Bill Klaproth: When it comes to kidney stones, how do you know if you have one, how are they diagnosed and treated? And what is the wake med kidney stone center? Let's find out what Dr. Matthew Lyons, Urological Surgeon, residency site co-director for urology at WakeMed Health and Hospitals.

This is WakeMed Voices, a podcast from WakeMed Health and Hospitals, I'm Bill Klaproth. Dr. Lyons, thank you so much for your time. Let's start here. What causes kidney stones?

Dr. Matthew Lyons: Yeah. Thanks so much for having me. I'm excited to be here. This is a topic I'm interested in and it's a lot of what I do. So everybody wants to know what causes kidney stones. a large part of it, just like a lot of other medical problems, is hereditary and it gets passed down through families. so, if you know family members who have kidney stones, you're at an increased risk for forming them yourself, the other.
Things that we can control that lead to kidney stone formation is really what we eat our diet and specifically how much fluid we take in whether we were dehydrated, routinely or not. folks who have medical conditions like diabetes, are an increased risk folks who are obese are at an increased risk. So, these are all risk factors that could potentially be modified by simply looking after our diet and staying hydrated.

Host: So keep drinking that water. That's a good point. So the main risk factors are one, it's hereditary and two lifestyle choices. So that's good to know. So what are the symptoms? How would someone know if they have a kidney stone?

Dr. Lyons: With a kidney stone, that they're either acutely trying to pass or has gotten stuck in their plumbing system. Basically the tubes that run from the kidney on down to the bladder, there's a tube in the middle called a ureter, and that's a place with some narrow areas that that stones can get stuck. So classically, patients will present with what we call. Blank pain. So that's pain in the low back, usually to one side or the other. It can even be up as high as where the rib cages on the back. It's a sharp stabbing pain. One that might wake you up from sleep or kind of stop you in your tracks and make you feel like maybe you got electrocuted. it can be associated with nausea and vomiting. also, some blood in the urine or some urinary symptoms such as frequency, meaning going to the bathroom more frequently than you're used to some stopping and starting of the urinary stream. and rarely a fever can occur with this constellation of symptoms, which is something to really pay attention to because, folks with a stone that's blocking the flow of urine and a urinary tract infection can actually be a life-threatening problem.

Host: Oh my. So when is it time to see the doctor, then?

Dr. Lyons: It's a very good question. You know, folks who have had kidney stones in the past, kind of know what they can tolerate and what their symptoms are used to. if you're a first time stone former, I think you might have one based on this, pain that you have in your back, it usually kind of comes and goes it'll last for a few hours, sharp stabbing, and then may just completely disappear. If you're able to keep your pain under control, you're able to eat food and you're not having a fever. it's reasonable to, inform your doctor of what's going on so they can get you in a and R in a relative timely fashion to get some imaging and prove that you have a kidney stone. if you have a fever or the pain is so bad that you can't eat food and you can't get through your daily life. That's a really good time to either get in touch with your primary doctor or get in touch with us at the wake med stone center at, nine one nine three five Oh R O C K. And we can get you in same day to get, imaging and potentially even treatment.

Host: So you mentioned imaging, is that how you diagnose kidney stones?

Dr. Lyons: Absolutely. Yeah, it's really the most important piece because without imaging, we don't know. Number one where the stone is located, in the, what we call the collecting system or the plumbing system of the kidneys. Number two, we don't know how, large it is, and those are both factors that help us decide what treatment is best because one of the treatments is, giving you supportive medications to help you pass the stone on your own. And the other options are, treatments or surgeries or procedures. So it's important to have that imaging, to know where we need to go from there.

Host: So, treatment options are, you said giving medications to help it pass all the way up to potential surgery? Is that correct?

