00:00 – Dr Scotland: There are a certain percentage of patients who
00:03 – will have kidney stones that harbor bacteria
00:06 – apart from the infectious stones, the struvide stones that we know.
00:09 – [Music]
00:22 – Melissa: This is part two of our interview with Dr Kymora Scotland
00:25 – who is a US-based urologist
00:27 – that specializes in endourology and stone disease.
00:30 – You can learn more about Dr Scotland’s background in part one.
00:33 – In this chat we’ll be covering more on kidney stones
00:35 – and their possible connection to reccurrent UTI.
00:38 – So let’s move on to treatment a bit then.
00:41 – Is there a kind of a size where you would say to someone
00:44 – let’s just see if it passes on its own
00:46 – versus intervening somehow?
00:49 – Dr scotland: Yeah. If somebody has a stone that’s five mililiters or smaller,
00:54 – especially if we’ve been able to manage their pain,
00:58 – because you know sometimes folks will have kidney stones,
01:02 – they’ll have pain they’ll come into the emergency room.
01:04 – and we can’t get your pain under control,
01:07 – or you’re still having vomiting,
01:09 – you’re having fevers and chills,
01:11 – you know, those are situations where it’s not safe for you
01:15 – to go home and try to pass it, so we will treat your stone then and there.
01:19 – Or at least we will you know, place a stent
01:23 – which is something that I’ll talk about a little bit later.
01:25 – Just to sort of drain the kidney so that you don’t have that issue.
01:29 – Melissa: Okay. Dr Scotland: But in the case where
01:31 – you we’ve been able to manage your pain,
01:34 – and you’re at least comfortable and able to go back
01:37 – and you know carry out your daily activities,
01:40 – then we’ll give you an opportunity to try to pass the stone
01:42 – if it’s a reasonable size and I think reasonable is about five or less.
01:46 – Now there are some patients who have recurrent stones
01:49 – and who’ve passed multiple stones before.
01:51 – So even in that case, a larger stone, they might be able to pass.
01:54 – I’ve had patients who have passed a one centimeter stone, believe it or not.
01:59 – And so in those patients, I’ll give them a little bit more leeway.
02:03 – If your pain is under control, I will tend to give you some time to pass it
02:08 – depending on the size of the stone and where it is.
02:11 – There are medications that we can give you to help to relax the ureter
02:15 – so that you’re able to pass the stone a little bit more easily
02:19 – Melissa: Okay and if that isn’t possible, what are the next options?
02:23 – Dr Scotland: It all depends on the size of the stone.
02:26 – If we’re talking about a patient who is trying to pass a stone
02:29 – then it’s probably of a small to medium size,
02:32 – in which case there are two options that we would be considering,
02:36 – and those are Shockwave lithotripsy and ureteroscopy.
02:39 – Shockwave lithotripsy is what is most
02:43 – most patients, I think, favorite procedure if you have to say there’s one.
02:49 – Because it’s not invasive.
02:51 – And what I mean by that is, it’s a situation where we will have the patient lay
02:56 – back on the table and we’ll use a probe,
02:59 – we’ll put that for when they’re back
03:00 – and then we use sound waves to break up the stone.
03:03 – So we’re not going into the body at all we’re not making any cuts or incisions.
03:06 – So patients are really happy with that generally speaking.
03:11 – you know most of my patients who have shockwave lithotripsy
03:14 – are doing well after the procedure, most people are back at work the next day.
03:19 – So it’s something that we try to offer, if it looks like it’s an appropriate stone
03:24 – in terms of the size, in terms of how hard we think the stone is.
03:29 – And we can tell how hard it is based on Imaging for the most part.
03:36 – Sometimes it just doesn’t look like it’s going to work.
03:38 – And sometimes even when we try Shockwave lithotripsy,
03:41 – it doesn’t work, it doesn’t break up the stone or we’re not able to identify the stone.
03:45 – So we have to move on to ureteroscopy.
03:49 – Ureteroscopy,
03:51 – it has rapidly become really the first option for most urologists I would say.
03:56 – Primarily because it has a better outcome than Shockwave lithotripsy.
04:02 – Shockwave lithotripsy, despite the fact that you know patients do pretty well,
04:06 – has a 70 per cent success rate. Melissa: Okay.
04:09 – Dr Scotland: Whereas urethroscopy has about a 92 per cent success rate.
04:12 – So most doctors will talk to their patients about uroscopy,
04:18 – because it’s more likely that it will work.
04:21 – Melissa: Yeah.
04:22 – Dr Scotland: Uteroscopy is also for most people will be an outpatient procedure,
04:27 – you come in that day, you leave that day.
