This week, Jill answers a listener question about kidney stones and heredity.
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Find more episodes of the Kidney Stone Diet Podcast here.
Who is Jill Harris?
Jill is a nurse and health coach that specializes in educating patients on kidney stone prevention. For more than 20 years she’s helped patients understand that kidney stones can be prevented with the right treatment plan. It’s one thing to be told to lower oxalate or drink more water, but HOW do you do it? That’s where she comes in. Through the educational resources at kidneystonediet.com, stone formers can learn everything they need to know to significantly lower new stone risk.
Who is Jeff Sarris?
Jeff’s co-founder of SPYR, a branding agency based out of Chicago, where he and his business partner Dave help awesome people like Jill create online platforms that make an impact. He’s also a certified health coach, Executive Producer of the Netflix documentary Minimalism, and host of the Starting Now podcast.
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Jeff Sarris: Welcome back to the Kidney Stone Diet podcast, the show about reducing your kidney stone risk and living your best life. I’m your host and fellow student, Jeff Sarris.
Jill Harris: And I’m Jill Harris, your kidney stone prevention nurse.
Jeff Sarris: Just lining up the shirt, getting the text looking good.
Jill Harris: Today I have the pink one on! Pretty right?
Jeff Sarris: Yeah, I really like ’em. I definitely need to get my own. I feel like just like a hoodie or something is going to be my go-to.
Jill Harris: Yeah, the other thing I told Dave is I want just kidneystonediet.com or maybe just put the Kidney Stone Diet goals on a t-shirt, you know what I mean, or a sweatshirt?
Jeff Sarris: It’d be kind of fun on the back, even, like on the back, so when you’re walking away people see it.
Jill Harris: Yes and then the little kidney here. I want that in a hoodie just because I want another hoodie. Like I need anymore!
Jeff Sarris: Yeah, it’s a good go-to! They’re comfy and I, actually, have a few, but I don’t have any like, sort of graphic T-hoodie. I don’t know what you call it, but like any sort of graphics or anything. They’re all just black.
Jill Harris: I know you do. You’re a total minimalist, and I love that about you.
Jeff Sarris: So, we have a big question today. I think we should just dive right into it.
Jill Harris: Ok, let’s go!
Listener Voicemail: Hi, Jill! It’s Kathy calling from Ontario, Canada. I just recently joined your Facebook group after doing some research and trying to get myself off the path of repetitive surgeries. So, I had my first ureteroscopy in 2018. After that, I passed probably about 20 stones over the next two years. In 2021, I had a ureteroscopy in March. I had shock wave lithotripsy in September 2022. I had another ureteroscopy in March and I’m scheduled for another one soon. I’m on the waiting list right now. So all of those have been on my left side and I have stones on my right side, but they’ve never caused me any problems. The ones that have caused me problems have always been on the left side.
My question, about a year ago, I was put on hydrochlorothiazide that obviously hasn’t prevented me from having surgery. But after the March of 2021 surgery, I had a lot of infections. And, after that, I was put on–it was trying to clear up the infections, one of which was called copthelia pneumonia. I ended up on multiple antibiotics and then what they ended up doing was putting me on a low dose macrobid and I’ve been on that for over a year–a prophylactic dose of macrobid. And my question about that is whether that is harming or helping the overall situation and whether antibiotics can play into causing repeat problems with kidney stones.
Another question that I have, that I can’t see on any of your other podcasts that I’ve been able to find so far is heredity. Right around the same age, my father had a lot of issues, right around late 30s, early 40s. And then just, recently, both my sister and brother at the same age have had one issue nothing as expensive as what I’ve had. So I wanted to know if heredity or other other health problems that I could look into might be addressed that are hereditary.
The other question, after I have this next surgery, they’re thinking about putting me on potassium citrate, which I’ve heard other people talk about as well. I wasn’t on that before so I’m considering doing that as well. Not sure if that should be in combination with hydrochlorothiazide or not given the fact that I’m not really making much gains, but I’m going to try the Diet like has been emphasized on your Facebook page, but just wanted to ask this question whether antibiotics can play into being harmful for kidney stone formers and the influence of heredity.
