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Scott Webb (Host): Kidney stones are common and often painful. But there are a variety of treatment options, including sonar and lasers to break up the stones and here today to tell us about kidney stones, why some people are a greater risk of developing stones than others, and the various treatment options is Dr. Clifford Maximo, he's a Urological Surgeon with Genesis. is Sounds of Good Health With Genesis brought to you by Genesis Healthcare System. I'm Scott Webb. Dr. Maximo, thanks so much for your time today. We were just kind of chatting here before we got rolling. And you know, I think maybe some people know what kidney stones are. Some folks may have unfortunately had them, but others may not, so to have you on and just kind of set the scene for us here, what exactly is a kidney stone? And do we know what causes it.

Clifford B. Maximo, M.D., FACS (Guest): Kidney stones, unfortunately affect one in 10 people in the population. Here at our institution, we see quite a number of people afflicted with kidney stones, having to do surgery on them. Kidney stones are usually formed as abnormal calcifications in the urinary tract, starting in the kidney. And then they're very painful when they travel through the system and cause blockage of urine.

Host: Yeah. Having had a or two in my lifetime, the very painful thing is something I can definitely identify with. I didn't end up needing surgery, but as you said, some folks that ends up being the option and you as a Urological Surgeon, certainly would know, and we're going to get to that. But before we do, are some folks just at greater risk based on their family history, lifestyle, things like that?

Dr. Maximo: Yes, unfortunately, in our society there's a lot of processed foods, high protein foods, foods high in sodium, and those are all risk factors for forming kidney stones. It's kind of two fold where a lot of it is hereditary. If your father or brother had kidney stones, you might be at risk for having kidney stones, but there are several things that you can do to prevent them. Number one, being increasing the amount of water that you drink, or at least fluid that you drink. I believe at Cleveland Clinic, they recommend up to eight to 12 glasses a day with half of that being water. At Ohio State, where I trained at they would recommend two to three liters of water a day, which also included lemonade being either unsweetened or sweetened, lowering your sodium amount.

It's usually recommended from the Mayo Clinic about two to three grams limitation per day. And now in with modern technology, someone might use like a My Fitness app or some sort of app to show the amount of sodium content in foods that might be helpful.

Host: Yeah, I think it would be. And I've heard that before. Certainly drink more water, cut down on the sodium and then the lemonade thing. That's one that I've heard other experts say that lemonade is really good for this, especially in the summer. So let's assume that you've spoken with a patient, you've gotten their history and you have a sense of like, okay, this is probably a kidney stone. So let's just maybe go through diagnosis and the respective treatment options, obviously including surgery.

Dr. Maximo: A lot of times when people are afflicted with kidney stones, they're going to know it. For men, they say that the pain is so bad that it's similar to women having babies, but usually they're presenting to the ER or they're complaining to their family doctor. And a simple x-ray might show a stone, but more diagnostic would be what we call it a CT stone study. And that's just a CAT scan without IV contrast. And usually if you show up in the ER with severe back pain, nausea, or vomiting they're going to order a CAT scan on someone.

Host: So then let's talk about the treatment options. Obviously, you know, I've spoken with a number of surgeons during my time doing this and most surgeons say well we prefer not to do surgery. It's always a last resort, but if we have to, we will. But what are some of the other treatment options? How do you break up those stones? Maybe are you using sonar, lasers, you know, some real sci-fi stuff. And then maybe talk about the surgical options as well.

Dr. Maximo: Yeah, we use both. And actually, when it comes to sonar or what's called extracorporeal shockwave lithotripsy, they're just using sound waves to break up the stones. I always tell my patients that's the most incredible surgery that man ever invented, where sound waves can actually come into your body and actually work to break up a stone.

For instance, like the surgeon, if someone has gallstones, they have to actually surgically remove the gallbladder. Were here, we can target a stone in the kidney or even in top portion of the urinary tube and fragment the stone and to sand, ideally, which would then can just pass on its own. But we also utilize a lot of lasers. That's actually how I became interested in urology, seeing all the fiber optic endoscopes used and lasering stones and reminding of me playing asteroids when I was a child.

