Peeing Through a Pasta Strainer: The Kidney Stone Episode

Join Brodie, Josh, and James as they tackle the painful (and surprisingly funny) world of kidney stones - why they happen, what makes them hurt so much, and how to keep your body from starting its own gravel business. From ER stories to myth-busting and prevention tips, this episode delivers real talk, laughs, and practical advice for anyone with kidneys! Also...rhubarb???

Episode Transcript

(00:01):
That magical hour where everyone in the emergency department, including me, wishes they were asleep.
A 3-year-old guy bursts through the doors, pacing, sweating, and convinced he's actively dying.
He keeps grabbing his right flank.
He's bent over then standing, then pacing again.
He can't get comfortable.
He tries to lie down.
Nope.

(00:21):
He tries the bathroom also.
Nope.
He tries Googling His symptoms catastrophic.
We get his test back in surprise, but also not surprised.
His CT shows a tiny, jagged little villain.
A four millimeter kidney stone, a rock.
The size of a lentil, bringing a grown adult to their knees.
So today we're talking kidney stones.
Why they happen? Why they hurt so much, and how you can stop your body from starting its own gravel business.

(00:48):
This is not another medical podcast. 19 00:01:29,694.631919398 --> 00:01:31,257.636454545 Brody, did you we're back. 20 00:01:32,64.631919398 --> 00:01:35,217.636454545 Did you just say shebang? It's I didn't say shebang. 21 00:01:36,264.631919398 --> 00:01:36,984.631919398 yeah, yeah. 22 00:01:36,984.631919398 --> 00:01:40,254.6319194 Listeners, uh, as we were getting into this, Brody just said shebang. 23 00:01:40,254.6319194 --> 00:01:41,34.6319194 Time to go. 24 00:01:41,997.63645455 --> 00:01:49,767.63645455 See, I'd said it I non off the record, the non-recorded shebang, which was supposed to stay that way. 25 00:01:50,127.63645455 --> 00:01:56,890.13645455 Dicks? it was, it was, uh, we had to uncover that, uncover that dirt. 26 00:01:58,347.63645455 --> 00:02:00,837.63645455 Um, my, the my episode, my editing. 27 00:02:02,877.63645455 --> 00:02:04,317.63645455 This'll be That, guys. 28 00:02:04,390.13645455 --> 00:02:05,890.13645455 that, that is true. 29 00:02:07,459.6319194 --> 00:02:08,517.63645455 Uh, Oh man. 30 00:02:08,650.13645455 --> 00:02:14,470.13645455 Oh Um, Josh, you, you, you seem to be in a different place than your usual recording spot. 31 00:02:14,710.13645455 --> 00:02:15,627.63645455 Tell yeah. 32 00:02:15,684.6319194 --> 00:02:18,84.6319194 am, I am, uh, there's a brick wall behind me. 33 00:02:18,84.6319194 --> 00:02:25,314.6319194 I, after five years of talking about it, we have finally our front room, which is now our office. 34 00:02:25,314.6319194 --> 00:02:26,304.6319194 And it's wonderful. 35 00:02:26,364.6319194 --> 00:02:29,964.6319194 Um, this room, when we moved into this house was like 40 years old. 36 00:02:29,964.6319194 --> 00:02:32,634.6319194 There was absolutely asbestos everywhere. 37 00:02:33,534.6319194 --> 00:02:38,214.6319194 And we, we, we initially made the mistake of putting a, uh, like a spin bike in here. 38 00:02:38,484.6319194 --> 00:02:40,674.6319194 And after three minutes of biking, I couldn't breathe. 39 00:02:40,674.6319194 --> 00:02:43,524.6319194 And like, my cardio's not great, but it's better than three minutes of biking. 40 00:02:43,854.6319194 --> 00:02:45,294.6319194 So we didn't go in the room again. 41 00:02:45,774.6319194 --> 00:02:48,744.6319194 And we finally just redid it over the last like six months. 42 00:02:48,924.6319194 --> 00:02:49,584.6319194 And here we are. 43 00:02:49,584.6319194 --> 00:02:50,334.6319194 We have an office. 44 00:02:50,455.13645455 --> 00:02:56,412.63645455 Oh, Nice asbestos still staying or? That was too, too expensive to get rid of, so, Black. 45 00:02:56,742.63645455 --> 00:02:57,912.63645455 Black mold is all gone. 46 00:02:58,509.6319194 --> 00:02:58,799.6319194 yeah. 47 00:02:59,22.63645455 --> 00:02:59,532.63645455 are better. 48 00:03:00,149.6319194 --> 00:03:00,439.6319194 Yeah. 49 00:03:00,907.63645455 --> 00:03:01,327.63645455 Better. 50 00:03:01,494.6319194 --> 00:03:03,264.6319194 We'll We're gonna, coughing, just go with it. 51 00:03:03,612.63645455 --> 00:03:06,132.63645455 I was gonna say, well watch your breathing as the podcast goes on. 52 00:03:06,475.13645455 --> 00:03:08,142.63645455 That's you start huffing by the end of it. 53 00:03:08,862.63645455 --> 00:03:10,662.63645455 We have some questions for your contractors. 54 00:03:10,735.13645455 --> 00:03:13,255.13645455 Pulse ox on your finger. 55 00:03:14,425.13645455 --> 00:03:16,45.13645455 It's a livestream pulse ox. 56 00:03:16,932.63645455 --> 00:03:17,382.63645455 Um. 57 00:03:17,514.6319194 --> 00:03:18,984.6319194 made a lot of bad life decisions. 58 00:03:19,225.13645455 --> 00:03:19,705.13645455 Yeah. 59 00:03:20,124.6319194 --> 00:03:21,684.6319194 Um, but yeah, no, it's pretty awesome. 60 00:03:21,714.6319194 --> 00:03:22,524.6319194 It's nice to do this. 61 00:03:22,524.6319194 --> 00:03:26,665.13645455 I used to just, uh, kind of hang out in my kitchen and everyone would walk by and I'd be like, Yeah. 62 00:03:26,814.6319194 --> 00:03:27,84.6319194 time. 63 00:03:27,205.13645455 --> 00:03:27,475.13645455 Yeah. 64 00:03:27,612.63645455 --> 00:03:29,394.6319194 wrong with that? a little bit of pri Nothing. 65 00:03:29,484.6319194 --> 00:03:29,694.6319194 Yeah. 66 00:03:30,19.6319194 --> 00:03:30,309.6319194 Yeah. 67 00:03:30,314.6319194 --> 00:03:30,774.6319194 It's true. 68 00:03:30,955.13645455 --> 00:03:32,305.13645455 a little bit of privacy, I guess. 69 00:03:32,994.6319194 --> 00:03:33,264.6319194 Yeah. 70 00:03:34,134.6319194 --> 00:03:34,734.6319194 your living room. 71 00:03:34,794.6319194 --> 00:03:35,607.63645455 You're not the Okay. 72 00:03:35,607.63645455 --> 00:03:38,574.6319194 I'm, I'm kitchen adjacent kitchen adjacent. 73 00:03:38,574.6319194 --> 00:03:39,204.6319194 Yeah, you are. 74 00:03:39,477.63645455 --> 00:03:40,932.63645455 in, not in Toronto World. 75 00:03:41,652.63645455 --> 00:03:42,342.63645455 Yeah, exactly. 76 00:03:43,344.6319194 --> 00:03:43,932.63645455 And, and Um. 77 00:03:43,944.6319194 --> 00:03:56,184.6319194 know what guys? I was really excited to to podcast in here, but I thought James was gonna just one up me right away saying he's going to like Fiji to meet the prime Minister of some like, but he didn't. 78 00:03:56,184.6319194 --> 00:03:57,114.6319194 So thank you James. 79 00:03:57,114.6319194 --> 00:03:57,894.6319194 I appreciate you. 80 00:03:58,135.13645455 --> 00:04:02,964.6319194 Well, I, I did just come from London, but, uh, I'm not gonna, you know, we go. 81 00:04:03,354.6319194 --> 00:04:04,224.6319194 There we go. 82 00:04:05,395.13645455 --> 00:04:11,967.63645455 I mean, you know, I, I mean, since you asked, uh, we did go to let that, You really did ask Josh. 83 00:04:12,580.13645455 --> 00:04:12,870.13645455 yeah. 84 00:04:13,14.6319194 --> 00:04:13,824.6319194 I know that's on me. 85 00:04:14,300.13645455 --> 00:04:14,590.13645455 Yeah. 86 00:04:15,387.63645455 --> 00:04:18,237.63645455 Speaking of old bricks, I'm sure you saw lots in London there, James. 87 00:04:18,775.13645455 --> 00:04:21,325.13645455 Speaking of asbestos and, uh, difficulty breathing. 88 00:04:22,224.6319194 --> 00:04:22,434.6319194 Yeah. 89 00:04:22,434.6319194 --> 00:04:24,205.13645455 Really? How Loved that. 90 00:04:24,655.13645455 --> 00:04:38,815.13645455 Oh, actually, uh, you know, broads, uh, the last time I've been to, I was in London, was with you, uh, when we're backpacking through Europe, uh, you know, Literally with just backpacks yeah, just, just one backpack each. 91 00:04:39,267.63645455 --> 00:04:39,927.63645455 before carry on. 92 00:04:39,927.63645455 --> 00:04:41,307.63645455 Only was a was a thing. 93 00:04:43,415.13645455 --> 00:04:43,705.13645455 Yeah. 94 00:04:43,965.13645455 --> 00:04:50,260.13645455 And uh, yeah, so it's been a while since I been to London and you know, God, like, you know, it was great. 95 00:04:50,320.13645455 --> 00:04:51,430.13645455 Uh, just me and my wife. 96 00:04:52,120.13645455 --> 00:04:53,50.13645455 Awesome. 97 00:04:54,70.13645455 --> 00:05:00,658.14098969 Um, team today we're talking about something that does not need a segue Ooh. 98 00:05:01,480.13645455 --> 00:05:04,623.14098969 it is, it is just so common Mm-hmm. 99 00:05:04,750.13645455 --> 00:05:08,638.14098969 painful just, we just gotta get into this, Yeah. 100 00:05:08,698.14098969 --> 00:05:09,658.14098969 It just, it had to be done. 101 00:05:09,658.14098969 --> 00:05:11,848.14098969 It's like ripping a bandaid off, I feel like. 102 00:05:12,658.14098969 --> 00:05:13,228.14098969 Yeah. 103 00:05:13,300.13645455 --> 00:05:13,858.14098969 like Yeah. 104 00:05:13,900.13645455 --> 00:05:14,860.13645455 like peeing out a stone. 105 00:05:15,13.14098969 --> 00:05:25,550.64098969 Yeah, and I'm gonna, I'm gonna say it once and then hopefully never again, but I just have to get the whole childbirth analogy outta here, recognizing that there's three dudes on this podcast, Yeah. 106 00:05:25,555.64098969 --> 00:05:30,383.14098969 Yeah, and, I and often we hear the, it's like giving birth, or as painful, as giving birth. 107 00:05:30,473.14098969 --> 00:05:31,843.14098969 I don't want to dive into that. 108 00:05:32,53.14098969 --> 00:05:33,43.14098969 I don't want to talk about it. 109 00:05:33,253.14098969 --> 00:05:36,403.14098969 I just want to acknowledge it and allow us to move on. 110 00:05:36,733.14098969 --> 00:05:43,513.14098969 'cause I don't know, it just seems to be a thing that guys say and I want the three of us to not be those guys. 111 00:05:43,645.64098969 --> 00:05:44,5.64098969 yeah. 112 00:05:44,5.64098969 --> 00:05:44,635.64098969 I agree. 113 00:05:44,710.13645455 --> 00:05:45,40.13645455 call. 114 00:05:45,295.64098969 --> 00:05:46,885.64098969 We know nothing about childbirth. 115 00:05:47,263.14098969 --> 00:05:48,163.14098969 Exactly. 116 00:05:48,223.14098969 --> 00:05:48,973.14098969 Exactly. 117 00:05:49,180.13645455 --> 00:05:52,480.13645455 No, So, listeners, we're talking about kidney stones. 118 00:05:52,590.64098969 --> 00:05:53,950.13645455 I, that's what we're getting into. 119 00:05:54,0.64098969 --> 00:05:54,420.64098969 mm-hmm. 120 00:05:54,790.13645455 --> 00:05:55,720.13645455 This is a fun one. 121 00:05:56,48.14098969 --> 00:05:56,398.14098969 Right. 122 00:05:56,620.13645455 --> 00:05:58,243.14098969 why kidney stones? Yeah. 123 00:05:58,300.13645455 --> 00:06:06,503.14098969 piqued your interest in this one? I mean, besides the fact that literally my last, like four me shifts, I have had at least three people each shift. 