well.

Hello and welcome to HealthLine .

I'm Jennifer Blomquist.

I have the privilege of hosting the program this evening.

I'm so glad you joined us.

We have a wonderful guest.

I've never had the privilege of being on the program with him.

Mark Evans has, but tonight would be my turn to interview him and ask him lots of questions.

He's a urologist here from Fort Wayne, and we're going to be focusing on kidney stones.

So as usual, the show always offers a wealth of knowledge for you that will hopefully help you.

Maybe you're not having this issue, but maybe you know somebody who is.

And you can learn some things tonight that should benefit you in the future.

So why don't I go ahead and introduce you to tonight's guest.

You may recognize him because he's been on before.

This is Dr. Scott Palmer, who's a urologist.

And we appreciate you coming back.

Glad to be here.

I know your office sent to me some information and what it said you want to focus on kidney stones is certainly not a happy topic.

I have never personally known anybody in my family who has had one.

I have a coworker and she left.

She seemed fine.

She left to go have lunch one day and a short time later she called and said she was in agonizing pain and didn't think she could drive anymore and asked if somebody could come get her and take her to the hospital.

And it turned out it was a kidney stone and she when she came back to work, I just remember her saying, I've never experienced such anguish.

So we know they're painful.

Do they come on.

Does the pain usually come on kind of suddenly or are there signs you can look for leading up to the issue?

It does vary.

And, you know, the experience is almost never pleasant.

But there are some people that get really severe pain and some that don't.

But yeah, usually it's something that you're pretty suddenly okay and it's the kind of pain that once you experience it, you kind of recognize it.

Okay, The term that we use is called colic, which would be the same thing with a gallbladder attack where you just cannot get comfortable.

So people that are passing kidney stones oftentimes will, you know, pace around.

They'll sit down.

Then they'll stand up and then lay down and roll over and then stand up.

And they just cannot get comfortable.

And oftentimes they have associated symptoms, things like a lot of urge to go to the bathroom because the Stones can actually trick their bladder into thinking that it's full.

And so they have this considers to go, But what, you don't go to the bathroom or you imagine you still urinate?

Yes.

Oh, sure.

Absolutely.

But it may just be small amounts and you may even convince yourself that you can't go.

And so sometimes people show up at the E.R.

and they're convinced that the bar is totally full and that they can't go, you know, it's empty so the stone can trick you that way.

Of course, nausea, vomiting, sweating, you know, it can be heard about the swelling.

It can be a lot of fever.

I mean, you have an elevated temperature.

Well, you hope not.

So if somebody actually has an actual fever when they're passing it still on that, we have to assume that they have an infection on top of the stone.

So they had the two issues combined.

You know, having one or the other is not necessarily a big deal.

But when you combine them, that's when it can actually be quite serious and life threatening.

So, I mean, the first time, though, you might have like you might have I mean, I would think it'd be scary.

You might have know it like my you know, this woman I worked with, she had no idea what was going on.

And she was younger.

She was definitely in her maybe late twenties.

Sure.

And in general, in good health.

So I don't know.

Is there a typical age or does it seem to impact men or women, certain ethnic groups?

Yeah, it's some if you look at population studies, most kidney stones occur in thirties, this kind of peak incidence area.

Now, what we are seeing in the last several years, though, is there is a there's a rise amongst younger people and we're not exactly sure why that is, but you're starting to see more people in their late teens and twenties, even teenagers.

Oh, absolutely.

Yeah.

Even kids can get them.

But you're starting to see a rise in that percentage of younger people that are coming in.

As far as demographics, kidney stones are more common in Caucasians, less common in African-Americans and Asians.

But you are starting to see a rise in African-Americans as well as women.

Traditionally, men were more likely to have kidney stones, but you're starting to see that gap close.

Any thoughts on why it's affecting younger people and why maybe before you said, you know, primarily Caucasians and I see it in the black population more, right.

Well, I think there's there are theories.

No one knows for sure.

But I think when you think about risk factors.

So, for example, our country has an obesity epidemic, and that is a major risk factor for kidney stones and as well as hypertension.

So a lot of the other medical issues that are rising in our country, it probably is triggering more kidney stones as well.

I was going to ask you if a if it's hereditary and if lifestyle had anything to do with it, you kind of alluded to the obesity factor, right?

So a family history is is a definite risk factor that's been shown in numerous studies.

