About Kidney Stones

What are kidney stones?

A kidney stone is a hard gravel-like mass in the kidney, ureter tube from the kidney to the bladder or in the urethra tube that passes urine out of the body. Kidney stones are usually made of mineral salts (most commonly calcium but sometimes uric acid, the gout chemical).

What should I know and do for kidney stones?

Symptoms include:

Pain that usually begins suddenly and commonly comes in waves of intensity

Pain that is in the back or flank and seems to move to the lower abdomen, groin or legs

Dark or bloody urine

Take medication exactly as directed.

Do not drive while taking these pain medicines.

Drink at least 2-3 quarts of fluids a day (water is best) to flush out the particle(s). Reverse osmosis filtered water for drinking water has much less mineral content and might be helpful for long term use.

Strong Narcotic pain medications as well as Ibuprofen if approved by your doctor help manage pain.

Also, at a recent Urologic conference studies were presented that found Medical expulsive therapy with off label use of (non FDA approved use for kidney stones) steroids, nifedipine calcium channel blocker, Flomax (tamsulosin), (as well as considering a low dose Viagra type medication) as a potential powerful tools to reduce acute painful stones working their way down when the stones are smaller than 10mm and certainly if 3-5mm.

What should I do if I think I have kidney stones?

Strain your urine so that you can catch the stone if and when it passes. Cheesecloth works well for this, as does any porous clothing material. If you do catch the stone or little chunks of sand or gravel, take them to your doctor so it can be analyzed. Your doctor may suggest a diet change based on the type of stones you have.

You should have at least an x ray called the KUB as well as routine lab work and a urine analysis and culture with the onset of likely kidney stone. Cat scan without contrast via stone protocol is now the best study to confirm a stone and assess position size and degree of urine tube blockage. The only downside is the cost and the modestly higher radiation dose especially in those with a history of multiple stones so sometimes a simple KUB and ultrasound can be done instead.

If you are female or have more than one stone or an infection related stone a more thorough investigation including a 24 hour urine test are in order. Also, if you don’t pass a stone within 10-14 days, you should seek help from a urologist as early permanent kidney damage starts to occur when the urine tube is blocked by a stone within 14 days and if fully blocked, a kidney will become non functional by 6 weeks from onset.

Stones <4mm have greater than an 80% chance of passing on their own within the 10 day wait period. Stones 4-6mm have about a 60% chance of passing on their own. Stones 6-8mm have a 40% chance of passing and stones >8mm should be referred to an urologist immediately for removal.

To help prevent formation of kidney stones:

If you have more than one kidney stone, especially if you have a family history of stones, you are more likely to have kidney stones again. But you can take steps to help prevent them:

Exercise on a regular basis at least 3 times a week

Follow diet instructions provided by your doctor

Drink more fluids. Try to drink enough water to keep your urine clear, about 8 to 10 glasses of water per day. Slowly increase how much you drink, perhaps adding one more glass of water a day until you are drinking 8 to 10 glasses a day. This slow increase will give your body time to adjust to the extra fluids. You are drinking enough water when your urine is clear or light yellow. If it is dark yellow, you are not drinking enough fluids. If you have kidney, heart, or liver disease and have fluid restrictions, talk with your doctor before increasing how much you drink.

Change your diet. This may be helpful, but it depends on what is causing your kidney stones. Your doctor may do more tests before deciding whether changing your diet will help reduce your risk of developing another stone. The results of these tests may suggest that it could be helpful to do one or more of the following:

Increasing how much fiber you eat. Fiber includes oat bran, beans, whole wheat breads, wheat cereals, cabbage, and carrots.

Eating less beef, pork, and poultry.

Eating a moderate or high amount of calcium-rich foods, such as dairy products. Getting your recommended amounts of calcium, combined with a diet low in sodium and protein, may decrease your risk of kidney stones.7 In older people and younger women, one study indicates that eating more calcium-rich foods reduces the risk of kidney stones.8

Avoiding foods that are high in oxalate such as dark green vegetables, nuts, and chocolate.

Not adding salt when you cook or eat. Try removing the salt shaker from your table.

Medicine

If you get more kidney stones despite drinking more fluids and making changes to your diet, your doctor may give you medicine to help dissolve your stones or to prevent new ones from forming. You may also receive medicine if you have a disease that increases your risk of forming kidney stones. Which medicine you take depends on the type of stone you may have.

Medicine to prevent calcium stones

About 80% of kidney stones are calcium stones.  Calcium stones that have already formed cannot be dissolved by changing your diet or taking medicines. There are medicines that may keep calcium stones from getting bigger or may prevent new calcium stones from forming:

Thiazides (such as hydrochlorothiazide, chlorthalidone).

Potassium citrate (Urocit-K).

Orthophosphate (Neutra-Phos).

Cholestyramine (Questran).

When and why should I follow up with the doctor?

If you have nausea or vomiting and can not keep fluids down.