124 00:06:07,43.14098969 --> 00:06:09,623.14098969 I have like worked up four or diagnosed kidney stones in. 125 00:06:10,973.14098969 --> 00:06:13,283.14098969 But you just get to the point of one you feel really bad. 126 00:06:13,283.14098969 --> 00:06:18,413.14098969 Two, I have this conversation multiple times on a shift about managing and pain control and, and what they are. 127 00:06:18,623.14098969 --> 00:06:21,893.14098969 I just thought it'd be kind of fun to dive in and be able to spend a whole episode on it. 128 00:06:21,953.14098969 --> 00:06:26,633.14098969 So that was kind of it really just, uh, it's common throughout there. 129 00:06:26,933.14098969 --> 00:06:28,85.64098969 Um, Yeah. 130 00:06:28,103.14098969 --> 00:06:29,813.14098969 I think there's a lot to be, a lot to be learned. 131 00:06:30,35.64098969 --> 00:06:30,455.64098969 Yeah. 132 00:06:30,653.14098969 --> 00:06:33,683.14098969 Super common daily presentations. 133 00:06:33,683.14098969 --> 00:06:33,953.14098969 Yeah. 134 00:06:34,55.64098969 --> 00:06:45,108.14098969 I did a little bit of digging in, the US and Canada, it's about 10% of adults who experienced kidney stone at least once in their life That's, that's a lot, right? That is a lot. 135 00:06:45,125.13645455 --> 00:06:51,995.64098969 adults by adults by age or by maturity? I, don't think the kidney stones discriminate. 136 00:06:54,908.14098969 --> 00:07:00,98.14098969 We'll get into risk factors, but I don't think Maturity is one of those. 137 00:07:01,220.13645455 --> 00:07:02,190.13645455 Yeah, just checking. 138 00:07:03,5.64098969 --> 00:07:07,565.64098969 But like, even more so, right? You're still at risk? yeah, you're still at risk. 139 00:07:07,775.64098969 --> 00:07:24,335.64098969 You know, for Brody in emergency rooms, I'm sure a lot of patients come in thinking that it's kidney stone, even though it's not a kidney stone, right? So I think you'll probably see more people, more than 10% saying that they think that they have kidney stone and you are working them up for it. 140 00:07:24,725.64098969 --> 00:07:29,846.14552484 I like the common theme of things that present like something, but really Yeah, And that's sake. 141 00:07:29,935.64098969 --> 00:07:30,505.64098969 episodes. 142 00:07:30,505.64098969 --> 00:07:31,316.14552484 And Yeah. 143 00:07:31,316.14552484 --> 00:07:31,406.14552484 Mm-hmm. 144 00:07:31,873.64552484 --> 00:07:32,113.64552484 Yeah. 145 00:07:32,383.64552484 --> 00:07:44,53.64552484 The other thing though is I think that everyone that works in the emerge gets really good at spotting who does have a kidney stone because like they often are, the people walking around can't get like, get comfortable. 146 00:07:44,83.64552484 --> 00:07:48,643.64552484 They're like, heaved over vomiting, look super unwell. 147 00:07:48,643.64552484 --> 00:07:53,833.64552484 And then they get like a shot of of Toradol and all of a sudden, like they can breathe and relax again. 148 00:07:53,833.64552484 --> 00:07:58,783.64552484 But it's like you can pick about as soon as they walk into triage, you're like, that one's got a stone. 149 00:07:59,113.64552484 --> 00:08:00,283.64552484 And I feel so sorry for you. 150 00:08:00,356.14552484 --> 00:08:00,836.14552484 right? Yeah. 151 00:08:00,836.14552484 --> 00:08:00,896.14552484 Yeah. 152 00:08:02,285.64098969 --> 00:08:09,398.14098969 I was gonna ask Brody, since we're talking about kidneys, tell us a little bit like high level, what do kidneys do? And then we'll, Yeah. 153 00:08:09,575.64098969 --> 00:08:09,965.64098969 from there. 154 00:08:10,55.64098969 --> 00:08:10,235.64098969 Yeah. 155 00:08:10,688.14098969 --> 00:08:11,18.14098969 Yeah. 156 00:08:11,18.14098969 --> 00:08:14,148.14098969 And I'd like to say that kidneys are one of the most misunderstood organs. 157 00:08:14,148.14098969 --> 00:08:15,348.14098969 And I don't mean that for like other people. 158 00:08:15,348.14098969 --> 00:08:16,68.14098969 I mean that for me., 159 00:08:16,653.14098969 --> 00:08:17,463.14098969 I hate the kidneys. 160 00:08:17,463.14098969 --> 00:08:18,573.14098969 I hate learning about them. 161 00:08:19,749.80765636 --> 00:08:22,939.80765636 I hate about all the different electrolytes I would second that which salts go which way. 162 00:08:23,299.80765636 --> 00:08:26,407.30765636 Like, I hate kidneys, like, yeah. 163 00:08:26,407.30765636 --> 00:08:29,79.80765636 I don't Like, uh, all of it sounds awful. 164 00:08:29,557.30765636 --> 00:08:29,917.30765636 Yeah. 165 00:08:29,919.80765636 --> 00:08:37,309.80765636 So with that bias, you know, kidneys are really,, they're filters for your blood, right? So they help you get rid of waste. 166 00:08:37,639.80765636 --> 00:08:39,889.80765636 They help you balance the fluids in your body. 167 00:08:39,889.80765636 --> 00:08:44,526.47432303 You're not too dehydrated, but you're also not keeping, you know, fluid on your lungs or in your legs. 168 00:08:44,576.47432303 --> 00:08:45,616.47432303 And they're really important. 169 00:08:45,616.47432303 --> 00:08:54,226.47432303 You see people that are on dialysis, for example, right, where their kidneys aren't working, like, these are things that people have to do either every day or every other day, depending on the type of dialysis they do. 170 00:08:54,226.47432303 --> 00:08:59,326.47432303 So they play a really critical role in keeping everything clean and balanced. 171 00:08:59,536.47432303 --> 00:09:00,976.47432303 But in the same way that. 172 00:09:01,756.47432303 --> 00:09:10,996.47432303 If you're filtering things out or you're using your Brita or your water filter, like over time there gets deposits and things, you know, salts will be there, things will start to crystallize. 173 00:09:10,996.47432303 --> 00:09:19,656.47432303 It's kind of the same idea with kidney stones then, right? Fluids going through, things are getting collected like they should be, and then sometimes things can kind of precipitate and crystallize. 174 00:09:19,798.97432303 --> 00:09:19,918.97432303 Yeah. 175 00:09:19,918.97432303 --> 00:09:29,568.97432303 So, would, uh, I would say, kidneys also give me a job because I feel like 90% of my patients come in with kidney injury and, um, yeah. 176 00:09:29,658.46978788 --> 00:09:30,498.46978788 thank you kidneys. 177 00:09:30,798.97432303 --> 00:09:31,968.46978788 Uh, one, Yeah. 178 00:09:32,238.97432303 --> 00:09:36,788.97432303 One thing I would add as someone who studies anatomy so, Brody said it's like a filter. 179 00:09:36,788.97432303 --> 00:09:42,698.97432303 So kidneys, there are two of them left and right, kidney, and then there's blood vessels that go in. 180 00:09:42,698.97432303 --> 00:09:46,178.97432303 So carry the blood and then carry the blood out of the filter. 181 00:09:46,358.97432303 --> 00:09:53,528.97432303 And then what's filtered out goes into ureter, which is the pipeline that connects the kidneys to the bladder. 182 00:09:53,858.97432303 --> 00:10:00,788.97432303 And then that's where the urine accumulates, bladder and then when it's ready to empty, it will squeeze into the urethra. 183 00:10:00,978.97432303 --> 00:10:02,208.97432303 And then that's how you pee it out. 184 00:10:02,265.85074026 --> 00:10:02,945.85074026 Yeah, that's great. 185 00:10:03,152.84620511 --> 00:10:06,692.84620511 bro, uh, James, thanks for not going into the anatomy of the kidney itself. 186 00:10:06,893.35074026 --> 00:10:07,183.35074026 Yeah. 187 00:10:07,188.35074026 --> 00:10:07,278.35074026 Yeah. 188 00:10:07,442.84620511 --> 00:10:13,308.35074026 wildly complicated and No, don't even know if I can go into that detail of that anyways. 189 00:10:13,322.84620511 --> 00:10:18,228.35074026 I, and like it is nuts and we'll do, we'll do an episode on kidney injury and things like that Yeah. 190 00:10:18,422.84620511 --> 00:10:19,82.84620511 really important. 191 00:10:19,292.84620511 --> 00:10:26,363.35074026 Uh, but the, the kidney itself is important in how stones form, but less important in what happens once the stones Mm-hmm. 192 00:10:27,65.85074026 --> 00:10:31,460.85074026 Uh, and to that point, the kidneys themselves live in what we call your flank region. 193 00:10:31,460.85074026 --> 00:10:37,830.85074026 So this is your mid back, kind of just at the bottom where your, your ribs would almost end, again, on both sides. 194 00:10:37,830.85074026 --> 00:10:43,140.85074026 And so when people start to develop kidney stones, they'll often refer as flank pain or kind of pain in that back. 195 00:10:43,320.85074026 --> 00:10:49,90.85074026 But then as James was describing that anatomy where the urine travels down from the kidney through the ureter into the bladder. 196 00:10:49,360.85074026 --> 00:10:51,280.85074026 Sometimes that pain will radiate around the front. 197 00:10:51,280.85074026 --> 00:10:55,480.85074026 It might even be in your right lower quadrant like we might see with appendicitis, for example. 198 00:10:55,660.85074026 --> 00:11:00,70.85074026 But it can be this kind of pain sometimes in the back, sometimes along the front or the lower part of the abdomen. 199 00:11:00,499.51287178 --> 00:11:16,527.51740693 what's, what's the stone? What's a kidney stone? Then we've talked about kind of the anatomy, but what's the actual stone we're talking about here? Yeah, so, similar if you were to leave a sugary drink out overnight and you start to see crystals form at the bottom, it's kind of how you can get stones in your kidney as well. 200 00:11:16,527.51740693 --> 00:11:20,417.51740693 It's filtering all these precipitates and minerals and things like that. 201 00:11:20,417.51740693 --> 00:11:21,827.51740693 And, they can just start to build up., 202 00:11:22,217.51740693 --> 00:11:26,947.51740693 And as those small crystals start to form together, or clump together, they can grow into larger stones. 203 00:11:26,977.51740693 --> 00:11:30,247.51740693 You know, and these aren't like nice polished stones you're getting at the gem store. 204 00:11:30,247.51740693 --> 00:11:35,407.51740693 Like they're, uh, really uncomfortable, really sharp,, and as they get bigger they really hurt a lot. 205 00:11:36,247.51740693 --> 00:11:40,687.51740693 There's, there's gotta be a story of someone who collected a kidney stone and made it into a wedding ring. 206 00:11:40,717.51740693 --> 00:11:41,860.52194207 We gotta Ooh. 207 00:11:42,460.52194207 --> 00:11:42,790.52194207 Yeah. 208 00:11:42,997.51740693 --> 00:11:44,530.52194207 It's to be a decent sized stone. 209 00:11:44,590.52194207 --> 00:11:45,130.52194207 That's sure. 210 00:11:45,190.52194207 --> 00:11:46,30.52194207 That that's fair. 211 00:11:46,90.52194207 --> 00:11:46,300.52194207 Yeah. 212 00:11:46,300.52194207 --> 00:11:50,410.52194207 If anyone, if any listeners that happened where you collected your stone. 213 00:11:50,753.02194207 --> 00:11:53,453.85527541 propose Yeah. 214 00:11:53,570.85074026 --> 00:11:53,930.85074026 honey. 