But with kidney stones being so common when somebody comes in with a stone and they say, well, my parents, you know, one of my parents had them, my dad or my grandfather or brother, you don't know necessarily if they're having a kidney stone because it's in the family.

It may just be coincidental, but we know that family history is a definite risk factor.

All right.

You know, and I'm that note I was just looking at the calendar.

It's only a few weeks from Thanksgiving.

That's a good time to tell people in your family about maybe issues you have.

You know, these are people you may not see for an entire year when you mentioned that, you know, sometimes people are maybe unaware of an aunt or an uncle or somebody like, hey, I had this issue just you guys might want to know if you feel comfortable sharing that most people probably do within their families.

Well, I think a lot of the subjects in our field are not things that come up very often in family.

Right.

Right.

But, you know, kidney stones probably is one that does occasionally.

But yeah, I mean, frequently I'll see somebody, I don't know, kind of canvas their family and they'll find out that they had an uncle who had stones or a grandfather and didn't they didn't know that.

Yeah.

Oh, there's a lot of things that you experience and then, you know, then your mom tells you, oh you know, yeah, we've had that, you know, years ago.

So, So just knowing that, that and who is most at risk, what are some things you can do if you're in that situation?

Should you go to the emergency room, you know, whether it be a child or somebody close to 30, Is that the best route?

Well, I think it really kind of depends on primarily the symptoms, you know, how bad the symptoms are.

So all of us in our field, we have patients that pass kidney stones occasionally and they kind of know the drill.

And so they can decide how bad it is.

And they want to go to the E.R., but a lot of them will just try to tough it out for a few days, you know, because they pass stones on their own before and they'll try to tough it out.

But there are certain things that if they're if it's happening, you definitely go to the E.R.

So like we mentioned before, fevers, that's a that's an absolute one.

And I tell people, if you're really, like incapacitated where you just can't eat or drink or you just can't function, then your best bet is just to go.

But I think it's a judgment call on the part of the patient.

And a lot of times it depends on their experience level as well.

I mean, obviously, if you're a first time former, like you mentioned, you're going to panic.

You have no idea what's going on.

But in people that have passed, you know, five or ten stones in all the time, you know, they can they can kind of read it, read the signs that just sounds that that phrase.

I hear that all the time.

Like I had a pass, a kidney stone.

That sounds horrible.

Can you even tell people or give them an idea of what is the size of a typical stone?

Like in terms of like a coin?

Like, would it be is it even smaller than like a dying usually?

Or We see a huge variety of signs.

Okay.

So, you know, you can have stones that are the size of a grain of sand that can put people in the hospital.

Really?

Sure.

Probably about the most common size we see kind of what I would call the routine stone be something about the size of a pea, maybe like a large pea.

Is it tend to be smooth or is it kind of a jagged?

They either are okay, but ironically, the size of the stone or the shape really has little bearing on the amount of pain or whether it's moving or not moving.

So there are basically two ways that people get pain with stones.

One is as it's coming down, the two, which is called the shorter coming from the kidney to the bladder, the shorter is actually a muscular pump.

So like any muscle in your body, it can spasm.

Okay.

So if it senses that there is something in there that should not be there, that can trigger a spasm, and that's typically the really severe like just stabbing like knife, like pain, they just drops you to your knees.

The other way is that if it causes a partial blockage of the kidney, the pressure can build.

And so you can start to get what's called renal colic, where the kidney itself, the capsule, the kidney senses that pressure.

And then you can get a lot of pain with that.

And that's also a lot of times where people get nausea and vomiting as well, because your body doesn't quite know what's going on.

The capsule is stretched, your brain is isn't quite sure is that the kidney or the bowels.

And so some people have just a sudden vomiting.

Yeah.

In that situation.

So do you do an ultrasound to detect it or what's the best way to to look.

Well, probably the most accurate way is a CT scan.

So people if they show up in the ER, if there's a suspicion that you're passing on generally we'll get a CT scan.

You can do an ultrasound which will confirm whether or not there is a degree of blockage or the plumbing is backing up on the kidney, but it wouldn't necessarily see the stone and they're not 100% reliable in that situation.

But CT scans are where you kind of really get the answer.

So if somebody comes in and they've got this issue, can you give them something with a pain reliever help or is there some medicine you can give them to at least alleviate some of the discomfort?

Well, sure.

I mean, I think that the first step when they come to the ER is make them comfortable.

And so the staff in the ER are going to do their best to try to get them as comfortable as they can.

But you know, kidney stone pain is a kind of pain if it's severe enough.

