidney stones for many, many years and we don't really have everything figured out.

But we know that certain diets, certain predispositions, certain diseases are factors.

Medications could be factors.

You know, when I evaluate people for causes for kidney stones, the most common thing I find is probably inadequate.

Hydration is a very common cause but it's not always simple.

You'll see people there are forming numerous kidney stones.

>> You can't necessarily always pin down the exact cause.

Well, we're going to stop here for just a second and Linda is requesting to stay off the air which is just fine.

I can read her question and she's asking what other problems?

This is a good one.

What other problems can be can let's see I'm sorry it's moving around here.

What other problems can untreated kidney stones cause that's what she's asking.

>> Well, it's a really good question.

As I mentioned earlier, kidney stones can be in your kidney for years without even being aware of it in a lot of it would depend on the type of kidney stones you're dealing with.

So for example, I mentioned infection based kidney stones so particularly in women you'll see certain kidney stones that develop because of some bacteria that cause chemical changes year which can lead to formation of kidney stones and once they start to occur it becomes kind of a vicious cycle where you have more stones you have the more bacteria have the more stones you develop and just keeps going and those kids don't have the kidney stones would necessarily cause a lot of pain.

But if they're in there for a long time they can gradually erode the kidney and they can also inflammatory changes some inflammatory pain.

And we know that from research that if people that leave those stones long down the road can have serious health consequences from that and the long term consequences of kidney stones and brushed on that.

But chances are if you've got them the first time you're going to have them again.

Yes, that's exactly right.

Statistically once you have one you have a higher risk of having more.

>> OK, let's go to line four with Michael.

He has a question for Dr. Palmer.

Go ahead, Michael.

I was just curious whether they are inherited.

My mother had them very bad all the time and three of us eight kids also have them and also is there any way that we can flush them?

I have to living in my right kidney at this time and I was just curious if I can get rid of them.

>> OK, great question.

We know the family history is definitely a significant factor in whether or not you're going to develop kidney stones but there are people that will get kidney stones even though they have relatives.

It wouldn't necessarily be directly related but we know that it is a big risk factor.

So can they be inherited?

Yes.

I mean you can definitely inherit traits that can predispose to getting kidney stones.

We've actually done research to try to identify are there specific genetic things you inherit and it's been kind of hard to pin down.

>> We think that there's kind of multiple loci is what they call them as far as causing kidney stones.

But can you inherit them?

Yes.

As far as fleshing out the kidney stones, you know, one of the more common things that I will talk to patients about is when they're passing a kidney stone should I drink lots and lots of liquids and try to flesh it out?

And research ironically has shown that drinking lots of liquid while you're passing a stone doesn't necessarily increase your chances of passing it.

But in terms of trying to get rid of the stones once they're there, typically you can't get rid of them with just drinking extra liquids or trying to flush them out.

We know that you can make modifications to your diet or medications or your health and that can help decrease the risk that this might become larger or more numerous.

But once they're in there, there's really nothing out there that's going to dissolve them directly.

>> OK, we thank you very much for your call and of course for keeping the lines open for you at (969) to seven to zero if it's a long distance but that 866- in front of it.

Now Dr. Palmer, before the show started we had a couple of moments to kind of catch up and it's a little bit but I was telling you about a bus that I had in my early years of radio.

He had kidney stones that were caused by his intestinal bypass surgery to lose weight.

>> So what's the correlation there?

That's a great question and it's something I see a fair amount of .

So basically when you have any kind of bypass surgery you're going to affect your gut in terms of absorption.

So really what happens is basically a combination of two things.

So when you have had bypass surgery of your gut you developed kind of a malabsorption situation where ingested foods don't have time or can't really be degraded before they get all the way through your colon.

Yeah, and a good example that is a substance called oxalate.

So what can happen is the oxalate doesn't have a chance to bind to other substances so it makes all makes it all the way through your corn and that's when your body absorbs it.

And the most common kind of kidney stone that we see is calcium oxalate.

So people that have malabsorption are at a higher risk.

They also tend to be more dehydrated because again they're not absorbing as much of the water, especially if that involve colon surgery where they have a reduced length of their colon.

So dehydration also is a factor in the kidney stone.

