After 21 years in the stone prevention sector, I feel blessed and grateful that I continue to have a gratifying career. As a nurse, it is one of my greatest passions to help patients understand that diet and lifestyle choices make a difference in maintaining a healthy body and mind.
But what about the patients who have not faired so well? What happened to those who made another stone? What did they do or not do that you can learn from?
Here are the eight principal reasons patients make new stones.
- Their doctor has never ordered a 24-hour urine collection for them. I can not begin to tell you how many new kidney stone patients never get urine collections ordered. Without doing a 24-hour urine collection, you will never know WHY you are forming stones. If your doctor has not ordered one for you, ask for it. If you’re told you don’t need it, push back. You do need it. Watch my video about why you need to do urine collections.
- They did the first urine collection but never did a follow-up collection. After the initial urine collection is completed, the doctor will go over the results with you and give you a kidney stone prevention plan. After you have been on this treatment plan for a couple of months, the doctor SHOULD order you another urine collection to see how the treatment plan has altered your results. If the follow-up results indicate your treatment plan has lowered your stone risk, excellent. If your results indicate that you need to do more work, then continue tweaking your diet.
- They did not receive a treatment plan. Ensure that you leave your doctor’s office with clear dietary guidelines on what to do to lower your kidney stone risk. These guidelines will be based upon the 24-hour urine collection results. Some patients are told to “increase fluids” and given the dreaded list of foods to avoid. There is more to stone prevention than this. Please read about the Kidney Stone Diet and all it encompasses here.
- They continue to eat out regularly. Patients tell me every day that they don’t have time to cook. The problem is that eating out is the antithesis of the Kidney Stone Diet. Eating out is always going to be high in sodium and added sugar. It’s nearly impossible to eat a low-sodium diet while consuming a majority of your meals outside the home. Therefore, one must do a bit of cooking. If you can read, you can cook. It doesn’t have to be this laborious, dreadful chore. I learned by watching YouTube and now have a complete meal plan service for my patients after only three years. Who would have thought such a thing? Not I. If I can cook with the bit of time I have, so can YOU! I spend a couple of hours on the weekend meal prepping for my week. Make time to create habits that support your health so that sickness doesn’t take it from you later.
- Their first stone bout was not terrible, so they didn’t take it seriously and make any dietary changes. Maybe they were one of the lucky ones that didn’t have the excruciating pain that often accompanies a stone. Don’t let this be the reason YOU neglect to ask for a urine collection. The next stone attack can be very different. Find out why you make that stone and get on treatment, so you don’t form another.
- They are caretaking for others and neglecting themselves. This reason is not as uncommon as you think. Many of my patients are busy taking care of elderly parents, spouses, or children. The best thing you can do for your sick loved one is to make sure you are well by taking care of yourself. When you are healthy, it makes you more available to those that need you. Don’t think of self-care as selfish. It is mandatory.
- They simply fell off the wagon. We all know this reason well. Too many of us start eating healthier, getting in our daily steps, and one crisis happens, and we fall off the wagon. The falling-off part is not the terrible thing; it’s the amount of time it takes us to get back to work. Plan on bumps in the road of life. Don’t let unhealthy eating be one of your coping skills. Swap it out for something healthier, like taking a walk to think or lessen stress. I often use walks to figure out a plan on how I can do or say something better. Movement helps me manage stress.
- They don’t do annual urine collections. By now, you may notice a theme. These urine collections are such valuable tools in managing stone disease and are very underutilized by physicians. I have never quite understood why, but it’s the story.
When we start any diet change, it’s easy to think we’re doing all the right things, but old habits creep back after a while. The annual urine collection must be done to make sure you’re keeping your stone risk low.
I hope this proves to be a reminder of all the steps you can take to lower your stone risk. After all, that is my greatest wish for each of you.
Your friend and advocate,
Hi Jill.. I follow you all the time and also conferred with you last year about my urine analysis.
My question is about butternut squash and oxalates. I don’t see if mentioned in the Harvard list.
How many oxalates in a 1/2 c serving?
Live the work you do!
Jill Harris, LPN, CHC
We don’t know. Squash has been thought to be low. My patients do enjoy it. But they do so in normal portion sizes. 1/2 a cup is for sure ok.