 In tonight's Your Health segment we're joined by Dr. Mark Siegelbaum, Chief of Urology and Director of Urologic Oncology, University of Maryland St. Joseph Medical Center. Dr, thanks for being with us. You're welcome. Thanks for having me. Thinking about seasonal conditions, I would have guessed sunburn was a summer condition. I would not have guessed kidney stones were a summertime problem. Why is that? It basically has to do with the fact if you're not hydrating yourself well enough or the temperature you're overheating outside and not hydrating, that combination platter will usually result or could result in kidney stones. So places in the southeast, for instance, which are classically known as the sunbelt, there's a much higher incidence of kidney stone disease down there. Fascinating. Millions of people get kidney stones every year, right? About 500,000 people wind up in emergency rooms across the country in in this country for kidney stone disease. Right, so we'll focus on the summer first and then broaden out. So talk about staying hydrated. What happens where, I mean, certainly you get thirsty on a day like today's been, what do people do wrong when it comes to staying hydrated? Well, kidney stones basically will form, start forming by little crystals, and then those crystals coalesce into larger crystals and actually become stones. If your urine is well lubricated, if there is a higher volume of urine, there's a much less chance that these little crystals will aggregate into a stone. So the more you drink, the more you urinate, the more the urine volume, the less chance of these stones forming. This is a terrible analogy, but there's a thing called rock candy and it's like a kid's school science experiment where you get a super saturated solution of sugar. You put a string in there and the crystals start to form and then they keep growing. Does it work that way where you get a little tiny crystal and then it grows from there? That's a great analogy, Jeff, actually, because the urine does become super saturated with these chemical components. Those chemicals might be calcium, they might be oxalate, they might be uric acid, and that's exactly what happens. There's too many crystals in the given volume of urine that you have and you become then at higher risk for forming these stones. So it's not a situation where it's a problem in the summer and it's not a problem in the winter. You could start something growing in the summer maybe and it continues to build. Does that make sense? Oh, absolutely. I mean, it's a all-year-long disease for us, quite frankly, but I think people just aren't a little bit more risk because they tend to not hydrate themselves perhaps as well when they're overheated. And as I said, it's just a matter of sheer volume of urine and generally in the hotter climates or when you're a little more dehydrated in the hot temperatures, you're a little more vulnerable. Let me remind our viewers, if you have a question about kidney conditions, kidney stones, give us a call. We'll have the number on the screen and you can also email questions to livequestionsatmpt.org. We hear these things are really painful. What's the first symptom that somebody comes in with? The most common is pain. It's a sharp pain, usually in the flank area, which is in the upper back area. And sometimes that pain will radiate down towards the front of the abdomen into the groin area that usually also is associated with nausea and vomiting perhaps, but pain is the synquinon symptom that's most common. When people have that pain, I'm guessing a kidney stone isn't the first thing they're thinking of. They think it's something they ate or they pulled a muscle maybe? That's a great point too. If they've never had one, they don't know exactly what they have. They generally probably think that they have gas pains, but this pain is very different than gas pain. And usually with gas pain, you can figure out a maneuver to sort of relieve yourself. This is just unrelievable, no matter how you position yourself or what you may take over the counter product you might take for your gas ailment. It just does not help. So it does eventually hit you that this is something different than you've ever had. All right, so two things can happen to the stone, I'm guessing. What are the possible outcomes here? Well, hopefully you wind up passing the stone. If it's small enough to pass, the problem is that the stone starts formation in the kidney. It has to go down a tube that connects the kidney to the bladder, which is like a piece of linguine. It's a very tiny, delicate tube called the ureter. And if it cannot fit through that ureter tube, it's going to block the tube and eventually the ureter and the kidney will fill up with urine. It's actually the distension of the kidney and the ureter with urine that causes the pain. It's not actually the stone itself that is painful. So if you don't pass it, you're going to have persistent pain. If you do pass it, it's almost an instantaneous relief of your symptoms. Is there anything that can help in terms of procedures, medication, to have it pass normally? Well, first of all, I would recommend to my patients that if they think they're having a kidney stone, the pain usually becomes so intense that you really need a little help from your friends. I would suggest that they go to the emergency room because, number one, we can hydrate them. Number two, we can give them pain relief. And number three, we can do the x-rays that we need to determine where the stone is, how big it is, and will they need help in passing it. Let's take a phone call. Baltimore County, this is Lewis. Lewis, thanks for the call. Go ahead. Hi. I'm wondering if being overweight makes you more likely to get kidney stones. Good question. Thank you, sir. That is an excellent question. And yes, people who are obese are at higher risk for formation of kidney stones. All types of kidney stones, but the most common are uric acid stones, which are a byproduct of some protein food stuffs that we eat. But they also have higher incidents of getting oxalate stones as well. So, yes, obese patients are at higher risk for kidney stone formation. Any other risk factors or demographics that work here, male versus female? There is a higher incidence of male stone victims compared to female. There is a genetic preponderance for stone formation. Patients who have Crohn's disease or ulcerative colitis could have it. Other diseases like hyperparathyroidism, patients are prone to getting stones. And also, people who have a very high sodium intake in their diet have a predisposition to getting calcium oxalate stones as well. Is there an age group where this problem pops up? It does affect all age groups, including children, but much less so in the childhood age range. And I would have to say probably in the fifth to seventh decade is probably the most common. All right. You talked about the emergency room could do an x-ray. What other diagnostic tools are available? The most common diagnostic x-ray that we would do in that setting is a CAT scan. And that will give us the position of the stone, the location of the stone and how big it is. We then decide if we would allow that patient to then go home and try to pass it on their own with a few medications that we would give them to aid them or whether they need to have an intervention with either a laser procedure through a scope or whether they might need a procedure where they can lay on a stretcher. They're anesthetized and from outside the body we can deliver shock waves to the stone to break them up into dust particles. How on earth does that work? I mean it sounds like science fiction. How do you apply the shock wave? Well to tell you the truth that science fiction has been around for close to 35 years and it started off immersing patients in a bathtub and they would be placed on a gantry immersed into this bathtub that sort of looked like a coffin. The stone then would be imaged on multiple different fluoroscopic images and then you deliver a shock wave that used to be transmitted through the water so that it wouldn't create such havoc inside the body but that shock wave treatment now has been really miniaturized. It almost looks like a portable x-ray machine and the energy is so focused and immediately directed onto the stone itself that it doesn't cause any damage to surrounding structures unless you overdo it. Let's get one more phone call Prince George's County. This is Arno. Thank you for the call. Go ahead. Yes. Does drinking high acidic juices such as cranberry juice help to dissolve kidney stones? Good question. Thanks. And also while we're talking summertime what about beer? Right. Beer probably is a reasonable thing to drink. I was just wondering if it makes you dehydrated though. Well I think ultimately because you probably urinate a little bit more perhaps if you're overdoing it but to have a couple of beers would be a good source of hydration. It's my kind of doctor right here. Right. So the caller wanted to know cranberry juice. Right. So cranberry juice actually is very bad for stone formers in fact because it has a high oxalate content in there. So specifically cranberry juice is bad because of the oxalate but also acidifying the urine is not a great thing to do in terms of having certain types of kidney stones because uric acid stones in an acid environment in fact would become worse. So cranberry juice is not necessarily a beverage that's recommended for stone formers. The best beverages for stone formers are either plain water or lemonade as long as you're not loading it with sugar. Very good. And just a sentence our summertime advice here is drink some water. Hydration, hydration, hydration that's the chief reason for preventing stones. Dr. Mark Siegelbaum, University of Maryland, St. Joseph Medical Center, thanks for your time. You're welcome. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.