215 00:11:54,383.85527541 --> 00:11:54,683.85527541 Yeah. 216 00:11:54,893.85527541 --> 00:11:59,123.85527541 Um, but Josh, it's, it is actually a good segue on collecting stones. 217 00:11:59,183.85527541 --> 00:12:09,773.85527541 'cause if you have a kidney stone and you pee through a sieve, for example, and you collect it, which I tend to recommend patients do, it's important because there's different types of stones you can get. 218 00:12:09,993.85527541 --> 00:12:14,133.85527541 And you can actually test the stones to figure out what type of stone it is. 219 00:12:14,233.85527541 --> 00:12:21,523.85527541 And that can really help with what your management is gonna be, your chance of it happening again, whether there's any preventative medications you could go on and stuff like that. 220 00:12:22,735.85074026 --> 00:12:27,58.85527541 Is it worth, is it worth going through the, the types, just kind of big, broad strokes, Yeah. 221 00:12:27,118.85527541 --> 00:12:27,508.85527541 Sounds good. 222 00:12:27,508.85527541 --> 00:12:31,588.85527541 So the, the most common one that we see is the calcium oxalate stones. 223 00:12:31,648.85527541 --> 00:12:34,978.85527541 These make up about 75% of all stones or so. 224 00:12:35,108.85527541 --> 00:12:38,558.85527541 And both calcium and oxalate are both normal parts of your diet. 225 00:12:38,788.85527541 --> 00:12:43,198.85527541 And good for us to eat and play very important functions in our diet and our body. 226 00:12:43,438.85527541 --> 00:12:48,148.85527541 But when they start to get out of balance for the proportion of those, that's when they tend to stick together. 227 00:12:48,368.85527541 --> 00:12:59,958.85527541 And we'll talk about other kind of big risk factors and things, but things we would see would be if you're, you know, dehydrated, high salt intake, you know, high oxalate foods, these are things that, can put you at higher risk for these types of stones. 228 00:13:00,796.35527541 --> 00:13:04,988.85527541 Can you tell us what they are The high oxalate food? High oxalate foods. 229 00:13:04,988.85527541 --> 00:13:05,298.85527541 Yeah. 230 00:13:05,448.85527541 --> 00:13:12,878.85527541 so these are things like spinach, beets, rhubarb, nuts, especially almonds and cashews. 231 00:13:12,878.85527541 --> 00:13:13,818.85527541 sweet potato. 232 00:13:14,750.85074026 --> 00:13:16,10.85074026 go back to Rhubarb for a second. 233 00:13:16,578.85527541 --> 00:13:17,28.85527541 Yeah. 234 00:13:18,15.85074026 --> 00:13:22,713.85527541 Is that a regularly eaten food? I mean, I've really only had it in pie version. 235 00:13:22,796.35527541 --> 00:13:23,116.35527541 a pie. 236 00:13:23,116.35527541 --> 00:13:23,396.35527541 Yeah. 237 00:13:23,396.35527541 --> 00:13:23,836.35527541 Strawberry. 238 00:13:24,303.85527541 --> 00:13:24,543.85527541 Yeah. 239 00:13:24,783.85527541 --> 00:13:25,473.85527541 Strawberry rhubarb. 240 00:13:25,473.85527541 --> 00:13:30,603.85527541 I don't know if I don't ever had raw rhubarb, but covered in sugar, I guess. 241 00:13:30,933.85527541 --> 00:13:31,293.85527541 Yeah. 242 00:13:31,411.35527541 --> 00:13:35,145.85074026 be very highly oxalic Okay, cool. 243 00:13:35,703.85527541 --> 00:13:41,85.85074026 Are you questioning my decision for putting that in front of nuts? Now I am. 244 00:13:41,703.85527541 --> 00:13:42,123.85527541 Me too. 245 00:13:42,620.85074026 --> 00:13:48,513.85527541 Yeah, I have, I have thoughts on that list, but you know what I committed. 246 00:13:49,376.35527541 --> 00:13:49,666.35527541 Yeah. 247 00:13:49,671.35527541 --> 00:13:49,861.35527541 Yeah. 248 00:13:50,671.35527541 --> 00:13:59,733.85527541 I mean, I, I think it's you know, I, I'm sure there are lots of people who enjoy rhubarb, so we don't wanna discriminate against, Yeah. 249 00:13:59,971.35527541 --> 00:14:02,253.85527541 you know, And I want to hear from you. 250 00:14:02,673.85527541 --> 00:14:02,913.85527541 Yeah. 251 00:14:02,943.85527541 --> 00:14:06,825.85074026 Listeners who enjoy rhubarb, you tell us all the ways Yep. 252 00:14:06,933.85527541 --> 00:14:09,153.85527541 you enjoy it, besides pie version. 253 00:14:09,255.85074026 --> 00:14:13,365.85074026 other, there's other parts of the world where it's probably a, a staple food. 254 00:14:13,596.35527541 --> 00:14:14,535.85074026 Yeah, Um. 255 00:14:14,730.85074026 --> 00:14:17,100.85074026 Yeah, Oh God, I derailed us. 256 00:14:17,100.85074026 --> 00:14:18,438.85527541 I very much so. 257 00:14:19,8.85527541 --> 00:14:19,428.85527541 Alright. 258 00:14:19,728.85527541 --> 00:14:20,58.85527541 Okay. 259 00:14:20,118.85527541 --> 00:14:22,398.85527541 So those are the calcium oxalate stones. 260 00:14:23,46.35527541 --> 00:14:23,336.35527541 Yeah. 261 00:14:23,448.85527541 --> 00:14:25,878.85527541 Second most common are your uric acid stones. 262 00:14:25,928.85527541 --> 00:14:29,528.85527541 These, are things we tend to see in patients that have those really high protein diet. 263 00:14:29,528.85527541 --> 00:14:37,648.85527541 So, you know, keto dieters, bodybuilders, and we also see it common in people that, have gout because they have a higher level of uric acid in the body. 264 00:14:37,678.85527541 --> 00:14:40,978.85527541 So those are the, second type, the third are struvite stones. 265 00:14:40,978.85527541 --> 00:14:42,508.85527541 Now these are a bit more rare. 266 00:14:42,508.85527541 --> 00:14:44,878.85527541 They tend to be more related to infections. 267 00:14:44,878.85527541 --> 00:14:55,408.85527541 So if there's an infection with the kidneys themselves, certain bacteria can change the acidity or change the pH of your urine and then actually make, may develop these kind of,, stones. 268 00:14:55,768.85527541 --> 00:14:58,48.85527541 And then, lastly are the cystine stones. 269 00:14:58,48.85527541 --> 00:15:05,678.85527541 And these are quite rare, tend to be related from genetic conditions, where you leak, cystine, which is an amino acid, which tends to then clump up into stones as well. 270 00:15:05,978.85527541 --> 00:15:17,78.85527541 So Yeah, its calcium oxalate, which are the common ones, uric acid, which are from kind of protein and gout struvite, which are infection driven and cystine from genetic conditions. 271 00:15:18,390.85074026 --> 00:15:24,870.85074026 and I think it's important to point out just if you eat all this stuff and you have lots of rhubarb, for example, doesn't mean you're gonna get kidney stones. 272 00:15:25,710.85074026 --> 00:15:26,970.85074026 They are just contributors. 273 00:15:26,970.85074026 --> 00:15:28,710.85074026 And we'll talk a bit more how you get these things. 274 00:15:28,928.85527541 --> 00:15:34,118.85527541 But if your diet, if your diet is only rhubarb and steak beware. 275 00:15:35,550.85074026 --> 00:15:40,146.35527541 Also, I wanna meet you because you are an interesting human Fascinating, Yeah. 276 00:15:40,148.85527541 --> 00:15:41,108.85527541 fascinating person. 277 00:15:41,168.85527541 --> 00:15:41,648.85527541 Oh man. 278 00:15:42,451.35527541 --> 00:15:51,731.35527541 Well, it's interesting though because, I remember, in our obesity episodes, Jeff, talked about, high protein diet as one of the diets that a lot of people use. 279 00:15:51,731.35527541 --> 00:16:01,581.35527541 So I think we're probably gonna see more and more of these patients who have high protein diets, who may have higher risk factor for, uric acid stones. 280 00:16:01,671.35527541 --> 00:16:10,281.35527541 And some of the stats have shown that there's increase in prevalence of kidney stones in the United States and Canada over the last few decades. 281 00:16:10,331.35527541 --> 00:16:13,721.35527541 There are a lot of risk factors, but one of them definitely is diet. 282 00:16:13,721.35527541 --> 00:16:17,381.35527541 And a lot of things in, in medicine, it's rarely one thing that causes it. 283 00:16:17,681.35527541 --> 00:16:19,331.35527541 So there's often other factors. 284 00:16:19,781.35527541 --> 00:16:22,661.35527541 Genetics often play a huge one in there. 285 00:16:22,961.35527541 --> 00:16:25,481.35527541 Um, other parts of your diet, medications you're on. 286 00:16:25,481.35527541 --> 00:16:30,131.35527541 So again, like we're gonna go through a bit more, but it's rarely, rarely, rarely. 287 00:16:30,131.35527541 --> 00:16:31,761.85981055 One thing that causes a Mm-hmm. 288 00:16:32,156.85981055 --> 00:16:32,576.85981055 Yeah. 289 00:16:33,339.35981055 --> 00:16:35,156.85981055 Yeah, high rhubarb intake. 290 00:16:36,11.35527541 --> 00:16:36,611.35527541 Exactly. 291 00:16:37,106.85981055 --> 00:16:40,514.3598106 Ru a rhubarb only diet, A lot of love for rhubarb. 292 00:16:40,976.8598106 --> 00:16:41,156.8598106 yeah. 293 00:16:41,156.8598106 --> 00:16:42,704.3598106 Lot of Yeah. 294 00:16:42,974.3598106 --> 00:16:43,124.3598106 Yeah. 295 00:16:43,124.3598106 --> 00:16:46,784.3598106 Although I might advise against a pure rhubarb diet, but yeah. 296 00:16:46,784.3598106 --> 00:16:51,469.3598106 Otherwise I definitely wouldn't want to be taking away anyone's protein, I, I definitely but. 297 00:16:53,196.3552754 --> 00:16:53,486.3552754 Yeah. 298 00:16:53,606.8598106 --> 00:17:03,606.8598106 All right, so, so tell us, Brody, 'cause you see the patients who come in with this a lot, certainly you've talked about it,, this is excruciatingly painful. 299 00:17:03,636.8598106 --> 00:17:09,319.5412165 Why does it cause so much pain? Uh, so again, like these patients, often I can spot them as soon as they walk in. 300 00:17:09,419.5412165 --> 00:17:10,619.5412165 And they're uncomfortable. 301 00:17:10,619.5412165 --> 00:17:11,819.5412165 Often they're vomiting. 302 00:17:11,819.5412165 --> 00:17:14,969.5412165 It's often a very quick kind of pain that comes on quite suddenly. 303 00:17:14,969.5412165 --> 00:17:19,679.5412165 Like they're sitting down having dinner, they're sleeping, and then all of a sudden there's this pain there and they can't get comfortable. 304 00:17:19,989.5412165 --> 00:17:22,269.5412165 so, you know, James, you're talking about the, the ureter. 305 00:17:22,269.5412165 --> 00:17:30,369.5412165 So the tube that connects the kidney down to the bladder, um, that's a, a very tiny, tiny muscular tube, right? It helps kind of get the urine down there. 306 00:17:30,429.5412165 --> 00:17:33,662.0412165 It might be the size of like a spaghetti noodle or so, Mm-hmm. 307 00:17:33,849.5412165 --> 00:17:38,569.5412165 now all of a sudden inside that tube you have these, growing or, very. 308 00:17:38,984.5412165 --> 00:17:43,814.5412165 Sharp edged stones that are in there and they get stuck along the way down. 309 00:17:43,844.5412165 --> 00:17:45,614.5412165 And then it's both a bit of a tearing. 310 00:17:45,614.5412165 --> 00:17:49,74.5412165 Sometimes there's some bleeding inside, that goes along with it. 311 00:17:49,304.5412165 --> 00:17:54,824.5412165 But it's kinda like you're trying to push like a hard Lego block through a drinking straw and it's just extremely uncomfortable. 