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>> Hello, welcome to HealthLine.

I'm Jennifer Bloomquist.

I have the privilege of hosting the program this evening and I'm so glad you joined us because you will walk away tonight definitely learning something.

I learn something new every show and the other nice part of this program is that we welcome you to engage with us in the program.

We keep the phone number up at the bottom the screen and we ask you to give us a call anytime through the program and ask a question.

We have a urologist here with us tonight.

We're going to talk about kidney stones not everyone's favorite topic but definitely something that afflicts a lot of people.

He's come with a wealth of information to share.

But maybe you have a question you'd like to ask and get some free advice tonight just giving us a call again, the number we keep at the bottom of the screen it's (969) 27 two zero.

It is still a free call if you're outside of Fort Wayne, just dial 866- in front of that and we'll put you through.

You have the option of asking the question live during the show which that's my preference because you can interact with the doctor.

He may need to get more information from you to give you a better answer or the other option is that you can just tell the call screener what you'd like to find out and we'll relay that to you.

We'll get your question answered either way.

So let's go ahead and meet our guest tonight.

He has been a regular on our program over the years.

>> Dr. Scott Palmer, thank you so much.

Oh, more than happy to appreciate it.

>> We you and I have done a program in the past about kidney stones and you know, we hear about I imagine most people watching know at least a couple of people who've had that I've worked with a couple of my coworkers had it.

I didn't realize how painful it is though until we had a coworker that had left to go have lunch.

She felt fine.

You know, she worked all morning and then she called in a panic and said she couldn't drive.

She was in such excruciating pain and it seemed to come out of nowhere and it turned out to be a kidney stone.

Yeah.

So I think some of us don't realize if you've not had it or been close to someone who's had it, it can be quite an ordeal.

>> Yeah, I would say most people at least know somebody who's had they're very common statistically one in seven men in their lifetime will get a kidney stone and one in ten women.

Oh wow.

And yeah the pain is not a it's not a fun experience if you go through it.

>> Is that common like my friend's experience where it came on very suddenly.

Oh OK. >> I don't know like sometimes if there are warning signs you can look for leading up to it or you know not really.

I mean most kidney stones when they try to pass that's when they cause pain and that can happen just randomly and I've always I've always told patients I think kidney stones are evil because they always pick the wrong time to try to pass.

You're on a safari in Africa and also you know they're passing but yeah, the pain can come on suddenly it can be in the back or the front or the side it can radiate and it's what we call a colicky pain.

>> So what's meant by that is no matter what you do you just can't get comfortable so it doesn't like come and go.

>> It's constant.

It can be OK but people that have them oftentimes are pace back and forth and then they'll sit down and stand up and walk and then they'll lay down and get back up and walk.

You just can't get comfortable whereas a lot of pain you have when you lay down you feel better, right?

>> Kidney stones you just can't seem to get comfortable with all that colicky pain.

>> So if that happens and somebody has that episode I mean I assume they should probably go see somebody.

>> I don't know if your primary care can handle that or is that more of an emergency room?

Is it?

>> Well, I think it depends on the severity.

OK, you've got people that have passed several stones in their lifetime and so they may try to ride it out, you know, and then after a few days if you stop bothering they might call and make an appointment or contact us and if the pain is really severe and you can't manage it or it's associated with excessive vomiting or fever or something like that, you definitely should be in the E.R.

What can they do because you you had told me before you have it some people just kind of ride it out if they've had it before.

So if the pain's really bad, is there something you give them to make them comfortable or is there something you could do to the stone?

>> Well, I wouldn't use very comfortable.

Yeah, you can try to take the edge off with pain medications but to be honest with you when it's really bad pills are just not going to do it.

>> OK, and even the IV pain medications sometimes don't work well in bad situations but many patients they kind of know the drill, you know, and they'll take some medication to help it pass which doesn't make a huge difference but it does help at times and like I said, they'll call if it's really bad or they just can't take it anymore.

>> Yeah, but many people kind of have that routine they go through.

So do you I assume this probably varies as far as the size and how long it takes to pass is a completely different patient or you know it's a matter of probabilities.

So basically the larger a stone is the less chance it's going to move all the way in the bladder.

OK, but there are some people that can pass larger stones without a problem and other people can't even pass small ones.

