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Ask Dr. Rick – December 2011 – Kidney Stones

December 12, 2011

The number one cause for kidney stones is not drinking enough water. Throughout my orthopedic career, we have always told our athletes how important it is to rehydrate by replenishing fluids and by drinking not just when it’s hot out. With older athletes, one of the most common problems is a lack of replenishment.

So what happens when you don’t replenish or drink enough water when you are training for a marathon, play 18 holes of golf or are out on the tennis court all day? Well, one of the most prevalent problems is the development of kidney stones. Kidney stones occur when older athletes are dehydrated and are not sufficiently hydrating. The most common symptom
of kidney stones is sudden, severe pain. When a kidney stone initially forms, it is usually painfree. Most commonly, athletes find out they have kidney stones when they get sudden, severe pain, which is often characterized as the worst pain in medicine.

When the kidney stone travels from the kidneys to the bladder, the opening is small; when the kidney stone dilates the opening, severe pain occurs. Older athletes can have pain in the side, in the groin and can have stomach pain. Also, their urine usually turns red or dark pink. Vomiting commonly occurs, and it is difficult to ambulate when the severe pain hits.

Normally, someone with kidney stones will be transported to the emergency room and X-rays or a CT scan is ordered along with a urine test. A urine test will identify blood in the
urine, and the X-ray and CT scan will confirm the location and size of the stone. Pain medicine is normally administered, and the athlete will then go through the process of either trying to pass the stone or have the stone removed.

If the stone is too big to pass and it is above the pelvic prim, lithotripsy is recommended. Lithotripsy is when shockwaves are used to break the stone up into small pieces so it can be passed. If the stone progresses below the pelvic brim and cannot pass, it is removed and a small flexible tube is placed in the ureter to keep the area open.

When the stone passes, it is generally very painful, and it is important to make sure that the stone has, in fact, passed. If the stone doesn’t pass, a process called hydronephrosis can cause damage to the kidney; increased pressure can cause harm to the kidney itself.

Once you have had a kidney stone, there is greater likelihood of a recurrence, so it is very important to hydrate and to drink a minimum of eight to 10 glasses of water or replacement liquids each day. It is also very important to see a urologist immediately if you are experiencing pain. Kidney stones in older athletes appear to be common and extremely painful, and again, my mantra of “hydration, hydration, hydration” is extremely important.

Ask Dr. Rick

“Dear Dr. Rick: Lately, I’ve had pain when I roll over on my shoulder at night trying to sleep. This has been going on for about two months. Can you please tell me what this could be?” Thanks. – James H., Chesterfield, Mo.

James, what you’re describing most commonly occurs when there is either an impingement or damage to the rotator cuff. Night pain is very common with shoulder problems, and if this has been going on for two months, you need to see your physician and explain to them that you are having night pain and pain whenever you roll over on your shoulder. You also need tell your physician if you are having pain during the day in your shoulder and what type of activities bother your shoulder. Go see your physician soon, and please keep us posted with your progress

“Dear Dr. Rick: When I wear high heels, I experience a great deal of pain in the front part of my knee. Do you have any idea what this could be?” – Lauren R., Ellisville, Mo.

Lauren, normally pain in the front part of the knee when wearing heels is caused by breakdown or some chondromalacia in the back of your kneecap. When you wear heels, pressure is increased in the front part of your knee, which causes patellofemoral overload and pain in the kneecap. I would tell you to begin wearing flat shoes, and if your pain does not resolve, you need to see your physician.

December Medical Tip: Hydrate, hydrate, hydrate!

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