312 00:17:55,94.5412165 --> 00:18:03,194.5412165 Things aren't really blending well, and that combination is just severe, sudden pain, vomiting, can't get comfortable. 313 00:18:03,614.5412165 --> 00:18:05,234.5412165 Like, yeah, it's pretty unrelenting. 314 00:18:05,722.0412165 --> 00:18:17,997.0412165 I, I could attest, you know, as somebody who, operates in abdomen, has seen ureter in, in live action, it's very tiny, diameter muscular, it moves. 315 00:18:18,87.0412165 --> 00:18:29,697.0412165 Uh, and, you know, you could see, if there's something that's, you know, large stone stuck there, and then there's all this musculature working on it and trying to squeeze that, you know, that could cause a lot of pain. 316 00:18:29,697.0412165 --> 00:18:42,147.0412165 So certainly I, I could kind of picture that and I'm just getting, it's cringe, you know, it's, I just feel like my I empathize for the patients who are experiencing this. 317 00:18:42,461.1115112 --> 00:18:48,126.6160464 What's weird about these things is, uh, similar James in your world, you know, people who get shoulder pain Mm-hmm. 318 00:18:49,266.6160464 --> 00:18:49,686.6160464 Mm-hmm. 319 00:18:49,751.1115112 --> 00:18:53,651.1115112 like liver issues, just 'cause some of the nerves are essentially shared between those organs. 320 00:18:54,11.1115112 --> 00:18:55,931.1115112 People get nausea with kidney stones. 321 00:18:55,931.1115112 --> 00:18:56,621.6160464 And it's Yeah. 322 00:18:56,831.1115112 --> 00:18:57,281.6160464 itself, Yeah. 323 00:18:57,311.1115112 --> 00:19:03,11.1115112 'cause there's actually shared nerves between the parts of the kidney and ureters that cause pain and the gut. 324 00:19:03,491.1115112 --> 00:19:07,54.1160464 And so it's, just another interesting fact Oh, change I like it. 325 00:19:07,84.1160464 --> 00:19:08,161.1115112 Everything, Yeah. 326 00:19:09,574.1160464 --> 00:19:10,864.1160464 everything is interconnected. 327 00:19:11,456.6160464 --> 00:19:11,746.6160464 Yeah. 328 00:19:11,971.1115112 --> 00:19:13,51.1115112 It is, it really is. 329 00:19:13,261.1115112 --> 00:19:14,671.1115112 Our James, I, fascinating. 330 00:19:14,884.1160464 --> 00:19:18,514.1160464 I heard your muscular ureter and all I thought of it was like the next action hero. 331 00:19:18,964.1160464 --> 00:19:20,344.1160464 I'm just like grinding it out. 332 00:19:20,554.1160464 --> 00:19:26,134.1160464 Just like, like sign me up, you know, rip ready for pain. 333 00:19:26,314.1160464 --> 00:19:27,784.1160464 He's gonna like take the world. 334 00:19:28,66.6160464 --> 00:19:34,286.6160464 the, the the unsung hero of our human body so much, so much liquid quit. 335 00:19:34,886.1115112 --> 00:19:40,226.1115112 every episode we have like fan fiction, we, we have live action comics just coming from every episode. 336 00:19:40,226.1115112 --> 00:19:42,136.6160464 We gotta do We, we just need fans. 337 00:19:42,669.4448446 --> 00:19:54,155.782713 yeah, Oh, yeah, well we got fiction and we got chat gpt, so maybe we can throw these in and get some computer generated models Hey, unless there, unless there's some artists that that wanna work with us. 338 00:19:55,8.282713 --> 00:19:55,668.282713 That's right. 339 00:19:55,859.1160464 --> 00:19:56,459.1160464 Oh man. 340 00:19:56,831.6160464 --> 00:19:57,221.6160464 All right. 341 00:19:57,221.6160464 --> 00:19:58,151.6160464 So, okay. 342 00:19:58,151.6160464 --> 00:20:00,341.6160464 I think we could kind of picture why it hurts. 343 00:20:00,341.6160464 --> 00:20:03,611.6160464 There's a big stone in this muscular ureter. 344 00:20:04,601.6160464 --> 00:20:07,391.6160464 diameter causes a lot of pain. 345 00:20:07,441.6160464 --> 00:20:09,391.6160464 But, tell us how you would diagnose it. 346 00:20:09,391.6160464 --> 00:20:19,101.6160464 Like what symptoms do they experience so when we think about the, the type of pain that they're having, again, this is typically a sudden onset severe pain that they have. 347 00:20:19,611.6160464 --> 00:20:24,271.6160464 But again, the stones can travel and they tend to get stuck in a couple of different places. 348 00:20:24,271.6160464 --> 00:20:28,501.6160464 So sometimes the stone will get stuck, you'll have a sudden amounts of pain 'cause there's the swelling. 349 00:20:28,501.6160464 --> 00:20:30,601.6160464 It might be causing some bleeding in the ureter. 350 00:20:31,11.6160464 --> 00:20:33,171.6160464 And then it might get unstuck for a little bit. 351 00:20:33,171.6160464 --> 00:20:34,191.6160464 You actually get some relief. 352 00:20:34,221.6160464 --> 00:20:39,831.6160464 And then there may be a period of time where for 20 minutes, 30 minutes, an hour, a couple of hours, you don't have any pain. 353 00:20:40,251.6160464 --> 00:20:41,781.6160464 And then all of a sudden it might come back again. 354 00:20:41,841.6160464 --> 00:20:45,771.6160464 And typically that's where we see where the stone is getting stuck as it's moving on its way down. 355 00:20:45,941.6160464 --> 00:20:52,1.6160464 sometimes will describe it as renal colic because it's this cono, colicy, episodic severe pain that they're having as well. 356 00:20:52,176.9448446 --> 00:20:53,796.9448446 We might see an elevated heart rate. 357 00:20:53,826.9448446 --> 00:20:56,316.9448446 Sometimes the blood pressure goes a little bit up with that as well. 358 00:20:56,346.9448446 --> 00:20:57,486.9448446 'cause then there are a lot of pain. 359 00:20:58,56.9448446 --> 00:21:03,106.9448446 Sometimes there's a low grade fever, although that usually makes me more worried about an infection on top of it. 360 00:21:03,106.9448446 --> 00:21:05,986.9448446 But really the diagnosis is made through some tests. 361 00:21:06,306.9448446 --> 00:21:08,646.9448446 And really there's four main tests that we look at. 362 00:21:08,696.9448446 --> 00:21:16,226.9448446 We'd look at your urine so a urinalysis and in here typically we would see signs of blood or bleeding, but we also wanna look for any concurrent infection. 363 00:21:16,226.9448446 --> 00:21:17,486.9448446 We'll talk about why that's important. 364 00:21:17,486.9448446 --> 00:21:21,946.9448446 So we look at red blood cells, which are signs of kind of bleeding within, the urinary tract. 365 00:21:22,226.9448446 --> 00:21:27,521.9448446 But we also look at things like white blood cells, which are more infection or inflammatory cells, and then something called nitrites, which are kind of. 366 00:21:28,106.9448446 --> 00:21:33,406.9448446 Break down byproducts of bacteria We'll often do some routine or kind of relatively basic blood tests. 367 00:21:33,466.9448446 --> 00:21:36,76.9448446 The one I think we're most interested in here is something called your creatinine. 368 00:21:36,436.9448446 --> 00:21:43,956.9448446 We've kind of talked about this before, but this is a really, an assessment for kidney function and how well your kidneys are filtering out, proteins in your body. 369 00:21:44,236.9448446 --> 00:21:51,16.9448446 So this is important as if you have a big stone that's blocking your kidneys or stones on both sides of your kidneys. 370 00:21:51,16.9448446 --> 00:22:00,236.9448446 For example, you can actually get an elevation in your creatinine, which would be signs of kidney injury, which again, just make us wanna watch you a little bit more closer or maybe bring you to the hospital depending on how abnormal those are. 371 00:22:00,896.9448446 --> 00:22:04,76.9448446 But then really to kind of, since the diagnosis, we're really looking at imaging. 372 00:22:04,226.9448446 --> 00:22:07,166.9448446 And for that we're often doing a CT scan or an ultrasound. 373 00:22:07,734.4448446 --> 00:22:08,94.4448446 Mm-hmm. 374 00:22:08,681.9448446 --> 00:22:10,91.9448446 Pros and cons to each of them. 375 00:22:10,391.9448446 --> 00:22:12,971.9448446 I'd say a CT scan is what I tend to go for. 376 00:22:12,971.9448446 --> 00:22:16,631.9448446 If it's the first time someone is coming in with possible kidney stones. 377 00:22:16,781.9448446 --> 00:22:19,181.9448446 And the reason for that is it's a more accurate test. 378 00:22:19,481.9448446 --> 00:22:24,71.9448446 It helps me look and rule out other causes of this pain besides kidney stones. 379 00:22:24,71.9448446 --> 00:22:26,31.9448446 So things like, appendicitis. 380 00:22:26,61.9448446 --> 00:22:28,671.9448446 Diverticulitis or even things like cancer. 381 00:22:28,671.9448446 --> 00:22:30,441.9448446 Again, we have these first time presentations. 382 00:22:30,441.9448446 --> 00:22:32,61.9448446 It can help rule out these other things. 383 00:22:32,341.9448446 --> 00:22:35,791.9448446 And then, if the other imaging tests then would be an ultrasound. 384 00:22:35,841.9448446 --> 00:22:39,251.9448446 So ultrasounds are nice because, they don't have any radiation. 385 00:22:39,511.9448446 --> 00:22:47,871.9448446 But they, they're not as accurate in being able to see all of the stones But they're really good then for, people that have recurrent stones, people that are pregnant, young people, that sort of thing. 386 00:22:47,953.9403094 --> 00:22:52,363.9403094 Yeah, and I think if we take a step back, even before the emerg family doctors are gonna see a lot of this. 387 00:22:52,513.9403094 --> 00:22:54,613.9403094 They may just order a straight up x-ray to start. 388 00:22:54,943.9403094 --> 00:22:56,383.9403094 Um, x-rays are fine. 389 00:22:56,383.9403094 --> 00:23:00,313.9403094 They just, they don't see some types of stone depending on what the stones are made of. 390 00:23:00,419.4448446 --> 00:23:00,839.4448446 Mm-hmm. 391 00:23:00,953.9403094 --> 00:23:01,743.9403094 So it's a good start. 392 00:23:01,743.9403094 --> 00:23:24,733.9403094 But if someone has classic pain for that and the x-ray's normal, it doesn't rule out a kidney stone Uh, birdie, since I don't think we've covered this before, urinalysis or urine test, when you ask someone to do urine test, can you tell us like what's important, like, in terms of like, is it midstream or, you know, discard the first little bit, or, you know, there there're little things that I remember., 393 00:23:24,783.9403094 --> 00:23:27,303.9403094 I was taught in me school, but I forgot, maybe you could remind us. 394 00:23:27,303.9403094 --> 00:23:29,678.3280645 And I think the listeners will find that interesting and useful. 395 00:23:29,763.4357743 --> 00:23:30,3.4357743 Yeah. 396 00:23:30,173.1069761 --> 00:23:41,743.1069761 I usually think of it with the exception of our chlamydia gonorrhea episode, where you want that early stream, but again, that's, that's a specific urine test, not my standard urine analysis. 397 00:23:41,743.1069761 --> 00:23:44,893.1069761 Most of the time I'd want a quote unquote midstream urine. 