But really the malabsorption in that situation is a more common well, the same kind of a strange side story to this is that this radio station this was in Evansville, Indiana, by the way, very early in my career and the hospital was right across the street from the radio station and this poor gentleman was in the hospital actually programing our radio station via telephone and we were going across the street all the time getting these notepads of information of what to do, songs to play and so forth.

>> But he was in so much pain.

>> But once the kidney stones passed which took probably five or six days, this is how long he was in the hospital at least that time he had a little medicine bottle with three kidney stones were about the size of a tip of my finger.

>> I couldn't believe that they actually passed.

And what do they pass through?

Well, they started the kidney obviously and then they go down the tube called the ureter to the bladder.

>> Now once they get in the bladder that's technically you've passed them.

So I think sometimes there's confusion about what the word passed means.

It doesn't really mean urinating it out.

It's really more about moving from the kidney to the bladder.

So once it gets in your bladder you're basically a passive stone and you may eventually void that stone out.

But that might be days to weeks may sit there for quite a while but that is that typically doesn't cause a lot of pain now there are circumstances where a can but typically the pain is from going from your kidney to the bladder.

So once it gets in your body you're basically done OK?

Ironically the size of the stone doesn't necessarily correlate with the pain.

So for example your coworker had large stones right now your chance of passing a large stone does go down so it can be harder to pass those stones but you can have just as much pain for misto the size of a grain of sand.

>> Oh so really the amount of pain doesn't really correlate with those eyes.

OK, so are talking from a grain of sand to stones about the size of the tip of my finger.

How how large can they get?

>> Oh you're quite large you know we do a certain kind of surgery.

We actually have to go into the kidney itself to take out stones or break them up and we'll sometimes do these things that are you know, about the size of maybe oh you know, a couple of golf size but they can actually form a mold inside the kidney.

Ironically, those kinds of stones that are really large in the kidney oftentimes people don't even know they have them but obviously they're not going to pass them.

So treatment becomes a little more complicated.

I want to talk about treatment in just a moment and talk about symptoms as well because we have another question coming up.

>> Line two in fact, Judy would like to ask you a question, Dr. Palmer.

Go ahead, Judy.

>> Hello, Judy.

>> Hello.

Hi.

Go ahead.

You're on the air with Dr. Palmer and let's listen through your telephone, not your television because we are on a delay.

Thank you.

All right.

Go ahead.

Yeah, they keep talking about the nutrition.

Could he give some examples of the nutrition, what to eat, what not to eat, please?

>> OK, you bet.

Sure.

And that's a great question.

I get that question a lot actually and I think the first thing I would say is you have to kind of dispel some of the myths that are out there.

One of the more common things that I hear from patients is that they're convinced that they're drinking too much pop and that's what's in their kidney stones.

But actually, you know, probably is not a huge cause of kidney stones.

It's not necessarily good for you.

I wouldn't recommend it as far as large amounts.

But as far as specific foods, that's a hard question to answer because you will hear about for example, spinach is fairly well known as something people are told to avoid or coffees or teas or colas nuts and what they're talking about there is a substance called Oxley's I was talking about earlier but really it's not always about kind of what you eat.

It's more kind of what you eat in combination.

So for example, I will tell people that if they tend to make calcium oxalate stones and they want to have a big spinach salad, that's fine.

But just make sure that you have some calcium with it and that's really the key is trying to combine certain things together so they don't have a chance to absorb into your system.

So for example, having a big spinach salad but having some yogurt along with it or cottage cheese or even taking a calcium tablet can really reduce your risk of absorbing all those oxalate and causing an issue with kidney stones.

>> All right.

>> So lean meats I mean just the standard protocol of good nutrition is pretty much and again it kind of depends on the situation because there are some people where, you know, intestinal absorption of certain substances can be a factor but there are many patients where it's not as much of a factor.

So you really have to kind of tailor your advice to the patient.

>> All right.

Let's move on to the symptoms of a kidney stone.

Well, we just talked it's mainly just pain sometimes blood in the urine.

>> All right.

And I noticed too on some of the things I read today nausea, vomiting.

Now why would nausea or vomiting be a symptom of a kidney stone?

Well, in two ways.

One is when your pain is really, really severe, some people will get nausea and vomit just because the pain is so severe that they can't really tolerate it.