I think some of that is anatomy.

Some of that is just the muscle spasm and how how severe it can be where even a very small stone if you have a really bad spasm you can have severe pain and not be able to pass it but the smaller gets the better your chances.

>> Now I could have sworn years ago the other person I knew who had it it was a friend's husband that I thought they did something to try and break it up.

Right.

So as far as treating stones yeah.

So somebody let's say that the pain is so severe they can't tolerate it and they end up in the hospital.

>> There's basically a few different options that we use or one is to go from below with a scope and go up and remove it and that usually requires a laser to break it up and then take the pieces out.

There's also a procedure where you have a machine put up against your skin.

It sends a shockwave through your body and you try to target the stone and hit it over and over and break it up.

>> The nice thing about that is it's noninvasive.

Right?

But the negative though is is that a hundred percent guaranteed either.

>> So there are pros and cons both ways.

I mean do most of the people if they're if it's really severe, does that require a hospital stay or is it just the outpatient?

>> Yeah, sometimes I mean most of our don't procedures are outpatient OK but we certainly do a lot of them inpatient as well.

I mean they're pretty miserable .

>> They'll get admitted and put on pain medications and then we try to take care of it as fast as we can either that night or the next day.

Yeah, I had heard it was comparable to child the pain that people experience if you didn't have any pain medication during childbirth that it can be that.

>> Yeah, I think sometimes it can be like that.

I mean it varies.

I pass on myself twenty years ago and I worked the entire time it took me six days but it wasn't horrible.

>> I could manage it.

Yeah but every situation is different.

Well so it sounds like it's a little you said one seven men will probably experience it versus one out of every 10 women.

So is there something about male anatomy that or is it lifestyle?

>> I don't think you've ever actually elucidated why there's a difference there I guess is it probably a combination of things?

It could be activity and sweating and being outside.

It's it's hard to say whether there's actually a sex difference in terms of genetics.

>> OK, how about age I wonder is like all ages all I wouldn't say I people I knew were younger.

>> I was shocked you know I thought it was it's something you experience I've seen all ages and the incidence is actually getting worse.

Oh yeah.

So if you look across the world and developed countries the prevalence of kidney stones is going up and up and up and some people think that part of that is just increased by chance.

Diagnostic studies you doing more and more CT scans and things like that.

But actually many of these studies were based on hospitalizations so that wouldn't necessarily explain that.

>> So we do we do see that the rates are going up among both men and women and across many developed countries.

>> All right.

Well, I have lots more questions I want to ask you, but I'm hoping that somebody watching will have some questions.

Again, this is Dr. Scott Palmer.

He is a urologist and we're talking about kidney stones if you have any questions about that or something urology lady urology related, please give us a call again.

That's why we keep that phone number at the bottom of the screen (969) 27 two zero I was wondering there's anything you can do to avoid getting a kidney stone, especially if you've had one avoiding a repeat episodes.

>> Yeah, there's there's what I call strategies that you can follow but there are some people that do all the right things and they can still get kidney stones.

But in terms of other strategies you can try hydration number one.

>> Yeah, it's you know, almost all kidney stone for his benefit from increased hydration in any particular is water the best water?

Certainly great.

But I tend to I tell patients to focus on the word hydration so really anything that you drink that doesn't have caffeine or alcohol hydrate to some degree.

So even things like decaf, decaf coffee , even decaf pop, you know, there's a lot what I would call urban legends out there about what causes kidney stones and what people should do and some of those are true.

Many of them are not true.

For example, you'll hear that colas and teas and coffees cause kidney stones but that's actually been disproven OK but heard all the time.

I'm glad to hear that.

Yeah.

And even Pop, you know, I think pop's not a great thing to drink all the time but but in terms of causing kidney stones probably in most cases not OK, do you find that it tends to be hereditary?

>> It can't be OK so probably the biggest risk factor for developing kidney stones is a strong family history.

>> All right.

And does necessarily I mean if you if you haven't once are you doomed to have it again if you don't make some changes, one risk is higher.

OK, so if you compare yourself to the general population, if you've had one there's about a chance you're going to have another one within five years.

>> Oh, that's soon.

OK, that's not that's not what I wanted to hear but I'm glad I know it.