In some cases they will give multiple rounds of opioid pain medication so they still had enough, maybe just like an anti-inflammatory or something that, well you'll combine that together, but in an acute setting where the pain is severe, they're almost always going to give I.V.

opioids in that situation.

Okay.

Now, when people that are managing their pain, oftentimes will combine an anti-inflammatory with an opioid and some other medications as well to make it more comfortable.

So you were mentioning this sounds just horrible when you're saying there are people that have passed 5 to 10 stones.

Sure.

And I assume, yes, if it's happened once, you're going to recognize it.

What how what?

I mean, does that just run the gamut as far as how long it takes for the stone to pass?

And what are maybe some other issues that can happen along the way that could maybe slow it down or speed it out?

Sure.

Well, we know that statistically the smaller a stone is, the more likely it is to move all the way through.

And when we say the word pass, what we're talking about is when it goes from the kidney to the bladder.

So once it gets the bladder, it once it pops into the bladder, you've passed it.

Now, it may not come out when you urinate later until later, but you've passed it into your bladder.

Okay.

So basically, whenever whenever somebody is passing a stone, you try to come up with, okay, what is their statistical chance of passing on their own and so, for example, if they have a three millimeter stone or a tumor, so that may be an 80%, 85% chance of passing, whereas if they have like a 70 millimeters stone, you're talking maybe a 30% chance of passing.

So you look at the size of the stone where it's at and also their symptoms to figure out should they give it time or not.

But if they decide to try to pass it, depending on how they're doing, we sometimes give them, you know, three or four or five weeks.

Oh, yeah, It depends on obviously how bad their symptoms are, what is the material that's in the stone itself, Is it fibrous or what?

I guess when you say stone, I think of something like a rock really hard.

It kind of is a rock.

Most of them are calcium based.

About 85% of kidney stones are calcium based.

And there's a couple of differen What commonly happens, though, people will jump to the conclusion that calcium is the problem.

And so you'll see people, people kind of, you know, as a reflex, they'll cut dairy products out of their diet or something like that or but rarely is the dietary calcium the issue.

But most most ones are calcium based.

And there's a few other stones that we see as well.

One is called uric acid, which the interesting thing about uric acid stones is they are what we call radial Lucent.

So on a CT scan you can see them just fine.

But on a plain x ray you oftentimes can't see them, whereas calcium stones typically you can.

And there's a couple of other stones out there that are more rare.

But calcium stones make up the bulk of what we deal with.

Now, I've also heard of and I don't know if this is common anymore, but years ago I would hear of practices where they would try to break up the stone.

Is it with lasers or, you know, if that's common or if there have been more advancements?

Well, in people that require surgery for the stone, it depends on several things.

So if the stone is not exceedingly large and it's calcium based and it's up high enough, you can do what's called Extracorporeal shockwave lithotripsy, which is basically using a shockwave that passes through your body.

And it promises stone over and over and over the idea of breaking up into fine fragments.

It's a technology that was originated in Germany.

I think, back in the 1970s, and it first started coming to the U.S. in the eighties, very, very popular because it's typically noninvasive.

So people come in, they get put to sleep.

They had the machine put up against the skin and it shocks the stone over and over and over.

There's no incision involved.

So that, okay, where you a laser come into place if you have to go from below with a scope and go up, you'll oftentimes laser the stone and break it up into fragments and then remove the fragments.

Oh, all right.

And then there's also other procedures.

There's one where we go through the back with the incisions about an inch or so long, and you actually go into the kidney itself and try to break up and remove stones.

Is that would that be a more severe case if you're going into the.

Well, typically they're large, very large stones.

So stones that form in the kidney that sometimes are kind of like a mold of a kidney, oftentimes associated with bacteria, The way to go get in, it's going through the back.

And it's a procedure that, you know, most of us do pretty regularly.

But again, what kind of surgery you do really depends on several factors.

I was going to ask you, because when you're talking that it could, you know, take a few weeks to pass a stone, do you sometimes know right away if you see the patient?

Yes.

Surgeries, you know, going to be need to be done?

Or do you sometimes look at somebody and say, we can wait and we'll monitor it and then decide?

Yeah, exactly.

So when you when you're talking to a patient is passing a stone, you're going to focus on two things, you know, one, what is there are odds of passing it.

What are their odds of passing it?

So again, a smaller stone has better odds, but you also have to factor in how severe the symptoms are.