04:30 – But we will put you to sleep
04:32 – and while there’s no cuts, what we will do
04:35 – is we will go into your urethra, which is the tube you urinate out of,
04:39 – we’ll go into your urethra up your bladder into the ureter
04:44 – if that’s where the stone is, and we’ll do that with a scope,
04:47 – that scope has a camera on the end so that we’re able to see on a monitor.
04:51 – And once we get to the the stone whether it’s in the ureter or the kidney,
04:55 – we will use a laser fiber to break it up.
04:58 – Sometimes the stone is small enough that we’re able to just grab it with a basket.
05:03 – But most of the time we’re going to have to break it up with a laser fiber.
05:05 – and then we take those pieces out.
05:09 – Afterwards, most urologists in most cases will place a stent.
05:17 – I mentioned that stent earlier. What that is is it’s a tube
05:21 – that goes from the kidney all the way down the ureter
05:24 – to the bladder so it’s quite long.
05:26 – and it allows drainage of urine from the kidney.
05:30 – Okay. And so, it’s something that we will sometimes do
05:34 – after uteroscopy or we will do,
05:36 – if a patient for instance comes in with a stone that seems like it’s infected
05:41 – so they’ve got a stone, they’re passing it, they’ve got fevers chills,
05:44 – we’re going to place a stent, and what that will do is it will drain the kidney
05:48 – so we can get all that urine out and then we’ll come back later and shoot the stone.
05:54 – So it’s gonna be uncomfortable. Melissa: Yeah.
05:56 – Dr Scotland: I should mention that. So for those patients who
06:00 – who have had erythroscopy before, the stents can be uncomfortable as well.
06:06 – But that tends to be what we do.
06:08 – The third procedure is something called PCNL.
06:10 – That’s for people who have really large stones. and the pcnl or
06:13 – The PCNL or percutaneous nephrolithotomy
06:16 – is a procedure where we do have to make an incision.
06:19 – So what we will tend to do is we’ll go into the back and make a small incision
06:23 – and then we have to tunnel into the kidney to get to the stone.
06:26 – If you’ve got lots of stone, then we need a little bit of a larger
06:31 – instrument to get that stone broken up and get it all suctioned out of the kidney
06:35 – so we’ll do PCNL.
06:37 – Melissa: Okay. How long does a stent stay in if you do need to use one.
06:42 – Dr Scotland: It really depends.
06:44 – In a situation where the ureter looks fine after the procedure
06:47 – and we think it just needs a couple of days you know,
06:51 – when you go in with a scope or when you’ve had a stone in the ureter for a while,
06:56 – it can cause some irritation and some inflammation,
07:00 – some swelling of the ureter.
07:01 – so if you think you need a couple of days for that swelling to sort of
07:04 – go down on its own while you’re draining things,
07:08 – you know sometimes I will only leave a stand for about three days.
07:11 – if I think it doesn’t need to stay for very long.
07:13 – But it can be anywhere from that to up to two weeks.
07:18 – Melissa: Okay. Dr Scotland: Depending on how things look
07:21 – if there is any damage to the ureter from the stone or
07:25 – during the surgery. The physician might decide to leave it for even longer.
07:29 – So it really all depends.
07:31 – Melissa: And then when the scent is removed is that also under general anesthetic?
07:35 – Dr Scotland: No. So there are different circumstances
07:39 – in which you will remove a stent.
07:41 – If you’ve got to go back and do another procedure
07:43 – potentially you might use anesthesia.
07:45 – But in those cases where, for instance like I said,
07:47 – I will leave a stem for three days
07:49 – the patient might actually remove the stent him or herself.
07:52 – We can leave a string connected to the stent
07:55 – and it sounds crazy but
07:58 – you can actually just grab that string and the stent will come with it.
08:01 – And everybody looks at me when I say that
08:04 – with just horror in their eyes, but it doesn’t actually hurt.
08:07 – And also my patients will tell me that it feels like
08:10 – you know something’s pulling which it is you’re pulling the stent,
08:13 – but it doesn’t tend to hurt.
08:15 – Most of my patients who I will keep a stand for a little bit longer in
08:20 – will come into clinic and we can take the stent out there so you don’t need
08:22 – so you don’t need anesthesia for that.
08:24 – We do what’s called a cystoscopy, where we go in with a scope just to the bladder
08:29 – and we have a monitor there so you can actually look
08:33 – at the whole procedure with me if you’d like
08:36 – Some people say yes some people say no.
08:39 – And then we go in and you can see the stent right there
08:41 – we just grab the stent and again, it doesn’t hurt.
08:43 – So we tend to give just local anesthesia at most.
08:47 – Melissa: Okay, that is very interesting. I didn’t realize you could pull that out yourself.
08:52 – What are the risks involved in the options that you just listed?