If you develop more intense pain in the back or abdomen

If you notice blood in your urine or your urine is dark

If you have difficulty passing you urine

If you develop fever or chills

Make sure that even if your pain has subsided or that you have passed what you think was the stone that you call your doctor’s office and let your doctor know. Also, find out if any further testing for follow- up is needed. Commonly a CAT scan or an Ultrasound is performed to make sure that there is no hidden blockage of the ureter tube which may lead to painless loss of a kidney over 4-6 weeks time. Lastly depending on the type of stone, the number of stones you have or have had and the size of your stones, your doctor may want you to follow-up for a more detailed evaluation, blood work and 24 hour urine analysis for stone forming tendencies that may have a stronger genetic component and put you at increased future risk of recurrent stones and other seemingly unrelated health problems.

Note- high amounts of protein in the diet and high amounts of sodium in the diet force an increase in urinary calcium which then binds to the usually excreted urinary oxalate from dietary sources such as fruits and vegetables and can increase stone risk.

Note on pain medications containing Tylenol/acetaminophen:

Take medications as directed, never more. Realize that there is acetaminophen in most prescription pain medications, and severe or permanent liver damage can result from prolonged use and after taking higher doses than recommended of this medicine.

Alternative Headache Therapy

Treating the different forms of headache and chronic pain syndromes often requires an individualized approach, utilizing a team of specific professionals to achieve lasting success. Several treatment trials may be required until lasting success is achieved. Using conventional prescription medications until the right nutritional and lifestyle approach is firmly established should be considered in order to decrease suffering and disability. Also, we sometimes need to treat depression or anxiety first in order to remove roadblocks to lifestyle change.

Treatment of these conditions results in gradual and delayed improvement. Once an adequate response has occurred, we can start to eliminate several of the supplements as long as your diet and lifestyle are back on a healthy track.

To reduce Pain immediately try laying down in a dark quiet room. Put a cold moist towel over your forehead. Massage your scalp using a lot of pressure. Put pressure on your temples.

Don’t smoke. If you do, quit.

Avoid excess alcohol (especially red wine). If you drink more than two alcohol-containing beverages a few times a week or if you binge not infrequently, cut down.

Avoid caffeine/stimulants. If you drink coffee, tea, sodas, chocolate, cocoa, carob, or take supplements with caffeine, Kola nut, guarana, Ma Huang, or ephedra/sudoephedrine in over the counter diet supplements or decongestant medications, you will need to slowly wean off of these over a few weeks.

Avoid regular use of pain medications (Excedrin/ibuprofen/Tylenol etc) more than three or four times a week, or combination headache medications like Esgic or Fiorinal on a regular basis.

Avoid strong odors, bright lights and loud noises. These can all be migraine triggers as can stress, weather change, fatigue, eyestrain, menstruation, loud noises, over exertion, and fatigue.

Avoid certain foods or food additives Some of these items may be triggers. Try to find out which if any seem to be associated with headache shortly after ingestion; Aged, canned cured, or processed meat (bologna, game, ham, herring, hot dogs, pepperoni, sausage), artificial sweeteners- Aspartamine/Nutrasweet, Avocados, Beans (pea pods, snow peas, pole, broad, lima, Italian, navy, pinto, garbanzo, and lentils), Brewer’s yeast (fresh yeast coffee cake, donuts, sourdough bread), Canned soup or bouillon cubes, most Cheeses especially aged cheese, Cultured dairy like buttermilk and sour cream, Figs, citrus fruits, Meat tenderizer (MSG), Nuts and peanut butter, Onions except for flavoring, Papaya, Passion fruit, Pickled salty or marinated foods (olives, pickles, sauerkraut, soy sauce, seasoned salt), Raisins, and Red plums.

Avoid missing meals or fasting. If you are overweight, moderate weight loss of five to ten pounds, at a level of a pound or two a week may provide benefit.

Be aware of symptoms that precede migraine such as fatigue, yawning, excitability, high energy, visual disturbances (flashes sparks, wavey lines, blind spots, and nasal congestion.

Consider early abortive treatments with Tryptan Rx medication, or Excedrin Migraine as indicated by your doctor. Realize that early treatment might prevent a full blown disabling migraine from blossoming.

Consider preventive or prophylactic treatments if you need headache medication more than 2 days a week or you are functioning poorly due to any aspect of the migraine spell on a fairly regular basis, you should consider preventive therapies. There are a few FDA approved medicines and a myriad of off label prescription medications in an array of categories such as blood pressure lowering, antidepressant and seizure prevention medications that if taken daily can lessen the severity and or reduce the frequency of migraine headaches.

Exercise- moderate levels such as a brisk walk outside for thirty minutes five times a week or swimming is very helpful, especially during daylight hours. Advance to include resistance training, stretching, and more intense aerobic exercise as time and tolerance permit. Start with a physical therapist or trainer to avoid injury.