So I'm going to go ahead and read the question here that we have from some of you called in James called in and wants to know what's the difference between a kidney stone and a gallstone.

>> That's true.

I don't I don't hear about gallstones as much as I do kidney stones.

>> Yeah.

I mean they're both very, very common and for the most part they're not really related even though they're both stones.

>> There was one study maybe fifteen years ago that showed there might be a slight association in terms of what you get when you have a higher risk of getting another.

But I think that probably has more to do with medical issues.

You know, diabetes, obesity, things like that.

>> But the difference is basically where they're formed.

So gallstones are formed in the gallbladder.

They can sit there for a long time just like kidney stones and then when they try to pass and that can lead to all kinds of abdominal pain especially after eating a big meal whereas kidney donors the chemistry is very different in terms of how they form.

>> But there's a number of risk factors whether it be genetic or dietary or sometimes medications that can trigger kidney stones and gallstones has some of the same risk factors in terms of diabetes, obesity, things like that.

>> There's risk factors for both with a gallstone.

Is there a difference in pain and I wondered yeah, Interestingly we talked about Kalicki pain.

You can't get comfortable.

They both kind of have that those are really two good examples of that whereas gallstones they often have what we call a crescendo effect meaning that the pain kind of gradually kind of comes on, it comes on it gets worse and worse and worse and it reaches a peak where you're just miserable.

>> Yeah.

And usually the pain is in the belly area.

You can't get comfortable like kidney stones.

You may be pacing back and forth and then it starts to kind of subside, you know, and it's that what we call crescendo risk kidney stone pain may come much more suddenly but they're very similar in a sense you can't get comfortable the whole time.

You know, I wondered since you can remove your you know, you can live without your gallbladder, you can removed.

So if whereas unlike with a kidney that I don't think they'd want to remove it unless it was clear but yeah.

>> Is that a solution with the gallstones do you consider that if it's if it's happening repeatedly in terms of taking a kidney out in terms of taking the gallbladder out?

>> Well under we don't we don't do that surgery that's that falls under a different field.

Yeah, but oh certainly if people are having right now if you recommend it well if you're having a lot of gall bladder tax you know taking a gall bladder as a common we have to treat that.

>> Yeah OK yeah just curious about that so they both sound terrible but the one at least you could live without you know the gall the gall bladder so you talked about the laser trying to break up the stone with the laser besides that you know you talk about drinking a lot of fluids but are there any other treatments or things you can do?

>> Well, I mentioned the one from the outside which is called Escorial Shockwave Lithotripsy.

That's true.

Yeah.

And that's a technology that was developed I believe in Germany back in the 70s.

OK, and it's become worldwide extremely popular and patients like it because it's not and it does have a high success rate but it's not perfect and I always tell patients that even if it's don't break up well you have to understand that the pieces are still there and they start to pass and so they can cause trouble.

But it is a very, very popular treatment and then of course the scope with a laser also very commonly I mean we do it literally every day and whether you do one versus another, it depends on several factors.

>> It depends on how big this one is, whether it is patient factors and there's other surgeries as well.

There's one where we go in through the back with a small incision actually go into the kidney and break up stones and pick out the pieces.

>> What kind of instrument do you use?

>> There's a different history.

You can use a laser in that procedure but the most commonly used instrument is one that actually it it's called an ultrasonic high frequency vibration but also has a hammering effect and a suctioning effect.

So you're actually kind of tried to break the stone up and try to suction out the pieces but you can do other things like the laser or you can even use what are called grassers to go in there and pull them out too.

>> I your kidneys tend to function OK after an experience like that does it I has to heal or it has to heal.

>> I mean you're poking a hole in a kidney so I mean it's going to bleed and yeah you know there's definitely trauma to the kidney but in terms of kidney function afterwards no it'll heal and kidneys rebound just fine.

>> All right.

Good good to know.

I just want to remind everybody one more time we only have about maybe ten more minutes left.

The show goes very quickly.

So give us a call if you have a question I hate to miss answering one of your questions, giving you some free advice tonight.

Again, the number at the bottom of the screen it's (969) 27 two zero.

What is this something that can be handled by a family doctor usually or you know, especially if you're having it repeatedly is you have to go to a specialist?

Well, I think for most people if you're having them repeatedly, you're better off seeing one of us.

OK now nephrology which is the medical field.