398 00:23:45,113.1069761 --> 00:23:49,743.1069761 So I'd want you to kind of, as you're peeing now, put the cup under, collect it now, take it away. 399 00:23:49,743.1069761 --> 00:23:50,643.1069761 Kind of finish your pee. 400 00:23:50,790.6069761 --> 00:23:53,193.1069761 like a second or two Yeah, exactly. 401 00:23:53,253.1069761 --> 00:23:53,853.1069761 Yeah, yeah. 402 00:23:53,853.1069761 --> 00:23:55,233.1069761 Kinda depends on how much pee you got in there. 403 00:23:55,233.1069761 --> 00:23:58,503.1069761 But yeah, I, I'm not really interested in like, the first little bit that comes out. 404 00:23:58,530.6069761 --> 00:23:58,830.6069761 yeah. 405 00:23:59,70.6069761 --> 00:24:02,703.1069761 Yeah, I don't want, like, I don't want you to not have enough, so I don't want like the end dribbles. 406 00:24:03,300.6069761 --> 00:24:03,510.6069761 yeah. 407 00:24:03,543.1069761 --> 00:24:05,553.1069761 I want kind of somewhere in, somewhere in between. 408 00:24:06,300.6069761 --> 00:24:15,223.1069761 So you talked about all the workups that you do but definitive diagnosis really through imaging, right? Is that fair to say? Yeah. 409 00:24:15,403.1069761 --> 00:24:26,923.1069761 And, and again, a, a CT scan, I'd say 99% of the time is able to show us a stone and ultrasound can the majority of the time as well, or otherwise, we see complications of a stone, like an enlarged kidney. 410 00:24:27,163.1069761 --> 00:24:31,333.1069761 And then again, some x-rays, but really especially their first time really should be confirmed on imaging. 411 00:24:31,333.1069761 --> 00:24:31,723.1069761 Yeah. 412 00:24:31,750.6069761 --> 00:24:32,40.6069761 Yeah. 413 00:24:32,40.6069761 --> 00:24:34,140.6069761 Another thing that I wanna ask you on the CT scan part is. 414 00:24:35,70.6069761 --> 00:24:41,580.6069761 Not all kidney stones on imaging are, culprits for your symptoms. 415 00:24:41,580.6069761 --> 00:24:41,760.6069761 Right. 416 00:24:41,760.6069761 --> 00:24:52,555.6069761 So if there's like something really small, for example, um, so are there different characteristics of the CT scan that you look for that will say, okay, this stone is likely to cause his symptoms? Mm-hmm. 417 00:24:53,103.1069761 --> 00:24:54,93.1069761 Yeah, that's a great point. 418 00:24:54,93.1069761 --> 00:25:00,243.1069761 James really, it brings me back to our gallstone episode too, right? Again, if you have stones in the gallbladder, but they're not impacted. 419 00:25:00,573.1069761 --> 00:25:02,13.1069761 Very similar with the kidney. 420 00:25:02,43.1069761 --> 00:25:09,623.1069761 So some people have kidney stones all the time, but they don't cause any pain 'cause they're really within the main part of the kidney, what we call the renal calyx. 421 00:25:09,923.1069761 --> 00:25:10,583.1069761 And they're not stuck. 422 00:25:10,583.1069761 --> 00:25:12,83.1069761 They're just kind of there floating around. 423 00:25:12,143.1069761 --> 00:25:14,743.1069761 They might dissolve, they might not, but they kind of hang out there. 424 00:25:15,313.1069761 --> 00:25:22,243.1069761 It's often once they start to travel into the ureter where they get stuck, that's where we then to, to see where they're causing pain. 425 00:25:22,873.1069761 --> 00:25:24,193.1069761 And people start to have symptoms. 426 00:25:24,193.1069761 --> 00:25:24,203.1069761 So. 427 00:25:24,763.1069761 --> 00:25:27,943.1069761 Findings, we would see that on imaging that would be attributed. 428 00:25:27,943.1069761 --> 00:25:32,563.1069761 With that then would be things like swelling of the kidney or might say the term hydronephrosis. 429 00:25:32,803.1069761 --> 00:25:36,313.1069761 Sometimes you can get hydro ureter, which is swelling of the ureter itself. 430 00:25:36,343.1069761 --> 00:25:40,153.1069761 There might be stranding, which kinda internal swelling they can see on the CT scan, for example. 431 00:25:40,153.1069761 --> 00:25:42,443.1069761 Those would be the things that we would see sometimes on imaging. 432 00:25:42,920.6069761 --> 00:25:46,13.1069761 So there's some evidence of obstruction, right? Yeah, exactly. 433 00:25:46,103.1069761 --> 00:25:46,463.1069761 Yeah. 434 00:25:46,898.1069761 --> 00:25:47,118.1069761 Yep. 435 00:25:47,580.1024409 --> 00:25:52,20.1024409 Alright, so we found the kidney stone and we think that it's causing your pain. 436 00:25:52,110.1024409 --> 00:25:53,445.1024409 So how do you treat it Bros. 437 00:25:54,797.6024409 --> 00:25:55,187.6024409 Yeah. 438 00:25:55,247.6024409 --> 00:25:59,837.6024409 Um, the other benefit to imaging is we get this a sense of the size of the stone. 439 00:25:59,897.6024409 --> 00:26:11,747.6024409 And the size won't necessarily directly impact what we're gonna do for you today in the emergency department, but it gives us an idea for what your likelihood of the types of interventions or type of management that you're gonna need for it. 440 00:26:11,747.6024409 --> 00:26:13,727.6024409 So again, we're talking about kidney stone. 441 00:26:13,727.6024409 --> 00:26:16,667.6024409 You talk about very, very small size. 442 00:26:16,667.6024409 --> 00:26:18,767.6024409 So we talk in the, in the sense of millimeters. 443 00:26:19,307.6024409 --> 00:26:27,687.6024409 And maybe just overall, if it's any reassurance to people that are having, or, may have a kidney stone about 80% of kidney stones as a whole pass on their own., 444 00:26:27,957.6024409 --> 00:26:30,507.6024409 You know, so that they don't need to go on to need any sort of advanced things. 445 00:26:30,837.6024409 --> 00:26:35,817.6024409 When we think about kidney stones, four millimeters and below is really your, this is quite safe stone. 446 00:26:35,817.6024409 --> 00:26:44,827.6024409 So if your, if your stone is less than four millimeters, over 90% should pass naturally, whatever that means, or, pass on their own. 447 00:26:45,57.6024409 --> 00:26:45,447.6024409 I don't know. 448 00:26:45,542.6024409 --> 00:26:46,709.5979058 I, without intervention. 449 00:26:46,767.6024409 --> 00:26:55,497.6024409 guess stones are natural, but like, I don't know, anyways, they'll, 90% of the time they'll pass on their own if they're under four millimeters. 450 00:26:55,737.6024409 --> 00:27:00,777.6024409 The timing for that though is, you know, most people take two to four weeks for that to happen. 451 00:27:00,777.6024409 --> 00:27:03,267.6024409 So it's not always like it's gonna be out there by the next day. 452 00:27:03,717.6024409 --> 00:27:11,157.6024409 The next range we see are kind of those medium sized stones and those are kind of four to six millimeters and those have a slightly lower chance of passing on their own about 60%. 453 00:27:11,337.6024409 --> 00:27:13,527.6024409 And we see that they do tend to stick around a bit longer. 454 00:27:13,527.6024409 --> 00:27:16,897.6024409 So on average, people take closer to kind of 45 days for those stones to go. 455 00:27:17,377.6024409 --> 00:27:24,217.6024409 And then really, once we're over six millimeters, then your chance for going on its own drastically goes down like less than 20%. 456 00:27:24,377.6024409 --> 00:27:28,457.6024409 And those are the ones that we're really referring for urology, for medical intervention. 457 00:27:28,457.6024409 --> 00:27:29,867.6024409 We'll talk about what, what that'll be. 458 00:27:29,867.6024409 --> 00:27:30,827.6024409 Uh, in a second there. 459 00:27:31,519.5979058 --> 00:27:34,589.5979058 Yeah, I dunno if it's helpful or not, but, No, it is. 460 00:27:34,589.5979058 --> 00:27:39,429.5979058 And and I think it's reassurance for people that, if you have kidney stones, the majority are small. 461 00:27:39,699.5979058 --> 00:27:45,904.5979058 Um, of the small ones, I think there's, a decent percentage that you won't even know you have them when you pass them. 462 00:27:46,267.6024409 --> 00:27:46,347.6024409 Hmm. 463 00:27:46,384.5979058 --> 00:27:51,34.5979058 many do cause pain, but I, I, I don't know what the percentages, but may pass it. 464 00:27:51,34.5979058 --> 00:27:51,454.5979058 Never know. 465 00:27:51,772.6024409 --> 00:27:51,952.6024409 Yeah. 466 00:27:52,252.6024409 --> 00:27:52,657.6024409 Yeah, definitely. 467 00:27:52,657.6024409 --> 00:27:55,852.6024409 We've definitely had that before where they might have like a little bit of blood in the urine for a day or two. 468 00:27:55,852.6024409 --> 00:27:56,872.6024409 It clears up and that's kind of it. 469 00:27:56,872.6024409 --> 00:27:58,132.6024409 And they may not have a ton of pain. 470 00:27:58,162.6024409 --> 00:27:59,212.6024409 That definitely can happen. 471 00:27:59,272.6024409 --> 00:27:59,662.6024409 Yeah. 472 00:27:59,752.6024409 --> 00:27:59,992.6024409 Yeah. 473 00:28:00,352.6024409 --> 00:28:01,642.6024409 Fairly with smaller stones. 474 00:28:02,314.5979058 --> 00:28:06,455.1024409 20 per up to 20% from what I'm reading here, can Hmm. 475 00:28:06,664.5979058 --> 00:28:07,534.5979058 you even knowing you have them. 476 00:28:07,805.9357743 --> 00:28:10,595.9357743 So I can talk about maybe what we tend to do in the emerge when you come in. 477 00:28:10,625.9357743 --> 00:28:13,415.9357743 And really, the first thing, again, these patients are super uncomfortable. 478 00:28:13,445.9357743 --> 00:28:20,345.9357743 So the first thing we're doing is really just pain management, right? We'll often put an IV in these patients, we're gonna be giving them pain medications. 479 00:28:20,375.9357743 --> 00:28:27,65.9357743 Nonsteroidal anti-inflammatory drugs or NSAIDs, tend to be the most effective pain medication for kidney stones or renal colic. 480 00:28:27,95.9357743 --> 00:28:30,525.9357743 So, this would be like an IV version, of Advil or Ibuprofen. 481 00:28:30,525.9357743 --> 00:28:33,705.9357743 So something called Toradol is one that we tend to reach for pretty quickly., 482 00:28:33,755.9357743 --> 00:28:37,585.9357743 Or if they're able to tolerate swallowing pills, we might give them Tylenol and Advil. 483 00:28:37,775.9357743 --> 00:28:42,35.9357743 That's usually the first thing is some IV fluids, anti-inflammatories, and sometimes it's really severe. 484 00:28:42,35.9357743 --> 00:28:46,155.9357743 We need to go on and give 'em narcotics, like morphine or hydromorphone to get them settled and comfortable. 485 00:28:46,827.9312391 --> 00:28:48,102.9312391 Just for our fan fiction. 486 00:28:48,102.9312391 --> 00:28:50,652.9312391 I, I tell patients Toradol is like super Advil. 487 00:28:50,865.9357743 --> 00:28:51,975.9357743 Yeah, I, 'cause definitely. 488 00:28:51,975.9357743 --> 00:28:52,992.9312391 Yeah, Yeah. 489 00:28:53,325.9357743 --> 00:28:53,535.9357743 I know. 490 00:28:53,535.9357743 --> 00:28:55,5.9357743 I never wanna say it like just Advil. 491 00:28:55,35.9357743 --> 00:28:56,805.9357743 'cause it works so much better. 