Kidney stones

I've recently had several questions about kidney stones so let's talk about those painful little things for a bit. Basically, kidney stones are the result of the crystallization of minerals and salts found in urine. Most often they are composed of calcium oxalate and less often, uric acid but other compounds can be found in them as well. Formed in the kidney, these stones move with the flow of urine and attempt to exit the body just like urine. Herein lies the problem AND the pain. Depending on the size and shape of the stone, some pass through the system without pain and one never knows they have passed a stone while others get "stuck" (clogging up the flow of urine) or descend slowly causing great pain as they drag along the wall of the ureter (the tube from the kidney to the bladder)., The pain is usually intense and spasmodic and is not relieved by activity or position. Patients with stones often pace or thrash about in the bed until they receive adequate pain medication or the stone passes. The pain usually begins in the lower back or flank area and moves toward the groin area as the stone descends through the urinary tract. The urine is often bloody due to the tearing of the wall of the ureter although blood is not always visible (it may be microscopic only). Diagnosis is usually made based on imaging studies when a dye in giving in a vein and x-rays are taking as the dye moves through the urinary tract or a CT scan is done to look for a stone. After diagnosis, it is necessary to determine if the stone can be passed or if there is need for some type of intervention to assist in moving/removing the offending boulder. (By now the patient is certain the stone is the size of Texas!!) If the doctor believes the stone can be passed, he/she may provide pain medication and order increased fluid intake. It may be determined that the stone could pass if a stent were inserted into the ureter in which case the patient is taken to the OR and the stent is placed under anesthesia ( thank you Jesus) using a scope. If the stone is too large to pass (it IS as big as Texas), the doctor may decide that lithotripsy is the best intervention. This procedure uses ultrasonic therapy to shatter the stone into smaller pieces that can be passed. This is a non-invasive procedure but is performed in an environment much like an OR. (Often these are portable units moved from hospital to hospital by truck.) Finally, if all else fails, the stone may need to be removed either with the use of a scope (going through the urinary tract from the bottom up and pulling the stone out) or, less often, by removing the stone through an incision. However the stone exits the system, the patient will be eternally grateful it is gone! It would be good if the making of kidney stones were a once-in-a-lifetime event but that is often not the case. For whatever reason reason, some folk just seem to make stones. An analysis of the stone can help determine the composition and adjustments can be made in diet, fluid intake, and even medications that may decrease the production of stones. So......if you find yourself experiencing symptoms of a kidney stone, begin by increasing you fluid intake in an effort to increase you urine volume. This may help to "flush" (pun intended) that sucker out. If the pain is more fun then you can stand, seek medical attention at an emergency room so that appropriate testing AND pain management can be provided as well as in-patient treatment if necessary. I you have more questions about kidney stones or any other subject for that matter, go to the comment area and enter you question or you can e-mail me @ gowens27@gmail.com. I would love to hear from you!

Greetings! Awoke yesterday morning to a call from the hospital where I work announcing that Joint Commission, the agency that accredits hospitals, had arrived for our survey. Finally! For months we have worked, "drilled", prepared, and collected data to show ourselves a safe and capable place to care for sick folks. In my 32 years as a nurse I have experienced many surveys. Sometimes it seems the surveyors are intent on finding something- anything- they can make a big deal over and other times they come in a teaching and supportive role. I think this time we may have the latter. My intent is never to be political about any given subject but health care surely is a hot topic now that deserves some discussion. My comments are related to my experiences caring for the rich, poor, old, young, insured, uninsured,ect.... You get the idea. We work in a system that is far, far from perfect. I get frustrated with limitations and hoops that insurance companies force us to jump through. I appreciate how difficult it is to provide safe appropriate care for patients when a practitioner must practice law suit prevention and not just sound medical care. I have seen how catastrophic illness can change a family's entire way of life. I could go on and on but I think you can see that I haven't missed much of the reality of health care we live in today. A word of caution, however. More involvement from non-medically oriented people telling doctors, hospitals, and other health care environments how to run their practices, is like asking the health care folks to make decisions about banking or car repairs. Surely changes need to happen but we must be careful that we don't mistake health care as only a business. Of course money must be made to provide services and safe nets must be in place to care for indigent and incapable folks but we should make our decisions based on providing the best care available for all patients and remember that all of us must be responsible people. None of us deserve anything without somehow involving ourselves in our on wellness. Surely we must all take responsibility for our poor choices that often lead to preventable illnesses. (Preaching to myself here!) We must answer some questions that were not even asked in the past. Must someone always be "liable" for our illnesses and poor outcomes? Is it realistic to think that there will never be an honest mistake made that may have a negative outcome? Is it too much to ask a practitioner to talk to his/her patient and form a trusting relationship? Can we not expect a safe, friendly, caring environment in hospitals, nursing homes, hospices, and other facilities? The questions go on and on and I nor any one person has all the answers; but, here's my final thought. Can we all put aside our own personal agendas, come together to do what is best for ALL of us, and formulate a plan for this country that reflects all the principles and beliefs that we say we hold dear? Surely we can put aside our egos, political differences, and personal preferences and just do the right thing. As I have said many times, The Emergency Room is the great equalizer. It's a place all of us may find ourselves one day. Is doesn't matter how rich, poor, old, young, smart or stupid you are there. When you need health care, you are at the mercy of "the system". Should we not have the best system in the world? Come on people. This ain't rocket science! It's taking care of those we love and ourselves. We can do better! Now. I feel better.