So you may have somebody who has a very, very small stone, say, two millimeters down low.

It's close to passing.

But if they're in severe agony, if they're incapacitated, you're going to say, look, you know, you have a good chance of passing the stone, but you're so symptomatic, your best bet just to have it removed.

Yeah.

By the same token, you may have somebody who has a larger stone, say nine mm.

But their symptoms are mild.

But at the same time you can tell them, well your chances are not great.

So even though your symptoms are mild, your best bet probably is to go and never move.

So you have to factor both of those things in.

And so it's a bit of a judgment call.

And so you you include the patient in that conversation as well.

And if they want to be aggressive and have it removed, that's fine.

If they want to give it time, that's fine too.

But I think they need to know where they're at statistically.

Yeah.

For these people that when you're saying it can take weeks, I mean, are most of those patients able to kind of function?

They can go to their job.

And I think, you know, if they're if they're symptomatic to the point where they can't work or they're, you know, they're bedridden, then they probably should just have removed.

But the majority of people that are passing a stone that are not severely symptomatic, we actually recommend activity because activity is one of the things that can improve your chances of passing the stone.

Yeah, I was going to ask you to we had kind of alluded to obesity being an issue.

So diet or lifestyle are the things, you know, if you find yourself in this situation that you should change are the things that help you.

If you eat or drink, that would help you to pass it?

Well Well, it it's a common practice to advise patients to, you know, go home and drink tons of liquids.

Yeah, very fluid.

Yeah.

But interestingly enough, research has shown that that really doesn't seem to have a big impact.

Okay, So there are two things that statistically will improve your odds somewhat.

One is we talked about IT activity.

So I tell people don't lay around, you know, be active.

The other there are certain medications that relax the the muscles of the tone of the tube that comes down from the kidney, but also where it pops into the bladder.

And so those medications relax those muscles, which can also increase your chances of popping the bladder.

Once it gets to the bladder.

Do you have any usually discomfort at that point or you would still I mean, it's I thought so, but yeah, well, it's still trying to pop into the bladder.

Yes, but once it gets in, once it'll settle down.

So typically the pain will go away within of anywhere from an hour to 24 hours.

Oftentimes people will, though, describe a real sense of relief.

They can say that they notice is often like, oh, okay, now I'm better.

And that's when it pops into the bladder, because typically it's pretty rare when you actually are getting rid of a stone, you know?

You know, and when you're in the bathroom getting rid of it, that for it to cause pain, in fact, in most cases they don't feel it.

You might feel like a like a very kind of a tickling sensation, but usually not a lot of pain.

Now, that said, there are cases occasionally where especially remember, the stone would get stuck as it comes out, but that's not real common.

And in some of those situations, people will assume that it's a kidney stone, but it may in fact be a bladder stone, which and they're different.

They form in the bladder itself.

But no, normally when you when you actually urinate the stone out, you don't feel that.

So once the stones in your bladder, oftentimes you feel a lot better.

That's funny.

You know, interesting that you say that they can tell when it's passed.

Yeah.

Some people kind of have that sensation or is like, Oh, okay, yeah.

Now I feel better.

Yeah.

And that's, you know, hitting this.

But sometimes the symptoms can linger for a day or so.

So even though the stone is passing the bladder, sometimes people have pain or urge to pee for several hours.

So once you've had a kidney stone, does that increase your chances?

It will happen again?

It does so by a lot.

Well, a fair amount.

You know, people that had their first kidney stone attack have about a 30 to 50% risk of having another one within five years.

Oh, gosh.

So that's why it's important for people that are passing kidney stones to kind of understand what steps they can take to try to reduce the risk and then people that are having numerous stones over and over and over, we do recommend some testing and some specialized testing to try to find out if there's something about their diet or their bodies that's actually triggering the stone formation.

Well, before the show, we were talking that I figured all of your patients would be men, you know, being a urologist.

And I figure that if women had urology issues, they would go see a gynecologist.

But, you know, if they if there's a woman who's had this issue, is it best to visit you regularly or visit a urologist regularly?

Is there?

Well, I think you can do to monitor in people that have had one stone, they pass it and then they're fine.

Yeah.

Yeah.

I think it's kind of a judgment call whether they want to come in and talk about kidney stones or not.

But certainly anybody who's following them over and over again, especially if they have a strong family history, should probably come in and talk to us and maybe run some tests and try to figure out what they can do to cancel them down.

