House Calls

SPR 2019

House Calls Magazine is a quarterly publication that focuses on health and wellness. It includes a wide assortment of articles with topics on the latest health and wellness information, nutrition, safety, lifestyles, and more.

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As temperatures rise and we head outdoors more frequently, people often fail to drink enough fluids to properly hydrate our moving bodies, which can translate into a spike in emergency care visits by patients complaining of powerful pains in the stomach and back. Kidney stones are a surprisingly common but unpredictable ailment that can differ widely from person to person—ranging from an unnoticed non-issue to the source of what many describe as the greatest pain they've ever felt. "I've had patients who have experienced both natural childbirth and kidney stones and say they would prefer the former," says Dr. Dennis Kubinski, a Roper St. Francis Healthcare affiliated urologist. In general, he says, kidney stone development is influenced by three factors: genetics, dehydration, and diet, each of which we explore below, along with the symptoms of and prevention methods for the condition. UNDERSTANDING KIDNEY STONES Kidney stones are hard, pebble-like masses that form in the kidney and cause trouble when they begin to migrate "downstream" through the urinary tract. As the body's drainage system, the urinary tract—consisting of two kidneys, two ureters, the bladder, and urethra—helps us eliminate extra water and waste products that the body doesn't need. Brought in by major arteries, blood passes through the kidneys, which act like fist-sized coffee filters to sieve out excess acids, salts, minerals, and liquid. Combined, this waste forms what we know as urine. Thin, muscular tubes called ureters then carry that urine from both kidneys to the bladder, which serves as a reservoir for the liquid waste. In a normally functioning urinary tract, we're able to control when we empty the reservoir, so to speak, expelling urine through the urethra. As a clearinghouse for waste products, the concentrations of minerals such as calcium, potassium, and sodium can be fairly high in the kidneys—especially when we're dehydrated. It's when mineral levels become too concentrated that tiny crystals, or kidney stones, can form out of the solution. W ith spring in full bloom, visions of beach days, pool parties, and other outdoor adventures are filling our daydreams. But doctors also recognize the warmer months as the start of something far more unpleasant: kidney stone season. P H O T O G R A P H ( D R . K U B I N S K I ) B Y A L E E C E K I N G S L E Y - T A Y L O R 32 { spring 2019 } h o u s e c a l l s Kidney stones vary greatly in size and severity, ranging from fine, sandy particles that pass through the urinary tract without notice, to masses as large as tennis balls, at their most extreme, that require surgical intervention to remove. Their make-up can also differ considerably. The vast majority are calcium-based, forming from crystals of calcium oxalate or calcium phosphate. Far less common are those composed of uric acid or struvite (a mineral created by bacteria found in the kidneys), and rarest of all are stones made up of cystine or ammonium acid urate. "For the most part, patients don't even know they have stones when they're in the kidney," Dr. Kubinski explains. But at some point, like other waste excreted by the kidneys, kidney stones typically start to move down the urinary tract—and can get lodged in the ureter (between the kidney and bladder) along the way. "This is when we see symptoms, which include a sudden onset of severe, sometimes unbearable, pain in the side and/or abdominal pain associated with nausea and vomiting," Dr. Kubinski says. Though kidney stones can cause additional symptoms—such as blood in urine—acute pain is what typically prompts people to seek care. TREATING KIDNEY STONES Though most kidney stones are able to pass on their own, some require medical intervention. If a stone is too large to pass safely through the urinary tract, a urologist may suggest breaking the mass down into smaller, more manageable fragments. There are three common methods for doing so: one uses shockwaves, another employs a laser, and a third calls for a jackhammer-like tool. "In each case, we discuss these treatment options and choose the best method based on the size and location of the stone, as well as patient's preference," Dr. Kubinski says. As a patient waits for these smaller stone fragments to pass, doctors may recommend a familiar non-steroidal anti-inflammatory drug, such as ibuprofen, to help keep the swelling down and pain manageable. "Sometimes a patient decides to try to pass a stone on his or her own and we help them do that with advice and medication," says Dr. Kubinski. Dr. Dennis Kubinski Roper St. Francis Healthcare's Kidney Stone Center of Charleston (316 Calhoun St.; Monday- Friday from 8:30 a.m.-4 p.m.) offers walk-in care to anyone who may have a kidney stone. "It is not uncommon for someone to come in with a kidney stone, have their pain controlled, get imaging done, and have their stone treated without ever leaving the building," says Dr. Kubinski. "It's essentially a one-stop shop." The center also provides information on kidney stone prevention. According to the National Kidney Foundation, more than 500,000 Americans visit emergency rooms annually for pain related to kidney stones.

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