Dr. Lyons: Absolutely. And again, it's all dictated by the size of the stone and the location of the stone. We use kind of x-rays in the office, which are, I always say it's kind of like a 1950s TV view of what's going on the inside of the body. it shows a lot of kidney stones, but not all of them. Occasionally we need to get CT scans. They get the definitive picture of the kind of HDTV look at what's going on the inside. if you're still in a small meaning less than a centimeter, we'd like to give you a chance to try to pass it with supportive medications and fluids, pain medications, and antinausea medications. If your stone is larger than that over a centimeter and in a blocking position, there's a very low likelihood that you'd be able to pass that stone kind of on the order of single digit percentage chance of passing it. So we talked to you about the different treatment options was ranged from blasting the stone from the outside of the body with shockwaves, that's something called shockwave lithotripsy to something I call going up and getting the stone, which is formerly called a ureter copy. So we basically go inside the body, no cuts on the skin. We go into the urinary bladder and put, an instrument with a small little laser fiber and chiseled the stone into small pieces and remove it with a small fishing basket. And remove the stone that way.

Host: Oh my goodness. Oh, we've all heard how painful kidney stones are. Oh my gosh. So I guess one question would be, is there a way to help prevent kidney stones?

Dr. Lyons: Absolutely. And this is, as important part of the process and the treatment process as the actual treatment itself. You know, folks who are a first time, kidney stone former have a 50% chance of making another stone in five years, if they keep doing the same things that they've been doing. So when I'm seeing a patient, it's the first time they've formed a stone, I basically give them three rules of thumb to follow, rule number one, is you gotta become a water bottle person, you have to drink enough water. And what is enough water mean? I usually tell them it's about eight to 10 glasses of water a day, so 80 to a hundred ounces. And it's really hard. And you know, if you're like me, it's hard to get to get that much water down. So having a water bottle nearby can make that helpful and more easy. For you to accomplish rule number two is adding lemon or lime juice into the water that you drink. It's not just an old wives tale, citric acid and lemon and lime juice actually helps prevent stones from forming up in the kidney. So it's a natural preventative that citric acid and then rule number three is avoiding things that are going to increase the amount of, of calcium in your urine. And those are the things we all like to eat. The fast foods, salty deli meats. sodas, all of those things are going to increase the amount of, of calcium in your, in your urine. And it's going to increase the likelihood of you forming a kidney stone. So if you can do make strides to improve those, those three rules right off the bat, we can hopefully decrease the likelihood of those stones coming back. And for patients who've had trouble with that and continue to make stones. Then we start getting into the realm of, of looking at medications to try to help improve all of those things.

Host: Okay. So those are three really good rules for us to follow eight to ten glasses of water a day, add some lemon or lime juice, and then stay away from all the fast foods and salty deli meats and things like that. So that's really good. So Dr. Lyons. Well, one last question for you and thank you for your time. Can you tell us about the Wake Med kidney stone center, which provides 24 seven access for diagnosis, treatment and prevention?

Dr. Lyons: Absolutely, so it's something that I'm really proud of and all of us at wake med urology are really proud of. As everybody knows, it's really tough to get in, to see a specialist. You usually have to go see your primary doctor, get a referral. we take the power and put it into your hands. When you're having these symptoms. All you have to remember is to call the number nine one nine three five O R O C K. And that'll get you in touch with our kidney stone center coordinator. She'll ask you to kind of what's your symptoms are what's going on. If you're really having an acute problem in significant pain, she'll put you in touch with one of our kidney stone staff members who can even prescribe medication to you over the phone. And then we can get you in and seeing and same day fashion. So even if it's, you know, in the morning and you call and you're having an issue, we'll get you in and seeing that our location, hopefully close to where you live, that same day and potentially even have a treatment that same day. If it's deemed that, that's what you need. all we usually ask of you is to stop by one of our imaging facilities, right near where the appointment is going to be. And we get that important imaging like I was talking about before. And that way, when I see you in clinic, we can come up with a good plan. That number one gets you pain relief. Number two, get your stone treated. If it needs to be treated. And number three gets you plugged in to help working on these preventative strategies to help the stones from coming back in the future.

Host: Yeah, that sounds great. What a great center you have there? Absolutely. Well, Dr. Lyons, thank you so much for your time. This has really been informative and insightful. Thank you again.

Dr. Lyons: It's my pleasure

Host: That's Dr. Matthew Lyons. And for more information, please visit WakeMed.org and if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Bill Klaproth with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Thanks for listening.