Should I get a blood test if I’m a kidney stone former?

Welcome back to the Kidney Stone Diet podcast, the show about reducing your risk for kidney stones and living your best life. I'm your host and fellow student, Jeff Sarris.

And I'm your nurse friend, Jill Harris.

I like nurse friend. I don't even know what to say. I don't even know what to say.

That was the dumbest intro, but look, everyone's like, "I don't care." Hi, I'm Jill. I'm going to help you with kidney stone prevention. There you go.

I like nurse friend, though. What did your little badge: "Jill, nurse friend?"

I'm your Yeah, I'm your little nurse friend.

Yeah. I mean, that's what you Yeah. You're You're making friends and helping people helping people feel better.

Yeah.

All righty. So, we have another question, and let's dive right in.

Okay.

Jill, this is Mark. I'm based in Minnesota. I have two questions for you.

One is: In patients who have oxalate stones, is any other Are any other metabolic workups

Warranted in that circumstance? And then the second question I have is: Is there anything you can do to dissolve stones? I know that's probably been asked before.

I just wanted to verify. I've read or heard that you could add, you know, lemon or lime juice to your water and that might help in preventing stones and/or even dissolving existing stones. So, that's it.

Thanks. Bye.

All right, Mark. They're great questions. And it, you know, it doesn't matter.

I never want somebody to say, "Oh, I'm not going to call cuz I know that's been asked a million times." My job is to help everyone understand what's best for them in preventing kidney stones. So, if you don't understand, or you have a question about it, I don't care how many times I've been asked that. I want you to get the right answer.

That's what I care about, so never worry about that.

So, are there any other workups when you have had a calcium oxalate stone? So, the first thing that we want you to do, you called it an oxalate stone, but it will be a calcium oxalate stone, so I want to clarify that. You want to do a 24-hour urine collection, and you want to see if indeed your oxalate is high.

You know, there's people that make calcium oxalate stones and their oxalate was never high.

There's other reasons why you may make them. And if your urine collection says that something is high, now, so, I'm going to break this down in two ways. So, because I think specifically you're asking about oxalate.

If your urine oxalate was like in the hundreds, which I've seen in 21 years like five times, then you may be sent for another metabolic workup at Mayo Clinic

Cuz that could be a genetic issue. It is so very rare, so I don't want everyone freaking out about that. It is so very, very rare, but I need to answer that question.

So, there is, but I'm sure that's not you, you know? Any oxalate, most oxalates, even when I do see it over 100, once you change your diet, it can be easily brought down, okay? There are the very few people that have a genetic thing called idiopathic hyperoxaluria.

It's very rare, people, so don't think you have it. Your doctor would be the first one to let you know. So, you get a 24-hour urine collection.

From that, lots of times, people's calcium is high. Everyone wants to think this is an oxalate problem. It's not always an oxalate problem.

Lots of times this is a calcium issue, whether you're not absorbing calcium, or calcium is being taken from your bones and it's being spilled into your urine because you're eating too much sugar, salt, or

Or you have something else going on. So, here's the thing, Mark. Here's a scenario.

Mark does a urine collection. His urine calcium is very high. He talks to Jill.

Jill says, "Work on your diet." And Jill also says, "Tell your doctor you want to do a follow-up to make sure that these changes in your diet actually help that urine calcium," because if the follow-up says, "Hey, Mark did a great job lowering sugar and salt,

And he's eating normal amounts of protein, but that calcium's still high," then that will warrant another workup, and that should be blood, and it should be to see, is your serum or blood calcium also high? If it is, you could have other things going on and the doctor will help you with that. So, that's very important.

It's an excellent question. And this is why Dr. Coe and many people who do this and are into the whole scientific part of this will say

The gold standard is you do a urine collection and a fasting blood draw the first time, okay? So, so you can rule other things out if the urine collection says something, like high urine calcium.

Yeah, and then he was also curious about anything for dissolving stones. So, he mentioned, lemon or lime juice, in your water.

Yeah. So, so I'm asked this multiple times a day because the internet will tell you a million different things. If you make uric acid stones, they can be dissolved.

They are the only stones that can be dissolved. How do you know, Jill? Well, just from a common sense, well, I've been doing this a long time, so I do know that, but just from a common sense perspective,

A doctor has taken a tool inside your body, basically a laser, like freaking Star Wars, beaming you up kind of thing. If you think sucking on a lemon, and lots of times those lasers won't even break up a stone. So, do you really think a lemon is?