>> Yeah, that's right.

They they also can run some tests and try to look for causes and so there's an overlap there.

But in terms of managing kidney stones that's going to fall under our field.

>> Primary care certainly can help with symptoms.

You know, somebody calls up and they say I'm asking a stone.

I'm just totally miserable and they can they can call in some pain medications.

But in terms of actually managing, they're better off seeing us.

>> And then what about just long term?

Does it have you know, if deal with this repeatedly, does it impact other systems in your body or do you end up having other issues down the road?

I wondered if like you were a better candidate for maybe something like cancer down the road if that had any impact on it if you have this happen?

>> Well, I don't think kidney stones by themselves or have been trying to be a risk factor for getting cancer or other things like that.

Now there have been studies showing that people have been treated for cancer having gone through chemotherapy or whatever have a higher risk of getting kidney stones.

>> OK, that's been shown.

But in terms of actually causing cancer or leading to other kinds of diseases, I don't think there's a lot of evidence for that.

OK, yeah, I just was curious when you talked about nephrology I always think about nephrology being really serious kidney issues, you know well that you would start with a urologist and then the nephrology I always associate that with kidney transplant.

>> The best way to think about it is we're the surgeons and the plumbers, OK?

Whereas there the function doctors OK so they deal with things like kidney failure or when the kidneys are causing other issues like hypertension and things like that.

So so we do overlap on many areas but really we're the surgeons and the plumbers and the function doctors.

>> Do you find that there's a lot of research going on right now to try and help people who deal with kidney stones or finding different ways to to deal with it or treat it?

>> Yeah, I mean I think there's always stuff that's kind of brewing out there.

But in terms of actually treating kidney stones, the technology gets better all the time.

But we haven't found that that magic pill that's going to just keep them away.

>> Yeah, that would be nice but that would be great.

Maybe someday we did have somebody who called and wanted to ask wanted me to ask the question for them.

I don't have eye contact since I've got to look at the closest camera let's see can making too much can and drinking too much mineral water cause kidney stones and be Stan I think is right.

Yes yeah yeah.

So stand that's actually a really good question.

I get that a lot of times especially people who have low water they'll wonder if they're drinking too much water causing kidney stones.

>> I think for the most part there hasn't been really any evidence of that happening.

I think mineral water or you know, one of the time minerals or well water is probably fine.

I certainly would not recommend avoiding it just because you're concerned about kidney stones.

Again, hydration is the key and generally minerals in the water are not going to cause kidney stones directly.

But that's a common question.

I get that when a lot you know, Stan, I'm glad you brought that up.

>> That made me think of something else that I feel like with all the Health and Human Services Department right now kind of opening our eyes to things that are in, you know, products that we consume, you know.

Yeah.

And and think about that like well water you know, because I know really if you have well water we've taken ours in to be checked like the extension office, you know.

But other than that, you know, it's not really monitored.

It's up to the homeowner.

>> You know, it's water softener.

Does that make any difference?

Not that ever I've never seen that.

OK, but there's there's been many things throughout the years that have kind of come up as potential contributing factors.

>> I mean yeah, for years they thought dairy products you know, calcium know cut back on calcium.

>> Actually what we found is for many people that actually makes it worse.

It rarely makes it any better.

You know, people like I said before, you know, people think that pop causes kidney stones or coffee these so there's been things that have kind of become ingrained in our society that are not necessarily true but we're learning all the time, you know what things you know really are contributing factors and which ones are not.

But for many people, you know, you can't necessarily pinpoint it.

I mean for many people it can be something kind of just nebulous.

You can't really figure it out but I tell patients you can only control those things.

>> You can't control you can you can control hydration.

You control how you eat and when you eat and those kinds of things.

But there are some people that do all the right things and still get kidney stones.

Yeah.

Yeah.

Now I understand that I was curious to have you ever heard of a pediatric case, Olavi Madames really OK now I never I have never I have a lot of kids I've never heard of that.

>> So I think youngest that I've done a procedure on was Fort Wayne that's pretty little.

>> Yeah.

And were there other can I ask were there other issues health issues with the child or can to a perfectly good case there was I mean I've treated many many children over the years from kidney stones and certainly when they developed kidney stones at a young age that's a red flag because we're talking about dietary things.