Jeff Sarris: And I think the call dropped out right at the end there, but we got the gist of everything. That’s a lot, a lot to be dealing with.
Jill Harris: Look, this is–when people say “how have you done this for so many years?” Because of Kathy! Absolutely because of Kathy! Because, you know, having these multiple surgeries like she has and having all these stones, I mean, we worry about going forward kidney function, right? I mean, this isn’t for the faint of heart having these surgeries, people. It’s just not! So, I’m glad that she’s taking this very seriously. She needs to get this under control. She has a family history of it. She had a surgery. After that surgery, she got an infection. You know, there’s surgical instruments going into your body. A very high risk of infection, right?
Please Talk to Your Doctor About Antibiotics
Of course, all surgeons always take the utmost care in, you know, cleaning their equipment and stuff like that, but we can certainly get infections. Infections are pretty common in hospitals. So, you know, she’s had a significant kidney stone history with a lot of surgeries and that always breaks my heart. So I’m going to be very evasive with the antibiotics and that’s something she really should talk to her doctor about. There has been some newer research and in about 2019, there was a study came out that said, you know, some antibiotics could increase–especially in younger people–kidney stone risk, but they have a lot more research to do. As I said, this is new. That conversation should really be had with her doctor.
Okay, that’s important to have. So I’m not going to address it here as a nurse. That is a doctor question. So I’ve got to be careful, sometimes. But the other the other thing I can address the hydrochlorothiazide–I will say this, I mean, so she’s on long-term antibiotics, macrobid, you know, really pump your doctor. “How long is this going to be? Is the infection still showing up? What’s going on?” You know, those are questions. You know, if we don’t have to be on long-term antibiotics, we definitely don’t want to. So please talk to your doctor about that.
Now, she’s going to be like, “Oh, that–,” but I just have to be careful. I have to be careful, sometimes, what I say because a lot of people can extrapolate what I’m saying and then do all kinds of things with it. I’ve been in this business long enough that I know that, so I must be very careful sometimes. So I will leave it at that for the antibiotic question. The other thing, the hydrochlorothiazide, I would assume you were put on that drug after a urine collection was done and then you were put on that drug. Hydrochlorothiazide is used to lower urine calcium in kidney stone prevention. You have a prolific kidney stone history.
Yes, Kidney Stones Can be Hereditary!
So, I’m wondering if you did a urine collection and the doctor saw that you had high urine calcium. And that is why most likely you were put on that drug. But I really want to know if you’ve done a urine collection. That’s what I want to know. The second part of her question was about hereditary. Absolutely! Kidney stones can be hereditary. So if you’ve done a urine collection, if one has and they are told, “Hey, you have high urine calcium,” meaning there’s a lot of calcium in your urine–and remember, people, I’ve never worked with somebody at the beginning in all these years that they said, “I get plenty of calcium!” No adult gets enough calcium. Not one, in 24 years, has said that to me. They’re not getting any.
“All right, Jill, so, then, how the hell is this in my urine, then, all this calcium?” Well, it could be many different reasons. You’re eating too much salt, and sugar, and meat protein, and that’s why those are goals of the Kidney Stone Diet because too much of those things can take calcium from your bone and dump it into your urine. Too much calcium in your urine and you’re not peeing a lot, those minerals and crystals and salts look for each other. Oxalate and phosphate see calcium in the urine, nobody’s peeing, so everyone’s just sitting in there together and they really want to find each other. This is why we want you to pee a lot. So this can run in families.
If somebody has high urine calcium, what the health care provider should first do is say, “Hey, get on the Kidney Stone Diet,” meaning lower your salt. Many of them will tell you that, but they don’t tell you about the sugar part. Many of them will tell you don’t overeat meat protein, but all of it needs to be done. It doesn’t mean you can’t eat meat, I eat meat. It just doesn’t mean you should have, you know, pounds of it a day. So, that’s the first thing I look at. I look at a urine collection, I don’t care about oxalate. I do care about, it’s not the first thing I look at. Mostly kidney stone disease is the combination of a lot of things, but, lots of times, it’s about too much calcium in the urine.