08:57 – Dr. Scotland: So for Shockwave lithotripsy,
09:00 – you can sometimes have a risk of blood in the urine.
09:05 – Uh, you can have some pain.
09:07 – Okay, I’ve had a handful of patients who do have some pain
09:10 – and that requires a little bit more pain medicine.
09:12 – Most people do fine with ibuprofen.
09:16 – you can have what’s called a hematoma. A hematoma is a bruise.
09:20 – Especially if there is a stone in the kidney that we’re trying to treat,
09:23 – there’s a small percentage of patients who can have a hematoma afterwards.
09:27 – That’s something that we just will monitor with time and make sure that all is well.
09:32 – with potentially serial ultrasounds.
09:37 – With ureteroscopy, most of the side effects or the risk of the procedure
09:42 – really have to do with the stents.
09:44 – There’s a very small chance that
09:46 – when we go in with a scope we might cause some injury to the ureter or the kidney.
09:51 – Primarily after that procedure, most people will have
09:55 – stent related pain or discomfort. the stent can also cause
09:57 – The stent can also cause irritation at the bladder.
10:01 – so you can have urgency and frequency you know,
10:05 – burning with urination, the symptoms that you unfortunately can have with a UTI.
10:10 – But the major thing I think most people
10:11 – will find is that stents can cause blood in your urine and so you can have a
10:15 – bloody urine off and on for the duration of the time you have the stent.
10:20 – Melissa: Okay.
10:20 – Is there a particular treatment option that is most suited to a particular type of stone
10:25 – or is it really about the size?
10:27 – Dr. Scotland: For the most part it’s about the size.
10:30 – Okay, if you’ve got a large stone you’re going to be talking about PCNL.
10:34 – There are some circumstances in which you might want to talk about ureteroscopy
10:38 – But possibly then you would have to do repeated uretoscopies.
10:42 – There are certain types of stones where you really want to make sure that
10:45 – you get every last bit out specifically struvite stones,
10:48 – which are the infectious stones, as I mentioned.
10:51 – And so sometimes with that you may do a PCNL.
10:56 – even if it’s a medium-sized stone
11:01 – just because you want to make sure that you get every last bit out.
11:02 – As long as it’s a smaller stone, you know you’re thinking about
11:05 – ureteroscopy or Shockwave.
11:07 – Melissa: Okay and with kidney stones, is there a risk of long-term kidney damage?
11:13 – Dr. Scotland: For most people, if you’ve got one or two small stones,
11:18 – there’s less of a concern with damage, especially if they’re just sitting there
11:23 – you’ve not passed any stones you just know you have them.
11:26 – For people who have repeated stone passage,
11:30 – there can be a risk of you know, long-term damage, we can eventually.
11:35 – And this is people, like I said, who have repeated stones over and over.
11:39 – we can over a years see a decrease in your kidney functions.
11:43 – For folks who’ve had multiple procedures
11:47 – we can sometimes see that with time.
11:49 – But you know generally speaking what will happen in that case is then
11:53 – you know your urologist, your nephrologists
11:55 – are going to be really closely following you and trying to make sure
11:59 – that we avoid any further injury to your kidney.
12:03 – Melissa: Okay.
12:04 – Acouple of people asked the question and you touched on this briefly,
12:07 – about whether there are any over-the-counter supplements
12:09 – that can dissolve kidney stones.
12:12 – Dr. Scotland: So I should be careful here when I say this because I-
12:16 – There is a medication that you can take,
12:18 – or I should say there are a couple of medications that you can take
12:22 – for uric acid stones
12:24 – that can sometimes dissolve them uric
12:27 – Uric acid stones are the only stones,
12:30 – as of right now, that are able to be dissolved with medication.
12:35 – There are lots of things that people will see online
12:38 – that claim to dissolve stones and that claim to prevent kidney stones,
12:42 – There are a lot of…hum…huh…
12:44 – herbal formulations, natural things,
12:47 – if you go online there are just, I mean, hundreds of them.
12:53 – What I will say is that there is very little data
12:59 – to support any of this.
13:01 – There are some studies that have been done for certain things like
13:06 – shanka Petra and some other things that folks will have heard of,
13:10 – that show…
13:13 – what I would call equivocal data,
13:16 – where it…
13:18 – it may work in vitro, and in vitro is in the lab,
13:22 – but it’s not necessarily been shown to work in animals or in humans.
13:28 – There are some of these supplements and things
13:33 – that have been investigated and they’ve not been shown.
13:38 – You know, full right out they’ve not been shown to really make a difference
13:43 – But most of the things that are online have never been tested.
13:46 – So it’s unclear whether they’re helpful.