Now, were there other things like people who have this issue, do they tend to have other underlying issues or chronic and chronic disease or I don't know if there are other contributing factors?

Oh, absolutely.

I mean, okay, So there are a number of risk factors that we see.

And unfortunately, the kind of risk factors that are getting worse in our country.

So things like obesity, diabetes, hypertension, there's this a number of health issues that make people more at risk.

Also people that are not active, people that are confined to wheelchairs or if they're bedridden.

So there's several medical risk factors that we can target.

And as some you can control and some you can't, but others have multiple risk factors.

What about medications?

Unfortunately, we live in a society where a lot of people are on medications long term.

So there's certain kinds that there's a handful, and most of those situations are rare.

But you will occasionally hear about stones are caused by even antibiotics.

There's a couple of sulfa and there's one fluoroquinolones that can cause that.

That's pretty unusual.

The expectorant that people take for coughing when they have a bad like a stroke.

Great wave, venison.

Okay, rare.

You see those?

Probably the most common stone that we see in our practice that's related to a medication that would be Topamax.

Topamax is prescribed often for migraines or chronic pain, sometimes for seizures.

And I would say probably I'd say maybe twice a year I'll see somebody who is forming start because of Topamax.

I just feel like ever since we had the COVID pandemic, I feel like people's eyes are opened wider into the field of medicine.

As far as, you know, looking at things a little differently and maybe being a little suspicious, like, you know, do I really need to take that medicine?

Is this making me in the long run, worse than this is making me more susceptible to illness?

So I think people in the back I know that there are a lot of people that are on medication and have no choice, but I think there are some people that are looking at it a little differently.

Have their eyes opened a little wider now?

I don't know if you find that from patients being more inquisitive about that.

I wouldn't say that I've heard the COVID epidemic as being something that has triggered a lot of focus on medications from the patients, but that could be the case nationwide.

Yeah, in our field, you know, we're kind of narrow in terms of what we see.

So it could be situations where people are very focused on what they do that might affect their immune system, for example.

Yeah, I just I listen to I'm kind of nerdy.

I don't listen to anything really trendy, but I do listen to some health related podcast.

And there are a couple of doctors I really like and some of them, they're not conspiracy theories or anything, but they offer up things like, Hey, you might want to think about, you know, this might end up causing you more trouble down the road.

Maybe, you know, change your ways.

So I think any any trip that you do, there's always going to be a positive or negative.

Yeah.

So.

Yeah.

Oh, yeah, you have to weigh that.

So if you put somebody on a diuretic for high blood pressure, well, they run the risk of becoming dehydrated, which can increase their risk of kidney stone formation.

Right.

So there's a number of things you have to factor in.

You know, is the benefit worth the risk?

And that would apply to really any medication that we prescribe or any surgery.

Oh, sure.

I mean, even taking a simple, you know, antibiotic, you know, there's always a side effect.

Absolutely.

We've seen that over the years in my own.

And even the decision to do nothing as a risk.

Yeah.

So every decision you make when it comes to your health has a risk factor.

Yeah, it is.

And you know, that's why sometimes you just have to read up as much as you can on your own, but also consults, you know, with people who are professionals in that field certainly makes a big difference.

And anything any advice you give to people, we only have a minute left, but things to think about in terms of being able to avoid this issue?

Well, I think in terms of just general stuff, hydration is really important.

I think a lot of times doctors use the word water.

And I tell people that's right.

It's much more about the word hydration.

So anything you drink that doesn't cause a diuresis like, say, caffeine, for example, or alcohol essentially hydrates.

And you want to pick things that are healthy.

But it doesn't have to be water necessarily.

But hydration is key.

Sure.

And ironically, healthy diets can sometimes be more risky.

So I tell people, if you're if you're a big spinach lover, for example, beets, you know, healthy things, if you combine that with calcium in the same meal, then your risk level is not as high as somebody who doesn't.

So there are certain things you can do.

But I would say hydration is one of the biggest ones.

Certainly.

All right.

Yeah.

There's I mean, there's you don't hear people talking about drinking like fruit juices so much anymore or, you know, things that maybe they always thought it was just water.

But interesting to hear other fluids are good, too.

Unfortunately, we are out of time, but I sure appreciate you coming on.

Thank you so much.

So happy to.

All right, Dr. Scott Palmer, thank you again.

I appreciate it.

And that is it for right now.

Take care.

And there'll be another Health Line coming your way next week.

Same time, same channel.

Take care.

Bye bye.