So, then the doctor should say lower your salt, do the Kidney Stone Diet, we’re going to do a follow-up to see if that helps. The patient does a follow-up urine collection. If the patient’s calcium is still high and they have followed the Kidney Stone Diet, then we’ve got to check for other things. And Kathy may be like, “Why is she talking about all this?” I will get to why I’m talking about it for you, Kath. The doctor should check to see how their blood calcium is. Is it high? If it is, you want to check the parathyroid hormone, another blood test. If that’s cool, and everything’s good, and vitamin D is also normal, if all those things have been ruled out, that’s when someone may be told they have IH, which is idiopathic hypercalciuria, which means like we’ve ruled everything else out.
We have no reason for this anymore. But the patient has a family history. If Kathy has IH, “idiopathic,” meaning we’ve ruled everything else out, “hyper”- too much, “cal”-calcium, “urea”-in the urine. If she has this, then about 50% of her blood relatives will also have this. So, yes, kidney stones can be hereditary. Absolutely! I would suggest everybody have urine collections in your family who has kidney stones. They most likely will have high urine calcium. I’m just a nurse. I don’t diagnose anybody. I’m just talking to my gal pal, Kathy, and telling her what could be.
So, I would assume, Kathy, you have had a urine collection and that’s why you were put on hydrochlorothiazide. I would also hope to the Sweet heavens above that you were told to watch your sugar, and salt, and all that because those pills are less effective unless you do. Some people will say, “Hey, I’m gonna take that pill. I don’t care about your Kidney Stone Diet.” But the pill doesn’t work as well unless you do the diet, so I still get my way. It’s just a healthy diet, anyway, whether you have kidney stones or not. We’re asking people to limit sugar and salt. Eat food within normal portions, get your calcium to feed your bones and lower oxalate. Drink enough water, so you’re paying all these extra salts out and you don’t keep them in your urine.
So, Kathy, you have homework. Make sure you get a urine collection. See, talk to your family, and see if they have had urine collections. The potassium citrate being ordered for you–lots of times it’s ordered with hydrochlorothiazide because hydrochlorothiazide can lower your potassium. So, those two drugs are given, typically, at the same time. You should be getting a blood draw to see how your potassium is holding up when using the hydrochlorothiazide. Potassium citrate will also help lower calcium in your urine as well and it will increase your pH if you need that.
But be careful, too, because maybe your pH is already really high. And that’s also another reason. You said you make calcium oxalate stones, though. So this is actually very complicated. Ask questions on the Facebook page, tag me so I can help you answer them. Think about the Kidney Stone Prevention Course, while it’s on sale for $40 on this date, October 27th. It may be off by the time you’re seeing this.
Jeff Sarris: And $40 off.
Jill Harris: Yeah, $40 off, okay? You might want to think about that, but if you don’t have the money for that, definitely use all the free resources we have here.
But, boy, I’d love to see a urine collection by you. And, if you have one, definitely schedule the urine consult with me and I will guide you and you will have an excellent doctor office visit in case the doctor didn’t share a lot of the information I did here. They’re, you know, they’re surgeons. They’re not always sharing all this information. They’re surgeons, that’s what they’re there for. So lots of still unanswered questions I would have for her, but definitely could be hereditary. It sounds like it is, but I’d need to see your urine collections to know. So, I highly suggest she has one and if she does have one to call for the urine consult for sure at kidneystonediet.com.
Jeff Sarris: Yeah, and that’s what’s so important is arming people with the questions to ask and the the knowledge because, like you said, there’s a line. There’s the things that you’re able to share and promote, help like guide, but you’re not diagnosing anything and that is something that you have to be very, very cautious with. Also giving the patient, arming them with those tools, like, well, you also have a doctor visit–a free download that sort of helps anyone improve their doctor visit, just with the knowledge and the questions to ask and things like that. And, yeah, I think that’s so valuable, because we only have so much time. You and I can do this every week for hundreds of weeks. Yeah, I mean, time with the doctor is minimal and it’s not their fault. It’s just how the system is structured. They only have so much time for each person.