But also too if a stone is causing a partial blockage of the kidney, you can get a little bit of what we call physiologic stretching of the renal capsule which is basically pressure backing up on the kidney and we know that the signals can be kind of your body.

>> Your brain is not quite sure what the signals are coming from and so just that stretching can misinterpret as abolish you by your brain which can trigger vomiting occasionally vomiting in the absence of pain they'll just have vomiting for no good reason and find out they have an obstructed kidney.

>> Oh OK. >> And then the fever and chills of course had to be attributed to the infection, right?

Correct.

Yeah.

Now certainly somebody is passing a stone and they have fever then that's a real concern because in that situation you're thinking that they have two combined problems.

OK, so they're passing a stone which by itself is can be a problem but also do they have infection along with it?

And in that situation you have to figure out a way to get the urine bypassed around the stone so you can get out because you do not want infected.

>> You're in this trap by a stone.

OK, yeah, that wouldn't be a good thing.

All right.

Well you mentioned the severe pain and the reason why I was asking you again is because we're going to segway into a question by Wesley who would rather be off the air but he's asking how can you tell the difference between regular back pain and kidney stones?

Yeah, that's that's a tough one and that's another great question because oftentimes I have patients come in and they'll be convinced they're passing kidney stones because they're having back pain and it can be difficult to differentiate the two because some people will have kidney stones but they're not necessarily passing but they're having back pain and the actual type of back pain can be real similar to just having a low back strain or having some kind of muscular issue or nerve impingement or something like that.

So it could be a little bit difficult to kind of pin that down.

I would say that in general if you have a stone that's not trying to pass that the pain probably is not from the stone but there are situations where especially large stones that can cause inflammation or the inside of the kidney can cause some pain but probably the majority of the cases the back pain that we see are more what we call musculoskeletal, you know, just related to poor posture or lifting or bending or something like that.

>> OK, and what is the protocol for diagnosis for kidney stones?

Well, I think again kind of goes back to the patient.

You're seeing a patient for the very first time that has no history of kidney stones and you're really suspicious of that.

You're going to start off with an X-ray or a CAT scan to kind of look for the stone itself.

You look at a urinalysis, you know, as your blood look for infection, things like that.

And of course you also look for other causes for their symptoms and somebody who's had numerous kidney stones, they often become rather good at knowing their own bodies.

So they'll call up and say oh, I'm passing another stone.

And in those situations oftentimes we will not you know, get some kind of involved x ray like a CAT scan and maybe just get a plain x ray just to get an idea of kind of how big it is and where it is and decide what to do with it.

>> Now if someone has a kidney stone and we said pass it goes in to your bladder but it comes out in the urinary process are they advised to hopefully keep that and maybe bring it in so that you can analyze it?

>> Well, we do we do recommend that especially in somebody who's never had an analysis before but still analysis really I think patients oftentimes are very interested in what their stones are made of because they're hoping that we can walk in the room and say OK, this is what it's made of and this is what you need to do to prevent it.

>> I wish it was that easy.

Unfortunately it's not the stool analysis is helpful but really for for the vast majority of patients it doesn't give you a whole lot of information as to exactly why is still informed because they kind of look the same.

>> Is that right?

Well, they can all look the same but a high percentage high percentage of them are the exact same substance which is that calcium oxalate.

But there are multiple causes for that.

The most common OK, and then let's talk about treatment options.

>> Sure.

So if somebody doesn't pass in St. basically you know how aggressive we are kind of depends on how aggressive they want to be.

Patients who have done how many stone episodes in your life oftentimes will say well I'll just try to ride it out and try to pass and we'll get more time if somebody is in really severe pain or having a lot of vomiting, they can't keep liquids down and we have to be more urgent about how we treat them.

Depends a little bit or a lot really on kind of the sizes don't know where it is and how well we can see it.

So for example, if a stone is fairly good size and it shows up well on a plane X-ray and it's kind of in the right spot ,a real common procedure would be to blast it with a shockwave.

It's a procedure called lithotripsy.

It was developed back in Germany in the nineteen seventies extremely popular procedure.

We do many of them here in Fort Wayne but it's still and it kind has to be in the right location and you have to kind of be able to see it on a plain X-ray in order to targeted the technology actually is essentially the same technology as depth charges you know that naval ships will use to go after submarines.