Host: Now we're definitely, we're dating ourselves, talking about asteroids for

Dr. Maximo: But we're actually physically lasering stones into dust. And a lot of these surgeries are really outpatient surgeries. And for larger stones, then it becomes more invasive where they might need a percutaneous surgery through the side. The majority of time it's conservative management. Most people pass their stone spontaneously as you may have. But when they do require surgery we have several options for it.

Host: Yeah, you certainly do. And you're right. Yeah. Mine passed painfully, but passed on their own, but it good to know that there are surgical options, invasive, less invasive. And we as patients, of course, we just always want options. The least path of resistance maybe is the way to put that, you know, the easiest way to break that stone up.

And I'm wondering, once somebody has a kidney stone, so they develop their first kidney stone, does that just mean that they're going to be more likely to develop stones? Is that indication to them that, oh, they're the type of person who gets stones, so you better be prepared for them again?

Dr. Maximo: Yes. And they are at increased risk for getting another stone. Since statistics varies, whether it's 40 to 50% in the next five to 10 years, but then, we really counsel them to do the preventative measures. Even though they might be at increased risk. So for you, we all, it's even for myself I have to remind myself to drink more water.

I try to make it more practical and say that well, if you go through your day and I like my coffee in the morning, to have a cup of coffee or second cup, and then maybe you drink some tea or something for lunch and then something else in the afternoon, and then something else for dinner, you might find out that you didn't really have much water at all. So some practical things that I would recommend. And then I got this from my OSU professors, is that to actually look at the urine. So if when you're going to the bathroom, if your urine looks really concentrated then you're not drinking enough water. So the goal would be to have your urine looking actually more like lemonade.

So as the more water you drink the lighter the color is going to be. And so that's maybe a practical way to remind yourself. Nowadays, we see a lot of fitness minded people carrying these containers that actually measure like a gallon. Another practical way of telling yourself to drink more water is instead of just saying like eight to 12 glasses a day or two to three liters a day, but maybe two to four bottles of water a day.

So the 500 milliliter bottles of water that we get, that'll be an easy way to count your liters. What I didn't touch upon earlier was that the majority of kidney stones are what are called calcium oxalate stones. And so you've may have heard that it's also the amount of oxalate in one's diet. And someone who eats a lot of spinach or rhubarb, chocolate, nuts which you knows the nuts would also behind sodium. They could be at increased risk. And a lot of people assume that too much calcium in their diet would put them at risk for having more calcium in your urine. But studies have showed that the opposite is true.

The fact you have diet supplemented with calcium, so dairy products, cheese, they actually have a lower risk of forming kidney stones because the calcium will bind to the oxalate in the gut and the body will be able to process it better. Also vitamin C supplementation. You know, some people want to take vitamin C for any type of cold or ailment that is directly converted into oxalate. And so we usually recommend any patient who's had kidney stones before to stop vitamin C supplementation.

Host: Doctor as we wrap up, what would be your final thoughts about kidney stones? You know, I know that they're fairly easy to diagnose. There's lots of treatment options. There's things we can do ourselves. But from you, the expert in the room what do you want folks to know?

Dr. Maximo: I think that modern day treatment is very advanced. But obviously the goal would be not to treat any stones and have people drink more water or lead a healthy lifestyle. Get more information like they would be doing today to educate themselves. And prevention is always jey.

Host: Yeah. As I preface today, as someone who's had a couple of stones and they painfully passed, prevention is absolutely key. That is a perfect way to end. If we can prevent stones, I think we're all better off, but if they do find themselves with Dr. Maximo and partners, sonar, lasers, minimally invasive options, all good stuff. Well, let's prevent them. If we can Doctor, thanks so much for your time. You stay well.

Dr. Maximo: Thank you too.

Host: And for more information, go to genesishcs.org. And thanks for listening to Sounds of Good Health with Genesis brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.