Maintain consistent sleep/awake hours. Schedules that vary often induce headaches.

*Magnesium Slo Mag (over the counter), or Mag Ox 400 mg, one pill two times a day.

Calcium 1,200-1,500 mg per day with Zinc/vitamin D
Calcium citrate with meals two to three times a day- Citrical, Oscal-D, Cal/Mag/Zinc, or nonfat dairy sources, especially from yogurt three to four servings day as well as green leafy vegetables.

B Complex or multivitamin with Bs-Centrum silver, etc…

*Take omega 3 fatty acids or Essential Fatty Acids (4-6 grams a day is the suggested range). This ideally it should come from actual fish (salmon, sardines, cod, or small mackerel), walnuts or fresh flaxseed oil has some omega 3 fat but its biological effects may vary. Extracted fish oil capsules are generally distilled and not likely to carry many impurities such as mercury or pesticides etc. Some brands that have less fishy aftertaste are Fisol and Omega Synergy that (can be bought by ordering it on the web at; www.designsforhealth.com or by calling 1-800-847-8302). These can additionally be kept in the freezer further reducing aftertaste issues if present.


*Vitamin B2 (riboflavin) may help when taken in higher than the 2mg/day RDA dose. Doses of (200mg 2x a day = 400mg a day) have proven helpful at decreasing headaches over time in many people. It usually takes about 3 months to start working.

*Feverfew (Tanacetum parthenium) containing greater then 0.2% parthenolide 50-100mg a day has proven to reduce migraines, and prevent recurrent attacks as a maintenance treatment where conventional treatments have been inadequate.

“MigreLief” combines Magnesium, B2/Riboflavin and Feverfew) 1 tablet twice a day $17 to $25 a month http://www.migrelief.com/FAQ.html

*Butterbur Petasites Hybridus in extract form known as Petadolex 150mg a day- as published in “Neurology” reduced the frequency of migraines by almost 50%– costs $40- $50 a month.- may cause upset stomach or burping – may also help in asthma and allergies

*Co-Enzyme Q10 100mg as a gel 3 x a day may reduce headache frequency by a third- worth a try for a month or two. If you find a good source it should only cost $40 a month but can be very expensive.

Sinus Buster capascin hot pepper nasal spray can help with chronic sinus congestion, sinus and migraine headache control as well as per noted from the Princeton Longevity Center 11/07,

Acupuncture has proved quite helpful for both acute treatment of pain symptoms as well as the maintenance of more chronic arthritic or inflammatory problems.

Less well proven approaches that some patients have reported success with include:

Evaluating for unfavorable bacterial overgrowth in the intestinal tract and removing, replacing, and repopulating and retaining a healthy balance of intestinal flora with probiotic supplements may also play a role in treating more serious inflammatory conditions.

Detoxification with a combination medical foods and elimination diets may also help achieve a reduction in the inflammatory process causing arthritis and chronic pain. It may also help to detoxify one’s system further reducing inflammation.

Fatigue- American Ginseng for, 200-2,000 mg per day as needed.

Insomnia- Chamomile tea and Valerian capsules at bedtime.

Domestic Violence: Protecting Yourself and Your Children

It is much more common than you think.

What is domestic violence?

Domestic violence is abuse by a caregiver, a parent, a spouse or an intimate partner. It can take many forms. Here are some types of abuse: Physical abuse is the use of physical force; sexual abuse means any forced sexual activity; emotional abuse includes threats, constant criticism and put-downs. Controlling access to money and controlling activities are other abusive behaviors.

What should I know about domestic violence?

Violence against a partner or a child is a crime in all states. Each year, at least 2 million women are abused in this country. Abuse happens to people of all races, ages, incomes and religions.
People who are hurt by their partners or parents do not cause the abuse. Alcohol and drugs do not cause abuse, although they can make the violence worse. Abuse can begin, continue and increase during pregnancy.

What can I do if my children or I am abused?

First, make sure you and your children are safe. Go to a safe place, such as the home of a friend or a relative or an emergency shelter. Take your children with you. Call the police if you think you can't leave home safely or if you want to bring charges against your abuser.
If possible, take house keys, money and important papers with you. Do not use drugs or alcohol at this time because you need to be alert in a crisis. The staff members at emergency shelters can help you file for a court order of protection.

What are other ways I can get help if I am abused?

Talk to your doctor, who can treat any medical problem, provide support and make referrals. Call an emergency shelter and ask about counseling and support groups for you and your children. Nurses, social workers and other health care professionals can also help you.

Other Organizations

Domestic violence center W. Chester 610 431 1430

Crime victims center Inc www.cvcofcc.org  610 692 7420

Crime victims center of Chester Co. Sexual assault 610 692 7273

Chester Co Legal aid services 610 436 4510

National Coalition Against Domestic Violence
http://www.ncadv.org
National Domestic Violence Hotline
http://www.ndvh.org
800-799-7233