Cheryl Martin (Host): About one in 11 people will get a kidney stone in their lifetime, often causing severe pain, and a trip to the emergency department. Here to break down the signs, symptoms, and causes of kidney stones is urologist, Dr. Abe D'Amato. He's a member of the Trinity Health of New England Medical Group. This is Transforming Your Health, the podcast from Trinity Health of New England. I'm Cheryl Martin, Dr. D'Amato, glad you're here today.

Abram D'Amato, MD: Thank you for having me.

Host: So what are the most common types of health issues you treat in the field of urology?

Abram D'Amato, MD: Urology is very broad. We see everything from cancer in the bladder, prostate, or kidneys to urinary issues, and one of the most common issues is kidney stones.

Host: What is a kidney stone, Doctor and how does it affect you when you have one?

Abram D'Amato, MD: Kidney stones form in many people for a variety of reasons. Some of it is dietary, some of it is genetic. Some of it can even be infectious. As the process starts to take place, chemicals and salts within the urine can crystallize and form quite literal hard stones. The chemical composition can vary greatly between different people. And when the stone is simply present in the kidney, you wouldn't necessarily notice. A stone can just be sitting quietly biding its time. People notice kidney stones when the stone moves out of the kidney and attempts to pass. The ureter that connects the kidney to the bladder is about a foot to two feet long, depending on somebody's height and as big around as a strand of angel hair pasta. Trying to get a kidney stone through it, is a little bit like trying to cram a porcupine backwards down a garden hose. It's the obstruction and trauma of this stone passing that causes very significant discomfort.

Host: And that's why there's a trip a lot of times to the emergency room?

Abram D'Amato, MD: Very much so. There are plenty of people who would say they'd rather be dead. It's very, very painful.

Host: Wow. So at Trinity Health of New England, you are taking a unique approach to caring for patients with kidney stones. Please tell us about the Stone Program.

Abram D'Amato, MD: So our Stone Program was designed to help patients that don't necessarily have a urologist ahead of time. They are coming in for their first visit to the emergency room where a lot of times they can be triaged and even though there may be significant discomfort, that can be managed and they're told they will need follow up for an intervention. The way that the Stone Program is unique is that we have a nurse navigator that's actively searching those patients out from the emergency room each day, getting in touch with them to help ensure that they get an appointment, usually the day after their emergency room visit, so they can be seen promptly and we can address the stone in the best way possible.

Host: Talk about how this program, you've touched on some, but how this benefits the patient and how does one get relief?

Abram D'Amato, MD: So the pain relief can be provided by the emergency room, but it's ultimately the relief of the obstruction and removal of the stone that is going to resolve the problem. There are some stones that are small enough to pass on their own without a surgery, and there are other stones that will require an intervention.

The whole reason to come in and see a urologist is to help determine which category somebody falls into and talk about the different options for intervention if that proves to be necessary. The Stone Program allows people to get in more quickly so that we can address the pain faster and fix their problem as quickly and easily as possible.

Host: So as a result of being a part of the program then, this could possibly eliminate the potential of kidney stones in the future.

Abram D'Amato, MD: There are things we can do to help evaluate why somebody forms stones and try to prevent them. But unfortunately kidney stones remain a chronic disease. The current estimate is that 50% of patients will have a second stone within five years of their first attack, and 80% of patients will have a second episode within 10 years. There are ways of figuring out why it's happening and trying to mitigate all of that. And that's also something that we do through the Stone Program and a visit to one of the urologists.

Host: Is it ever life threatening?

Abram D'Amato, MD: Rarely, it can be. If there's an infection brewing behind a kidney stone, the bacteria is trapped inside of that obstructed kidney and urine. That infection can then spread into the blood and that can be very dangerous and deadly. Typically, although the pain can be severe, it's not a life-threatening condition.

Host: You mentioned early on that diet could be a reason for a kidney stone. If it is diet, what does a person need to do in terms of changing a diet to minimize getting kidney stones in the future?

Abram D'Amato, MD: The single most important factor is that kidney stones tend to be formed in concentrated or dehydrated urine. We recommend that people drink two to three liters of fluids, 60 to 90 ounces at a minimum every day. The best way to make sure you're getting enough liquid is when you go pee, the urine should be clear.

We know that citrus, lemons, limes, grapefruits, oranges, clementines, lemonade, orange juice, whether it's drinking the juice, eating the fruit, or squeezing it into your water or cooking, there are chemicals in citrus that can help prevent stones and more is better. Calcium in general is a good thing. We need it for our bones and calcium is very rarely the reason people form stones.

Things like dairy, cheese, yogurt, those are fine. Other forms of animal though, be it eggs or chicken, fish, beef, pork, animal; when we consume that protein, it can move chemicals out of the blood and into the urine where they cause problems. Now, I would never expect anybody to become a vegan on my behalf. The idea is to limit how much intake somebody has. A serving or two a day is reasonable, and a serving of animal protein is the size of your palm. The most important dietary thing besides fluid intake, is avoiding salt, and that's any form of salt because when we eat that, it pulls chemicals with it into the urine.

So whether it's restaurants or canned goods, potato chips, french fries, deli meats, popcorn, white salt, pink salt, sea salt; any form of salt can contribute to stone formation, and we should have as little of it as possible in the diet.

Host: The salt is in all the things we like.

Abram D'Amato, MD: Absolutely. It tastes fantastic.

Host: Anything else, uh, Dr. D'Amato you want to add about your program or how to manage kidney stones?

Abram D'Amato, MD: Generally, the best thing to do is to actively seek out care. I encourage my patients to be the squeaky wheel and let us know when there's a problem, because that's when we know we need to fix it. If somebody has any questions about the program or feels that they want to be seen to discuss stones in more detail, the best way to get in touch with us is to call our nurse navigator. She can be reached at 860-707-3280 and help arrange an appointment quickly for an evaluation and discussion.

Host: Dr. Abe D'Amato, thanks so much for briefing us on kidney stones and for telling us about the unique approach Trinity Health of New England is taking to care for patients suffering with kidney stones. Thanks so much.

Abram D'Amato, MD: You're very welcome.

Host: Again, To talk to a Stone Program Nurse Navigator, call 860-707-3280. That's 860-707-3280 or go online to TrinityHealthofne.org/stone. That's TrinityHealthofne.org/stone. If you found this information helpful, please share it with others, especially on your social media. Thanks for listening to the Transforming Your Health Podcast.