492 00:28:57,372.9312391 --> 00:28:59,38.4357743 Oh, It's so great fast. 493 00:28:59,38.4357743 --> 00:28:59,368.4357743 Yeah. 494 00:28:59,625.9357743 --> 00:29:00,555.9357743 and very fast. 495 00:29:00,985.9357743 --> 00:29:09,475.9357743 And then for most people, 'cause again,, their stone is most likely gonna be this kind of small to medium sized, I'm gonna send 'em home, so I'm gonna send 'em home with pain medication. 496 00:29:09,475.9357743 --> 00:29:11,925.9357743 So, you know, first line again is anti-inflammatories. 497 00:29:11,925.9357743 --> 00:29:15,285.9357743 So again, like in ibuprofen or Advil or Naproxen. 498 00:29:15,335.9357743 --> 00:29:22,215.9357743 And I tell people to take the pain medications regularly, right? We know that like all medications, they wear off after a certain period of time. 499 00:29:22,215.9357743 --> 00:29:26,985.9357743 And if I know that that stone is gonna be there for like two or four weeks, then I really want you comfortable. 500 00:29:27,15.9357743 --> 00:29:30,165.9357743 'cause otherwise the pain didn't get worse and you're gonna have to come back to hospital. 501 00:29:30,165.9357743 --> 00:29:41,505.9357743 So, you know, I'm discharging these patients with these non-steroidal anti-inflammatory drugs and telling 'em to take it every 12 hours or every eight hours, depending on what it is, just so that they're, they, they've got something on board to keep them comfortable. 502 00:29:41,835.9357743 --> 00:29:46,425.9357743 And then often I will prescribe, I guess like a, a morphine or hydromorphone or something stronger., 503 00:29:46,585.9357743 --> 00:29:50,355.9357743 So that if, the other medications aren't working, they don't have to come back to the emerge necessarily. 504 00:29:50,355.9357743 --> 00:29:52,128.4357743 If it's just that, a breakthrough, yeah. 505 00:29:52,785.9357743 --> 00:29:53,325.9357743 yeah. 506 00:29:53,532.9312391 --> 00:30:02,670.9357743 and, and just, and just to be clear, like these are the patients that are coming in with clear kidney stone related pain, not the ones that you just see a kidney stone when you're looking for something Yes, exactly. 507 00:30:02,730.9357743 --> 00:30:02,910.9357743 Yeah. 508 00:30:02,910.9357743 --> 00:30:05,250.9357743 These are people that have coming in, we've done imaging. 509 00:30:05,250.9357743 --> 00:30:08,580.9357743 I'm convinced that their kidney stone and the kidney stones is the cause for their pain. 510 00:30:08,610.9357743 --> 00:30:09,570.9357743 That's what I'm sending 'em home for. 511 00:30:09,630.9357743 --> 00:30:09,900.9357743 Yep. 512 00:30:10,160.9357743 --> 00:30:15,470.9357743 And then the other things that we, we tend to do as well is we encourage hydration that we'll talk about this maybe later. 513 00:30:15,470.9357743 --> 00:30:20,570.9357743 I'm not saying like you're gonna go home and chug four liters all at once as everyone takes a drink. 514 00:30:21,950.9357743 --> 00:30:30,120.9357743 But, you know, one, make sure that you're at least staying well hydrated because, again, a common cause of stones is dehydration. 515 00:30:30,580.9357743 --> 00:30:34,470.9357743 And then there's medications we can do for, medical expulsion therapy. 516 00:30:34,470.9357743 --> 00:30:36,900.9357743 So these are medications like Tamsulosin or Flomax. 517 00:30:36,950.9357743 --> 00:30:37,610.9357743 Interestingly. 518 00:30:38,60.9357743 --> 00:30:45,480.9357743 We commonly prescribe these for, for men with prostate issues in the same way that they help with blood flow and peeing by dilating ureter when people that have enlarged prostate. 519 00:30:45,540.9357743 --> 00:30:56,713.4357743 Similar thing for helping a stone pass, just kind of help, helps give you a co a little bit more wiggle room, a couple more millimeters in your spaghetti tube to let those, those tones go and pass Yeah. 520 00:30:56,743.4357743 --> 00:31:00,960.9357743 It's tot it's his joint, his joint in there. 521 00:31:01,350.9357743 --> 00:31:02,460.9357743 It's too muscular. 522 00:31:02,520.9357743 --> 00:31:06,520.9357743 He's gotta stop working out or she, or she or she. 523 00:31:06,520.9357743 --> 00:31:07,30.9357743 He or she. 524 00:31:07,420.9357743 --> 00:31:07,600.9357743 Yeah. 525 00:31:07,600.9357743 --> 00:31:07,720.9357743 Yep. 526 00:31:07,785.9357743 --> 00:31:08,5.9357743 Yep. 527 00:31:08,290.9357743 --> 00:31:09,130.9357743 Talk about the muscle. 528 00:31:09,243.4357743 --> 00:31:09,463.4357743 or. 529 00:31:09,987.0401221 --> 00:31:16,667.0401221 And then lastly it always sounds weird, but I do recommend people pee through a sieve to try to catch the stone. 530 00:31:16,727.0401221 --> 00:31:22,727.0401221 and again, this, I don't know, maybe you've got one at home, it's always an awkward conversation. 531 00:31:22,727.0401221 --> 00:31:24,314.5401221 Where do you get one? Yeah. 532 00:31:24,944.5401221 --> 00:31:29,324.5401221 Can you, can you recommend what seive Just your like Yeah. 533 00:31:29,414.5401221 --> 00:31:33,47.0401221 Is it the metal one that you have at home in the kitchen Well, yeah. 534 00:31:33,77.0401221 --> 00:31:34,697.0401221 'cause I mean, you need something like that. 535 00:31:34,697.0401221 --> 00:31:35,747.0401221 'cause it's gotta be small. 536 00:31:35,747.0401221 --> 00:31:38,567.0401221 So Yeah, like your metal pasta, strainer. 537 00:31:38,597.0401221 --> 00:31:42,437.0401221 'cause you need something that's gonna get something that's a couple of coffee filter. 538 00:31:42,737.0401221 --> 00:31:42,947.0401221 Yeah. 539 00:31:42,947.0401221 --> 00:31:44,897.0401221 But that'll probably fill up too much. 540 00:31:44,924.5401221 --> 00:31:46,127.0401221 to filter Yeah. 541 00:31:46,157.0401221 --> 00:31:47,387.0401221 You'll just pee on yourself. 542 00:31:47,549.035587 --> 00:31:48,539.035587 good coffee filters. 543 00:31:48,539.035587 --> 00:31:48,659.035587 Yeah. 544 00:31:48,719.035587 --> 00:31:49,109.035587 Good call. 545 00:31:50,99.035587 --> 00:31:50,369.035587 Yeah. 546 00:31:50,477.0401221 --> 00:31:57,797.0401221 So, yeah, honestly, like that's kind of your, There's no medical sieve there's no, there's nothing that if, if there is, I, I'm looking I am. 547 00:31:58,637.0401221 --> 00:32:04,277.0401221 If there is, I apologize to everyone who I've been telling to pee through their pasta strainer for the last 15 years. 548 00:32:04,634.5401221 --> 00:32:08,894.5401221 and then they have to start, they have to use it again afterwards for cooking. 549 00:32:10,109.035587 --> 00:32:10,919.035587 no, hold on. 550 00:32:10,919.035587 --> 00:32:11,969.035587 I just looked this up. 551 00:32:12,329.035587 --> 00:32:15,839.035587 Comfort axis, stone collector, non-sterile calculus trainer. 552 00:32:16,109.5401221 --> 00:32:16,679.5401221 Wow. 553 00:32:16,967.0401221 --> 00:32:17,87.0401221 Oh. 554 00:32:17,219.035587 --> 00:32:20,452.0401221 This is Amazon and not endorsed by any means There's one, hold on. 555 00:32:20,452.0401221 --> 00:32:21,952.0401221 There's one called The Pocket Strainer. 556 00:32:22,225.0446572 --> 00:32:25,347.0401221 I'm sure Then it's very subtle and convenient just Yeah. 557 00:32:25,352.0401221 --> 00:32:25,462.0401221 Yeah. 558 00:32:26,815.0446572 --> 00:32:32,165.0446572 any other uses besides catching a kidney stone gonna read, I don't want to go down that yeah. 559 00:32:32,282.0401221 --> 00:32:33,482.0401221 come in three packs, by the way. 560 00:32:33,752.0401221 --> 00:32:34,82.0401221 Sorry. 561 00:32:34,82.0401221 --> 00:32:34,562.0401221 Continue. 562 00:32:34,735.0446572 --> 00:32:40,615.0446572 I wonder about if you're taking it to go, is the plan to then put it back in your pocket after yeah, anyways? Well, Yeah. 563 00:32:40,702.5446572 --> 00:32:41,722.5446572 it comes in a three pack. 564 00:32:42,385.0446572 --> 00:32:42,745.0446572 That's why. 565 00:32:42,745.0446572 --> 00:32:43,135.0446572 That's it. 566 00:32:43,312.5446572 --> 00:32:43,582.5446572 out. 567 00:32:44,515.0446572 --> 00:32:45,85.0446572 expendable. 568 00:32:45,682.5446572 --> 00:32:45,982.5446572 Yeah. 569 00:32:46,12.0401221 --> 00:32:47,332.0401221 Guys, I love this podcast. 570 00:32:47,332.0401221 --> 00:32:48,472.0401221 The things we uncover. 571 00:32:48,545.8779906 --> 00:32:54,215.3734554 I'm glad that I know now I'm a better person now that I know about this than before, so Thank you, Brodie Yeah. 572 00:32:54,848.3779906 --> 00:32:55,658.3779906 You are welcome guys. 573 00:32:57,363.3779906 --> 00:32:57,583.3779906 Oh. 574 00:32:57,725.8779906 --> 00:33:08,508.3779906 So um, broads when will you do more in the emerge? Like what's gonna kind of tip you off to something more is going on and when are you gonna refer to urology? Because I think Yeah. 575 00:33:08,610.3734554 --> 00:33:09,318.3779906 things Yeah. 576 00:33:09,318.3779906 --> 00:33:13,618.3779906 So I'd say where the pathway changes in the emerge, is if there's some red flags. 577 00:33:13,678.3779906 --> 00:33:21,208.3779906 So these are people that have fever or I'm worried about a concurrent infection in the kidney that really is like one of the few urologic emergencies. 578 00:33:21,208.3779906 --> 00:33:27,628.3779906 Urologists may disagree, but you know, fever with an infected kidney stone, definitely an emergency. 579 00:33:28,168.3779906 --> 00:33:30,328.3779906 It's also an emergency if that's your only kidney. 580 00:33:30,418.3779906 --> 00:33:37,888.3779906 So these might be patients that have a transplant, um, or they're born with like a single solitary kidney, or if they already have really bad kidney function. 581 00:33:37,888.3779906 --> 00:33:43,18.3779906 So again, looking at their creatinine and their blood work, if it's quite elevated, again, I'm, I'm worried about that. 582 00:33:43,240.8779906 --> 00:33:43,660.8779906 Mm-hmm. 583 00:33:43,978.3779906 --> 00:33:46,288.3779906 and then lastly, if like people really can't keep anything down. 584 00:33:46,338.3779906 --> 00:33:49,578.3779906 if I'm trying to send you home on oral pain medications and you're just vomiting the whole time. 585 00:33:49,923.3779906 --> 00:33:50,913.3779906 I probably can't send you home. 586 00:33:51,123.3779906 --> 00:33:56,43.3779906 So that's where things change a little bit, for what that initial management would be, where I would normally just send you home. 587 00:33:56,133.3779906 --> 00:34:01,437.9975558 Those are patients that are gonna stay, typically unless they have those red flags, I'm still sending you home. 588 00:34:01,437.9975558 --> 00:34:07,527.9975558 But if you have a larger stone, I just know there's a higher likelihood it's going to need something, it still might pass on its own. 589 00:34:07,797.9975558 --> 00:34:16,167.9975558 So then I'm making a referral to urology, and again, usually the urologist will see you in a couple of days or a week or two because again, sometimes these stones pass anyway. 