The difference is obviously it's not nearly as powerful but also to you're actually trying to channel or you're kind of shaping that shockwave to a point and then you try to move the stone into that point and blast it and has a high success rate.

But it's not perfect.

There are some stones and don't break up well but most do.

Another common procedure is to go from below and do it and take a scope and go up there and actually find the stone and either remove it or take a laser and break it up.

>> And then I mentioned the stones in the kidney there are very large or sometimes I should go into the kidney itself and get those.

All right.

Well not to put panic into people but if they're having some back pain or are having some they're just not feeling right and they you know, we've talked about some of these symptoms and I think I have a stone.

So what should I do?

>> Who should I see?

Well, again, I've done it depends on how severe your symptoms are.

So for example, if you're having your pain so severe you can't tolerate it or you're having a lot of vomiting or particularly if you're having fevers you're going to want to go to the emergency room and have that evaluated fairly urgently if it's just something that's kind of jabbing every so often you're not quite sure you can always make an outpatient appointment to come in and be evaluated.

I should mention that the pain with a kidney stone is kind of distinct.

It's what we call colicky pain.

So people when they're passing a kidney stone one thing I hear a lot is that they can't sit still, they can't get comfortable so they'll shift and move and shift and walk and pace and then we call that colicky pain and that's typical for kidney stones whereas compared to say appendicitis for example, where you don't want to be touched, you don't want to move late oh kill now colicky pain it just like as you mentioned you just can't get comfortable or just have pain in your abdomen or it could be in your abdomen and be in your groin.

It can be in your back and then it can actually be in the.

I mean there's a variety of places where you can get it if the stone is down low you oftentimes will have urination symptoms you'll have like really bad urge to urinate but then you have the pain and kind of that classic colicky pain is where you just cannot get comfortable.

All right.

Well let's talk about reducing kidney stone risk.

We did talk about that a little bit at the top of the show but just kind of a take home material for our viewers.

What's it just a good way to just say, you know, I'm on the right path maybe not to get kidney stones?

>> Well, certainly one option is to go through the testing right.

And to look for specific things that show up in your analysis now would that be a urine, urinalysis or blood?

>> Both actually.

OK, so typically if we're going to try to evaluate somebody for more specific causes for their stones I do a twenty four hour urine collection and see what shows up on that as far as chemical things in terms of just general everyday recommendation's I tell people you know use common sense obviously.

So hydration that's number one always on the list so people that make kidney stones generally have to drink enough where they're really constantly you know you're urinating clear urine because that's a good sign you're hydrated and many people that make kidney stones were our recommendation might be to drink more than a gallon a day.

>> Wow.

A gallon of water a day or some kind of hydration.

So I tend to tell patients don't think about the word water, think about the word hydration.

So really anything that hydrate counts but water obviously is a big one but flavor water, even juice decaf decaf is OK as long as it's not excessive.

>> Well, in something that because we're going to wrap up here in just a couple of seconds it's been a very informative program but one the symptoms was a blood in the urine right now from shows I've done previously on Other Subjects and any time you see blood in fecal matter or in the urine, it's usually not a good thing.

Right.

So would the urine if you have blood in your urine, is it possible for that to go away temporarily and it's going to come back but if you have it you see it once you really should have that checked out.

>> Yes, definitely so when you actually have blood in the urine it doesn't always mean anything serious but it is something that needs to be evaluated and kidney stones is one certainly one thing you think about but anybody who has one of your own really needs to be checked out.

>> All right.

And you know, kidney stones are very popular, very popular, very common, not a very popular thing.

>> So it's not a major, huge deal.

>> But just get it checked out because there are several treatment options and there are doctors to help Dr. Scott Palmer, thank you very much for all your information.

It's great to see you back and especially on our brand new set.

Yes, Glanbia and hope to see you again really soon.

Thank you.

All right.

We'll be back next Tuesday night.

Jennifer Blomquist will be here and we'll be talking about orthopedics and ankle and foot surgery as a matter of fact with a foot and ankle surgeon.

So be sure to join us then seven thirty Tuesday night only here on PBS's Forward.

Wait until then, good night and good