>> So OK, anybody who's really young that gets kidney stones, I do recommend that they go through what we call metabolic evaluation which is primarily a 24 hour urine collection and looking for causes but somebody who's, you know, gets their first home when they're fifty five or 60.

Yeah.

That could be something dietary or could be medically related but at a young age that's a red flag.

>> Yeah that would be horrible to think of a child going through that to do any different treatments with a younger patient.

>> Not necessarily.

I mean I think the options are still the same obviously always with with kids you know sometimes the instruments have to be modified or you have to get special instruments but for the most part the options determine how you treat them is going to be the same.

>> OK, all right.

Yeah, I'm surprised I had never I've never heard of that before but obviously it does happen.

>> So what about long term as far as some of the patients you've seen?

Have you seen anything that is somebody who's really turned the situation around, maybe somebody who's had a few kidney stones and maybe they made some significant life changes health health wise, diet wise, you know, because some people a I would I would start getting really down in the dumps if it was happening repeatedly and so I don't know if you have any words of wisdom there.

>> Well, you know what's interesting about it is that there's a certain irony that some of the healthiest diets are probably some of the more riskiest and so it's kind of a catch 22 situation.

>> You know, people that come in and say all I eat is nuts and greens and it's like well that might be the problem.

>> Yeah, You know, so it's about being healthy is not necessarily going to fix kidney stones but you know, people that, you know, get control of other health issues so they lose weight.

They can control their diabetes.

You know, they hydrate absolutely.

>> People can turn things around.

Yeah.

There's such a you know there's all those different diets.

They have all the different names, you know, fad diets I guess you would call them.

But you know, I made a lot of people these days who just are plant based diet.

I don't know if you recommend that or not because I'm just thinking the protein especially for children every situation is different.

>> Yeah.

So if somebody has a certain special diet you run some tests and see if maybe that might be contributing but in many cases it's not so it's not always diet everything all right.

>> We just have a couple of minutes left so we could squeeze in a real quick question if you want to give us a call, it's (969) 27 two zero against Dr. Scott Palmer, his specialist in urology.

I was just wondering you know, I've got to ask you earlier when you talked about the stone getting was it passes and gets into the bladder, are you out of the woods or does that still cause pain when you're at that point it's in the bladder.

>> You're you're going to be out of the woods now they're very rare cases where it gets heart coming out and that is a common misconception.

So that's actually a good point.

So when we talk about passing a kidney stone, when it goes from the kidney to the bladder, it's not typically when you actually it out.

>> So does it I mean is it smaller by the time it gets into the bladder?

I mean is it size sometimes reduced by that point?

>> I want to say it's about the same now are rare times with a break up on the way down but usually it's about the same.

>> So where it started where it came out will be the same because they're pretty firm.

They're like rocks.

>> Yeah you have to change a lot.

Yeah.

Do people I don't even know if people have to show it to their doctor to be measured.

>> Does that help you at all.

It's not necessary going to help in terms of planning no but I think it's always something that patients like to see.

I'll take pictures of their stones OK but there are times where you go in there and you'll find it laying in the bladder.

I just had that happen Friday.

I was just in there.

Yeah, yeah it happens.

Patients are asking us don't and they don't realize it's already passing the water but they have surgery and there it is.

>> All right.

That's interesting.

I would not like the same after oral surgery and I want to see my teeth or I'm good not seeing it.

>> It depends on the patient is through.

>> We're going to quickly try and get one in here.

This was some Dave called in and wanted to know if doctors would use lasers or I can't see OK couldn't see the first part of the word to treat kidney stone absolutely.

>> Every day OK I mean those are the those are that most common treatments that we do for kidney stones.

>> There's other surgeons that we do but boy every day we do that do that I mean it's literally every single day.

>> Yeah it sounds like it keeps you pretty busy.

They keep us busy among all the other things you do so.

All right.

Well thank you so much and you probably won't be back on.

I appreciate your charities and yeah, I tell people you're going to learn something no matter whether this is an issue deal with now I mean it helps to know in case something happens down the road or to you or to a loved one.

So thank you so much for all the folks who called in tonight.

Really appreciate that as well.

And we are done for this evening.

I'm Jennifer Bloomquist.

Take care.

>> Have a great week and we hope to see you back here next week for help line.

Take care