Jill Harris: Yep, and, you know, she said she’s from Canada, so, people would say, “Oh, you’re so lucky! It’s free health care!” Well, but you’re in line. You heard she needs a surgery and she’s waiting. She’s on line for that list. So it’s not like, you know, like here in the States–although after COVID, it’s been a hot mess here in the States, quite frankly, to get in to see a doctor–so now we’re experiencing that, too. But the point is, when we have something wrong with us, we can’t just lickity split get into a doctor’s office these days, and especially Canadians. They have a harder–they are on a waiting list. So, everybody has their pros and cons.
It’s really important. She has a significant history here. She now has an infection and she’s still working on that. Nobody wants to be on long-term antibiotics. I don’t like all these surgeries she’s had. That’s not great for her plumbing, obviously. A lot of scar tissue, like I said, can get long-term, decreased kidney function. Listen, people, kidney stones can be prevented, but you need to educate yourself. So if you’re listening to us, you’re doing that and I’m super happy that you’ve taken the initiative to arm yourself with the right information so you can have more productive doctor office visits. And I’ll tell you what, I’m not good at a lot in life, but I’m really good at this. So if you want to get there faster pay for my services, I keep them pretty low.
There’s some expensive ones, like private, but there’s many ways, cheaply, you can work with me. We have things at all price points, so everybody can have access to them. It’s super important. The course is the best way to get access to me because you get those group calls and they are really, really cheap. First month is free. Thereafter, $19, four dollars a week. And that would be over almost $2,000 in calls I’m giving away! I can’t stress this enough. It’s kind of crazy what we’re doing, but it’s really valuable to you. And I made all these services based upon all the craziness I went through when I was sick. If I only had access to the information I did, I would have been educated a lot better earlier, instead of playing phone tag and Portal tag with my doctors. It was a mess.
I know it sounds like I sell a lot. It’s not just that. Get the free resources. I’m just interested in getting you–Jeff is interested in getting you information. I want you also to talk to each other in in the community here on the YouTube channel. Discuss things, be robust, ask questions. There’s other people that are already chiming in, like our Facebook page, already helping when somebody has a question. I haven’t gotten there yet. I do answer every one of them, but sometimes it takes a minute for me to get there, and I’ve already seen other patients and students helping each other here in the YouTube community, which is exactly what we have on Facebook.
We’re fostering a community. We are big on that. Because when we have disease, we must get support. We must get the right information, and it must be in a safe place, and I’m really big on that, too, and so is Jeff. So, Kathy, I want you to get help. So, be active in the Facebook group, please, if you need me go to kidneystonediet.com My email, everybody, is email@example.com. I answer emails, too, so use it. Use it, use it! Use the resources that you have because kidney stones can be prevented.
Jeff Sarris: You are accessible everywhere! That is such a huge part and it’s vital to all of this. It’s not just the education because every every scenario is a little different. Everyone needs needs attention in a certain way to help get them along their path. We’re doing our best, through the podcast, to really give as much info across the broad spectrum of this this illness, ailment, disease, however you want to look at it to help as many people as we can. So, yeah, the site, again, is kidneystonediet.com. It’d be awesome to see in the comments down below, people helping one another on this episode, specifically, on others. If you have other questions and whatnot, that could be right on YouTube as well because like you said, Facebook is such a valuable resource already.
If you have a specific question that you want Jill to answer on the show, the number is 773-789-8763 and we will feature you on a future episode. Kidneystonediet.com is where you can find all the free resources, the weekly email newsletter that comes out every Saturday, links to the Prevention Course group, the prevention group on Facebook, and everything else. It’s all found–
Jill Harris: And, also, can you please help us get higher in the rankings because we’re not and I want people to be able to find us! Please press the red subscribe button! I learned a lot from YouTube channel. I love YouTube and so I always subscribe to the people that are helping me the most because I know it helps them. So can you do us a favor, we would love it if you would just press that button. It just means that you’re subscribed to our channel. Nothing really happens for you. There’s nothing. It just helps us. I’m not above asking for help either, so if you could click that button, that would mean the world to us. Thank you so much.
Jeff Sarris: So with that, we’ll wrap and we will see you guys next time.
Jill Harris: Thanks, Kathy. I look forward to hearing from you!