590 00:34:16,167.9975558 --> 00:34:32,321.3308891 So it allows them to kind of give you the opportunity to pass this on your own, before kind of exposing you to, the risks of a medical procedure or intervention that you may not need if your body's able to pass the stone on its own and really may, the urologist may very well do nothing different either, but mm-hmm. 591 00:34:32,348.326354 --> 00:34:33,848.8308891 may follow you Right. 592 00:34:34,148.326354 --> 00:34:36,11.3308891 you and, and Yeah. 593 00:34:36,578.326354 --> 00:34:39,568.8308891 discharge or have to do something more invasive, which we'll get Yeah. 594 00:34:39,701.3308891 --> 00:34:41,51.3308891 Yeah, yeah, yeah. 595 00:34:41,111.3308891 --> 00:34:44,51.3308891 And if you do pass a stone,, if you bring it in, they can analyze it. 596 00:34:44,51.3308891 --> 00:34:49,251.3308891 But really, there's three main buckets or interventions for, when the stones are bigger, they're not passing. 597 00:34:49,251.3308891 --> 00:34:52,311.3308891 There are those red flags And these are shockwave lithotripsy. 598 00:34:52,311.3308891 --> 00:34:55,941.3308891 This is where they're using kind of like sound waves or ultrasound to kind of break up the stone. 599 00:34:56,361.3308891 --> 00:35:01,891.3308891 Um, they can do something called a ute where they actually kind of go up, pass a bladder into the, the ureter. 600 00:35:01,951.3308891 --> 00:35:03,391.3308891 Sometimes they can kinda laser things out. 601 00:35:03,391.3308891 --> 00:35:05,341.3308891 It's fairly Star Wars, like Death Starry. 602 00:35:06,203.326354 --> 00:35:06,623.326354 Mm-hmm. 603 00:35:06,821.3308891 --> 00:35:11,781.3308891 And then in some cases they actually put stents in, you're can now going on the inside stenting, open that ureter. 604 00:35:12,51.3308891 --> 00:35:13,881.3308891 so it's big enough that the stone can pass. 605 00:35:14,41.3308891 --> 00:35:16,861.3308891 But then the stent has to be retrieved or taken out at some point in time. 606 00:35:16,861.3308891 --> 00:35:23,511.3308891 So again, it always best if, if you don't need those things and it's able to give yourself a bit of time, to allow things to pass. 607 00:35:23,511.3308891 --> 00:35:29,661.3308891 But those are the three big things that you'd be looking for that the urologist may do if it's not passing or there's some of those red flags. 608 00:35:30,33.8308891 --> 00:35:31,168.8308891 Yeah, exactly. 609 00:35:31,328.8308891 --> 00:35:39,578.8308891 That's actually a really good segue to the next important topic let's say you have one of these stones and they're removed or they're broken up, you're still at risk of getting them again. 610 00:35:39,578.8308891 --> 00:35:47,318.8308891 So Brody maybe, maybe kind of go through what causes kidney stones and how to prevent them, because I think, uh, those two things are directly related. 611 00:35:47,656.8354243 --> 00:35:47,986.8354243 Yeah. 612 00:35:48,286.8354243 --> 00:35:56,386.8354243 At a high level, really people develop kidney stones where there's an imbalance between the things that promote crystals and the things that prevent crystals in your urine. 613 00:35:56,446.8354243 --> 00:35:58,666.8354243 And there's a handful of culprits that we'll talk about. 614 00:35:58,946.8354243 --> 00:36:02,636.8354243 But by and far, like the number one reason is patients are dehydrated. 615 00:36:02,636.8354243 --> 00:36:04,196.8354243 They're just not drinking enough water. 616 00:36:04,506.8354243 --> 00:36:10,926.8354243 So again, if you think your urine is concentrated, you know, you should have you more of like a pale yellow as opposed to kind of an apple juice type color. 617 00:36:11,56.8354243 --> 00:36:13,836.8354243 try to be cognizant, drink more fluid. 618 00:36:13,936.8354243 --> 00:36:16,36.8354243 and, and again, depends on the type of stone too. 619 00:36:16,36.8354243 --> 00:36:21,106.8354243 Hydration works better for some stones than others, but that is a core tenant to many parts of medicine. 620 00:36:21,106.8354243 --> 00:36:21,632.3399594 Stay Mm-hmm. 621 00:36:22,714.8399594 --> 00:36:25,234.8399594 Uh, second thing are high salt diets. 622 00:36:25,294.8399594 --> 00:36:29,14.8399594 Um, so well, yes, salt definitely makes food taste a lot better. 623 00:36:29,554.8399594 --> 00:36:31,144.8399594 It does make your kitties work a lot harder. 624 00:36:31,802.3399594 --> 00:36:32,192.3399594 Yeah. 625 00:36:32,614.8399594 --> 00:36:34,114.8399594 and it's not just the sodium itself. 626 00:36:34,114.8399594 --> 00:36:37,684.8399594 The, the, again, kitties are very complicated. 627 00:36:38,454.8399594 --> 00:36:45,314.8399594 When you eat a lot of sodium, your kidneys as they're managing that sodium, they also end up dumping calcium into your urine. 628 00:36:45,494.8399594 --> 00:36:50,474.8399594 So you can think of it as like the more sodium you eat, the more calcium you're putting into your urine. 629 00:36:50,474.8399594 --> 00:36:56,474.8399594 And as we talked about, the more calcium in the urine, the more chances of you getting these stones, especially those calcium oxalate stones. 630 00:36:56,984.8399594 --> 00:37:00,884.8399594 Um, and so the third thing, again along the line would be really high oxalate foods. 631 00:37:00,884.8399594 --> 00:37:03,164.8399594 And again, looking at the imbalance for calcium. 632 00:37:03,164.8399594 --> 00:37:06,134.8399594 So again, Can we're gonna talk about our, uh, our rhubarb. 633 00:37:06,432.3399594 --> 00:37:09,341.8354243 has high oxalate? just no. 634 00:37:09,461.8354243 --> 00:37:10,481.8354243 Nobody say the word. 635 00:37:10,571.8354243 --> 00:37:11,771.8354243 Nobody say the word. 636 00:37:11,776.8354243 --> 00:37:12,66.8354243 We're done. 637 00:37:12,672.3399594 --> 00:37:17,59.8399594 I think it starts with R and end Yeah. 638 00:37:18,9.8399594 --> 00:37:18,299.8399594 Yeah. 639 00:37:18,944.8399594 --> 00:37:25,274.8399594 But the one thing that's interesting, I won't run that list again, but the one thing that's interesting is then some people think, oh, well, a low calcium diet. 640 00:37:25,539.8399594 --> 00:37:26,409.8399594 Will actually be better. 641 00:37:26,509.8399594 --> 00:37:27,949.8399594 but it's actually not the case. 642 00:37:27,979.8399594 --> 00:37:29,419.8399594 calcium on itself isn't bad. 643 00:37:29,699.8399594 --> 00:37:31,109.8399594 Oxalate on itself isn't bad. 644 00:37:31,389.8399594 --> 00:37:33,19.8399594 It's, the mismatch between the two. 645 00:37:33,19.8399594 --> 00:37:45,639.8399594 So especially if you're, if you're having more oxalate, if you don't have enough calcium, if you're restricting your calcium, then you get less calcium absorbed, so it goes into the kidneys and then it actually connects with the calcium in your kidneys and then gets stones. 646 00:37:45,969.8399594 --> 00:37:51,21.8354243 Um, so, and, and that used to be, that used to be the recommendation like years ago. 647 00:37:51,21.8354243 --> 00:37:56,667.3399594 Say low calcium diet, low calcium diet, and then all this evidence came out and said, uhoh, I think that's actually worsening Mm-hmm. 648 00:37:56,769.8399594 --> 00:37:58,401.8354243 or bad, yeah. 649 00:37:58,551.8354243 --> 00:37:58,941.8354243 Oops. 650 00:37:59,414.8399594 --> 00:38:00,39.8399594 it's okay. 651 00:38:00,459.8399594 --> 00:38:02,259.8399594 Um, I think we've talked about it before. 652 00:38:02,289.8399594 --> 00:38:07,839.8399594 Most of the things that we learned were wrong, and I'm sure Yeah, of the things we're talking about today will eventually be disproven as well. 653 00:38:08,217.3399594 --> 00:38:08,507.3399594 yeah. 654 00:38:08,631.8354243 --> 00:38:09,201.8354243 it's okay. 655 00:38:09,201.8354243 --> 00:38:13,551.8354243 There's no way this podcast will live Uh, will say, these guys were so wrong. 656 00:38:13,859.8399594 --> 00:38:14,89.8399594 The sieve. 657 00:38:14,89.8399594 --> 00:38:17,184.8399594 The sieve will forever outlast us. 658 00:38:17,242.3399594 --> 00:38:20,362.3399594 the one true, one true lasting medical intervention. 659 00:38:20,454.8399594 --> 00:38:22,224.8399594 It's The one true fact. 660 00:38:23,1.8354243 --> 00:38:25,131.8354243 the Pockets have is the best investment of all time. 661 00:38:25,191.8354243 --> 00:38:26,364.8399594 Do it Oh God. 662 00:38:27,249.8399594 --> 00:38:32,319.8399594 Um, fourth thing that we see for risk factors are, specifically high animal protein, intake. 663 00:38:32,319.8399594 --> 00:38:34,659.8399594 So your red meats, poultry fish. 664 00:38:34,919.8399594 --> 00:38:41,969.8399594 And what we see is the protein makes the urine more acidic and that's increased acidic environment is, which helps kind of promote stone, formation. 665 00:38:42,319.8399594 --> 00:38:43,519.8399594 And then there's kind of the more rare thing. 666 00:38:43,519.8399594 --> 00:38:45,619.8399594 So, we talked about somebody's family or genetics. 667 00:38:45,619.8399594 --> 00:38:52,369.8399594 So if you happen to have someone in your family that had a kidney stone, hate to break it to you, but you probably have a higher risk for kidney stones as well. 668 00:38:52,849.8399594 --> 00:38:54,139.8399594 And then, gut issues as well. 669 00:38:54,139.8399594 --> 00:38:57,49.8399594 So patients that have, difficulty absorbing things in the body. 670 00:38:57,49.8399594 --> 00:39:01,189.8399594 So these be people with inflammatory bowel disease like Crohn's disease or ulcerative colitis. 671 00:39:01,429.8399594 --> 00:39:02,659.8399594 They have chronic diarrhea. 672 00:39:02,689.8399594 --> 00:39:05,899.8399594 Or James, with your bariatric surgery patients. 673 00:39:06,79.8399594 --> 00:39:07,66.8354243 Uh, shine. 674 00:39:07,219.8399594 --> 00:39:16,609.8399594 now again, you have more difficulty absorbing that oxalate, which means more of it ends up in the kidneys, which again, as we know now, is a, a recipe for kidney stones. 675 00:39:17,342.3399594 --> 00:39:25,862.3399594 Not, not all bariatric surgery, but that's why it's very important to be compliant with, micronutrient guidelines that we have for our patients. 676 00:39:26,216.6823631 --> 00:39:26,546.6823631 Love it. 677 00:39:26,833.3490297 --> 00:39:29,473.3490297 then I think just, just add on, we won't go into detail. 678 00:39:29,473.3490297 --> 00:39:32,743.3490297 There are certain medications that can increase the risk of certain types of stones. 679 00:39:32,943.3490297 --> 00:39:38,713.3490297 But we would never not put per a person on a medication just because of the stone risk if you need the medication. 680 00:39:39,13.3490297 --> 00:39:39,938.8535649 So we Mm-hmm. 681 00:39:40,3.3490297 --> 00:39:41,413.3490297 in details, but there are some. 682 00:39:42,173.3490297 --> 00:39:47,123.3490297 I think I like, we were gonna talk about prevention and stuff, but I think it kind of goes along the lines of what you just talked about, Brody. 