Come on. Now, I'm not saying that specifically to you, Mark, I'm saying it to the "Well, my doctor said if I suck on a lemon, that stone's going to fall right out of me." It's not. If it's a uric acid stone,

Maybe. If it's a uric acid stone, potassium citrate definitely will help that dissolve. So, uric acid, once you alkalinize the urine, it can de-acidify that little stone.

So, uric acid stone is when you have very

I think probably de-acidify. "De-acidify" sounds a little different.

See, that's going to be a great new Jill term. "De-acidify." Thank God you're here, because I would have continued talking real serious. "De-acidify your urine." You're so funny!

So, d- what do you say, Jeff?

De-acidify.

Yeah, thank you. So, that pill, potassium citrate, will do that. If you make uric acid stone, that will be very helpful in dissolving it.

It doesn't guarantee it, but it absolutely can. I worry about the sucking on a lemon thing. A lot of patients don't need that.

They don't even know what kind of stone they make, and the doctor will ask them to do that. And again, as a nurse, I don't override any doctor's orders, but talk to your doctor. "Doctor, how will this help me?

How do you know it will help me if I haven't even done a urine collection? How do you know that's an issue, you know, that I need to take care of?" Lots of times, citrate also will help lower urine calcium, so that's why a doctor may be suggesting that for you. But every time a doctor suggests a treatment plan for you, so you can educate yourself.

And doctors love educating patients, it's just that we don't know what we don't know, so we don't ask

Questions. But I don't care if you have kidney stones or any other medical condition, when a doctor offers you a treatment plan, please ask them why they're doing that, so you can understand, because I think when a patient understands why they're doing something, they're more compliant. They're like, "Oh, if I don't do that, then I'm this is going to be a problem, and I know if I do it, it's going to help me not make kidney stones." So, just ask the doctor why you are being put on a certain treatment plan, so then you can understand why that's going to help you and then you'll be more compliant.

And, the other thing is, doctors like talking to patients that are more educated and ask questions about things. And, also, when a doctor says, "Hey, this is low, or that's high," dear doctor,

What do you mean it's low? How low? What do you mean it's high?

How high? Where should I be? Where am I?

You know, so ask all those questions no matter what medical condition you're you're dealing with. I think that's really important, too, because you should know what's going on in your body, and the doctor's there to help you understand it all. That's what they really love to do, you know, if they have time, anyway.

A lot of doctors are going to be like, "Oh God, she's telling them to ask more questions!"

Yes, I am. It's your body. Ask, ask!

Doctors are very helpful, especially when you know the right questions to ask. Sometimes health professionals, me too, we're very busy, so sometimes we go on autopilot a little. And, I really don't, because I'm a patient, so I understand these things.

But, I'm just saying, you know, they're in and out of offices all day long, and, you know, we just want to make sure that they're explaining things so we can understand it. So, don't be shy.

You know, we would go to a restaurant and we'd raise a fit if our soup was cold. Why are not we Why are we not really getting in there with our own body and our own medical conditions? It's It's interesting to me, you know.

So,

Yeah, the doctor's there to help, but, yeah, if you're not

They're there to help.

If you're not fully educated to, even the questions to ask, it does make it a more challenging situation. But that's that's why Jill's here and you're here to help with the urine analysis and your consults and everything, and really educating people to have better doctor's visits, better outcomes from the treatments that they may be, having to go under.

So,

Yeah, I think that's a great spot to end on end this week. And let's look I always have to look up the phone number to make sure I say it correctly. But, if you have a question Yeah, if you have a question, you can leave us a voicemail.

It's 773-789-8763 and we may feature that question on a future episode. Be sure to check out, alkalinediet.com where you can find everything that Jill's up to. You can find the Kidney Stone Prevention Course, the email list where she sends you an email every Saturday morning, and,

Yeah, there's so much out there and Jill is always available to help, so.

Yes! A little addicted.

Yeah, for sure.

My kids are like, "Really? Are you still talking about kidney stones? It's midnight, Mom." I'm like, "Yeah, it is.

So, what the hell are you doing up? Get to bed!"

Yeah! Yeah, I mean, we're talking about this, in between recordings, too. But, yeah, we're very similar in that regard where we're just we're driven.

We want to achieve and there's always more to do. But, yeah.

Yes, and we want our patients to achieve, too, so come on, get on your prevention.

Absolutely! So, yeah, thanks again for listening. Be sure to subscribe wherever you're listening or watching right now, and we will see you next time.

Thank you, caller. Have a good day, everybody!