683 00:39:47,361.3535649 --> 00:39:47,651.3535649 Yeah. 684 00:39:48,83.3490297 --> 00:39:50,213.3490297 is kind of The opposite things. 685 00:39:50,633.3490297 --> 00:39:53,63.3490297 The opposite of what just said. 686 00:39:53,388.8535649 --> 00:39:54,203.8535649 Lobar diet. 687 00:39:54,983.3490297 --> 00:39:55,751.3535649 Low rebarb diet. 688 00:39:55,793.3490297 --> 00:39:56,243.3490297 diet. 689 00:39:56,381.3535649 --> 00:39:56,801.3535649 Damn it. 690 00:39:57,203.3490297 --> 00:39:57,863.3490297 diet. 691 00:39:57,923.3490297 --> 00:40:00,311.3535649 Uh, stay just ordered a Costco amount of rhubarb. 692 00:40:00,311.3535649 --> 00:40:05,73.8147142 What am I gonna do with it? All right, so maybe we All right. 693 00:40:05,91.3147142 --> 00:40:11,613.8147142 now do our favorite I, yeah, I, I prepared some myths to bust for you guys, if that's okay. 694 00:40:12,3.8147142 --> 00:40:13,953.8147142 Um, I, I say like, it's a question. 695 00:40:13,953.8147142 --> 00:40:16,605.810179 I know it's okay because, um, or bust. 696 00:40:16,635.810179 --> 00:40:18,435.810179 Let's not yeah, yeah, here. 697 00:40:18,526.3147142 --> 00:40:19,891.3147142 Yeah, yeah, yeah. 698 00:40:19,953.8147142 --> 00:40:20,283.8147142 Yeah. 699 00:40:20,883.8147142 --> 00:40:21,183.8147142 Okay. 700 00:40:21,453.8147142 --> 00:40:21,813.8147142 All right. 701 00:40:22,13.8147142 --> 00:40:24,233.8147142 So first myth, we're gonna bust it there. 702 00:40:24,563.8147142 --> 00:40:29,543.8147142 Do energy drinks cause kidney stones? No, not, not directly. 703 00:40:29,543.8147142 --> 00:40:29,663.8147142 Yeah. 704 00:40:29,663.8147142 --> 00:40:30,623.8147142 This is, this is a thing. 705 00:40:30,893.8147142 --> 00:40:31,800.810179 Yeah, this is a thing. 706 00:40:31,973.8147142 --> 00:40:32,543.8147142 this is the thing. 707 00:40:32,693.8147142 --> 00:40:35,123.8147142 This is a thing commonly asked on Google. 708 00:40:35,333.8147142 --> 00:40:35,633.8147142 Yeah. 709 00:40:35,783.8147142 --> 00:40:40,253.8147142 You can also swap energy drinks for like soda or pop or carbonated drinks. 710 00:40:40,313.8147142 --> 00:40:41,180.810179 But, Okay. 711 00:40:41,273.8147142 --> 00:40:43,943.8147142 um, the answer for all of those is. 712 00:40:44,468.8147142 --> 00:40:46,790.810179 No, not directly, huh? God. 713 00:40:46,970.810179 --> 00:40:48,20.810179 I I love Dr. 714 00:40:48,20.810179 --> 00:40:50,25.810179 Pepper, so I would've been devastated. 715 00:40:50,438.8147142 --> 00:40:51,548.8147142 the OG doctor. 716 00:40:51,758.8147142 --> 00:40:59,108.8147142 Yeah, Yeah, So the energy drinks don't cause kidney stones, but they do give you wings though, right? yeah, they do. 717 00:41:00,368.8147142 --> 00:41:03,980.810179 Red Bull is still, a, that is a sponsorship plug right there. 718 00:41:04,40.810179 --> 00:41:06,338.8147142 That is we give you wings, not stones. 719 00:41:08,271.3147142 --> 00:41:08,601.3147142 Right. 720 00:41:08,601.3147142 --> 00:41:10,521.3147142 So not directly Brody. 721 00:41:10,581.3147142 --> 00:41:11,768.8147142 Um, Yeah. 722 00:41:11,888.8147142 --> 00:41:16,868.8147142 But things that are, have Yeah, yeah, high in sugar, high in sodium. 723 00:41:16,868.8147142 --> 00:41:19,918.8147142 They're highly acidic and but you at risk for dehydration. 724 00:41:19,968.8147142 --> 00:41:25,818.8147142 But good news for those that are just like drinking normal, like plain sparkling water, you're okay. 725 00:41:25,908.8147142 --> 00:41:29,568.8147142 'cause without those additives, the car, it's the carbonation itself doesn't do it. 726 00:41:29,568.8147142 --> 00:41:30,948.8147142 It's really the acidity. 727 00:41:31,128.8147142 --> 00:41:37,428.8147142 Uh, often the kind of phosphoric acid and sugars and stuff you're adding So plain sparkling water on your own should still be okay. 728 00:41:38,25.810179 --> 00:41:40,815.810179 if you didn't say that, big sparkling water would've come after us. 729 00:41:40,845.810179 --> 00:41:44,16.3147142 'cause I know the most absolutely popular Yeah. 730 00:41:44,265.810179 --> 00:41:45,975.810179 We would've been in so much trouble. 731 00:41:46,728.8147142 --> 00:41:47,18.8147142 Yeah. 732 00:41:47,708.8147142 --> 00:41:50,948.8147142 Big water Is that what we call them? Is that a big pharma? Big water would come after us. 733 00:41:50,961.3147142 --> 00:41:51,351.3147142 water. 734 00:41:51,605.810179 --> 00:41:51,665.810179 Yeah. 735 00:41:52,611.3147142 --> 00:41:53,571.3147142 The water mafia. 736 00:41:53,675.810179 --> 00:41:54,665.810179 Big water, big farm. 737 00:41:54,665.810179 --> 00:41:54,965.810179 Yeah. 738 00:41:55,62.1480475 --> 00:41:55,362.1480475 Yeah. 739 00:41:55,454.1435124 --> 00:41:58,982.1480475 I think our, our next one I'll just take, 'cause I already said it yeah. 740 00:41:59,294.1435124 --> 00:42:04,184.1435124 um, feel like I have to show, I have some knowledge, but I don't kidney stones. 741 00:42:04,544.1435124 --> 00:42:07,274.1435124 Uh, we already talked about can you pass stones without pain? Yeah. 742 00:42:07,304.1435124 --> 00:42:10,34.1435124 About 20% of people probably will for the smaller stones. 743 00:42:10,464.1435124 --> 00:42:14,94.6480475 But, many people unfortunately will have that kind of pain that Brody talked Yeah. 744 00:42:14,730.2292664 --> 00:42:17,752.7292664 Uh, the other one I often, the cranberry juice. 745 00:42:17,912.7292664 --> 00:42:21,152.7292664 It always pops up like for a variety of reasons. 746 00:42:21,202.7292664 --> 00:42:25,312.7292664 Tell us Brody, whether it cranberry juice is helpful to get rid of kidney dose. 747 00:42:25,750.2292664 --> 00:42:26,40.2292664 Yeah. 748 00:42:26,180.2292664 --> 00:42:29,317.2247313 So no evidence for it helping with kidney stones, I. 749 00:42:30,325.2292664 --> 00:42:35,485.2292664 there is decent evidence for it, for preventing or treating urinary tract infections or UTIs. 750 00:42:35,485.2292664 --> 00:42:38,125.2292664 So if you're drinking it for those reasons, continue. 751 00:42:38,125.2292664 --> 00:42:40,195.2292664 If you enjoy cranberry juice, continue. 752 00:42:40,375.2292664 --> 00:42:41,965.2292664 But it's not gonna help you with your stone. 753 00:42:42,937.7292664 --> 00:42:47,472.7292664 Uh, the next one I, I see often is, uh, is due to kidney stones dissolve. 754 00:42:47,502.7292664 --> 00:42:50,112.7292664 So no, most don't dissolve. 755 00:42:50,152.7292664 --> 00:42:53,902.7292664 With the exception of, some of the uric acid stones can be given medications to all of them, pretty much. 756 00:42:53,902.7292664 --> 00:42:57,712.7292664 Everything else though, needs to either pass or be broken up in neurology. 757 00:42:57,712.7292664 --> 00:43:01,792.7292664 So, um, if the stone's in there, it's probably gotta come out. 758 00:43:01,852.7292664 --> 00:43:05,782.7292664 Um, or it might just live in there forever and you're totally fine, which is another subset of people. 759 00:43:05,832.7292664 --> 00:43:11,472.7292664 And then, I'll just finish off the myth busing segment with I can flush out a stone by drinking a ton of water. 760 00:43:12,292.7292664 --> 00:43:14,572.7292664 If they're stuck often they're stuck. 761 00:43:14,862.7292664 --> 00:43:17,772.7292664 And you may need a bit more intervention than than water. 762 00:43:17,802.7292664 --> 00:43:18,132.7292664 Yeah. 763 00:43:18,182.7292664 --> 00:43:23,732.7292664 There's not really like a plunger equivalent for your urinary system, like Uhhuh, one, once it's plugged, it's plugged. 764 00:43:23,732.7292664 --> 00:43:26,132.7292664 You can't really dislodge it by drinking much more. 765 00:43:26,222.7292664 --> 00:43:27,512.7292664 It's kinda the way I think about it. 766 00:43:28,229.7247313 --> 00:43:34,592.7292664 kidney stone plunger, but I don't want to go down that route 'cause I'm, I'm kind of interested. 767 00:43:34,605.2292664 --> 00:43:36,539.7247313 he, Nope. 768 00:43:37,559.7247313 --> 00:43:43,665.2292664 I, I don't want any algorithms taken over once I write that your shopping suggestions will, uh, be very interesting. 769 00:43:45,119.7247313 --> 00:43:46,979.7247313 I already looked up kidney stone sieve. 770 00:43:46,979.7247313 --> 00:43:48,119.7247313 I am stopping there. 771 00:43:48,419.7247313 --> 00:43:48,749.7247313 Yeah. 772 00:43:50,42.7292664 --> 00:43:50,822.7292664 Oh man. 773 00:43:51,45.2292664 --> 00:43:51,265.2292664 God. 774 00:43:51,572.7292664 --> 00:43:53,762.7292664 Um, all right boys, this was, this was fun. 775 00:43:53,762.7292664 --> 00:43:57,152.7292664 Should we, uh, bring it home? Close it up. 776 00:43:57,209.7247313 --> 00:43:57,389.7247313 Yeah. 777 00:43:57,389.7247313 --> 00:43:57,449.7247313 Yeah. 778 00:43:58,597.7292664 --> 00:43:58,717.7292664 I. 779 00:43:59,0.2292664 --> 00:44:07,305.2292664 I'll, I'll, I'll start by stating the obvious, you know, we should avoid rhubarb, high rhubarb diet to prevent kidney stone. 780 00:44:08,114.7247313 --> 00:44:08,984.7247313 Off script. 781 00:44:09,740.2292664 --> 00:44:09,960.2292664 no. 782 00:44:10,100.2292664 --> 00:44:18,145.2292664 My, my, my takeoff message here is hydration, really just keeping yourself hydrated, making sure that your urine is usually clear. 783 00:44:18,395.2292664 --> 00:44:21,425.2292664 And that's the simplest way to prevent kidney dose. 784 00:44:21,495.2916247 --> 00:44:21,687.9957064 Yep. 785 00:44:21,905.2916247 --> 00:44:28,390.7961599 think, number two is diet does matter and I'm not gonna go into specific diet recommendations 'cause it depends on the stones you Mm-hmm. 786 00:44:28,535.2916247 --> 00:44:29,975.2916247 or, um, depends on the stones. 787 00:44:29,975.2916247 --> 00:44:31,325.2916247 You may not know you have. 788 00:44:31,565.2916247 --> 00:44:32,765.2916247 So, uh, diet matters. 789 00:44:32,765.2916247 --> 00:44:34,985.2916247 Listen to your doctor when they, when they talk to you about that. 790 00:44:35,103.6476338 --> 00:44:37,143.6476338 And I'll wrap up with the red flags. 791 00:44:37,203.6476338 --> 00:44:41,253.6476338 So, fever, vomiting, can't keep anything down. 792 00:44:41,433.6476338 --> 00:44:45,33.6476338 Or if you've only got one kidney again, you'll probably stay in the hospital. 793 00:44:45,153.6476338 --> 00:44:46,573.6476338 Get to get, treatment right away. 794 00:44:46,720.3143005 --> 00:44:47,290.3143005 Thanks guys. 795 00:44:48,157.3097653 --> 00:44:49,0.3143005 So I was fun. 796 00:44:49,87.3097653 --> 00:44:54,337.3097653 to finish off, we should all take a big swig of water and, and, and sign off with that. 797 00:44:54,910.3143005 --> 00:44:56,332.8143005 Cheers to our kidneys. 798 00:44:57,160.3143005 --> 00:44:57,970.3143005 to the kidneys. 799 00:44:59,377.3097653 --> 00:45:00,187.3097653 Take it easy guys. 800 00:45:00,970.3143005 --> 00:45:01,375.3143005 Oh, see you guys.