13:49 – And so my patients will come and they’ll talk to me about these things
13:53 – and what I will do is I’ll ask them to
13:56 – have me take a look at it, see what the ingredients are,
13:59 – and if the ingredients don’t look like
14:02 – they are, you know, concerning for me
14:05 – and I’ll explain what that means in a minute,
14:07 – then I’ll tell them “Hey listen you know”,
14:09 – I don’t know if it’s gonna help.
14:10 – It doesn’t look to me like it will hurt.
14:13 – And so if you’d like to try it, I really don’t have a problem with it
14:17 – I tend to be of the opinion that we don’t know everything as doctors
14:22 – and so I’m not going to tell you flat out that these things don’t work.
14:25 – I just don’t see any you know data to support them.
14:29 – Now what I mean by whether there are ingredients that will hurt them,
14:34 – well there are some ingredients that are thought to be healthy
14:39 – that can be associated with stone formation. Melissa: Okay.
14:43 – so for instance, lots of folks will take turmeric.
14:47 – and it’s become one of the things in the last few years
14:50 – that people think is a cure.
14:52 – All and you know I don’t have any thoughts either
14:55 – way about turmeric, except for the fact that I know
14:58 – that turmeric actually breaks down into oxalate.
15:02 – and so I’ve had lots of patients coming
15:06 – who have been taking a ton of turmeric
15:08 – especially you know during the pandemic now.
15:11 – And they’ve never had stones before and now have stones.
15:14 – I’ve also seen a lot of people who
15:17 – take excessive amounts of vitamin C supplements.
15:20 – Now vitamin C also breaks into oxalate.
15:23 – And so…
15:24 – the data there is not entirely clear as to whether vitamin C causes stones.
15:30 – Okay, I should mention that it’s a little bit equivocal it’s controversial.
15:34 – But you know,
15:35 – there’s really no reason for folks to be taking
15:37 – excessive amounts of vitamin C in any event.
15:40 – I will you know just caution them about things like that.
15:43 – So you’ll talk to people about those kinds of things
15:47 – that could be problematic.
15:48 – But generally speaking
15:50 – you know, if people are taking things and they’re not problematic,
15:56 – I don’t have an opinion either way.
15:58 – Melissa: Huhm. I know a lot of people would be taking
16:01 – high doses of Vitamin C if they’re on a Hiprex protocole.
16:04 – Do you think that might be an issue?
16:06 – Dr. Scotland: So you know I don’t see a lot of patients
16:11 – who are on Hiprex for recurrent UTIs
16:14 – who then subsequently form stones. Melissa: Okay.
16:17 – So I think it’s fine.
16:18 – If you’ve not formed stones before
16:20 – and especially if you don’t have calcium oxalate stones,
16:23 – then you know vitamin C for most people tends to be not a problem.
16:29 – Melissa: Right. Okay so let’s talk a little bit more about the connection between
16:33 – UTI and kidney stones.
16:35 – So a lot of people were asking if it’s kidney stones
16:38 – that might be harboring bacteria that continuously cause the UTI symptoms,
16:43 – and we briefly discussed the other way around
16:45 – whether UTI could lead to kidney stones.
16:47 – The other questions on this topic were, were the biofilms form on kidney stones
16:52 – and could then contribute to chronic infection.
16:55 – What are your thoughts on that?
16:57 – Dr. Scotland: Okay. So again, there are a certain percentage of patients who
17:02 – will have kidney stones that harbor bacteria
17:07 – You know, apart from the infectious stones the struvite stones that we know.
17:11 – And so what I do with those patients is, once I treat the stone,
17:17 – we tend to find that their UTIs go away.
17:20 – So you know if you are a person who has recurrent UTIs
17:23 – and you’ve got kidney stones,
17:25 – it may be something to consider. Melissa: Huh hum.
17:29 – Dr. Scotland: In terms of whether biofilm form on stones,
17:32 – well it’s interesting because that’s one of the things
17:35 – that I’m working on right now.
17:36 – We don’t necessarily know that yet. Melissa: Okay.
17:40 – Dr. Scotland: I also do research, I have my own laboratory.
17:43 – My team is looking at this question.
17:47 – There’s not really been data to confirm this yet.
17:53 – Melissa: When do you think you might be able to?
17:56 – Dr. Scotland: Hopefully, I will have some data
17:59 – for publication in the next year or so.
18:01 – Melissa: That’s exciting. Yeah! We will.
18:04 – you’ll have to send it to us so we can share it.
18:06 – the other question around the bacteria being harbored by kidney stones
18:10 – is when they are broken up using one of those techniques
18:13 – could that release bacteria into the urine and then
18:16 – cause infection as a result of treating kidney stones?
18:20 – Dr. Scotland: So that could be the case.
18:22 – So in the case of a patient who has had recurrent UTIs
18:28 – and they’re coming to see me because their doctor has said “this person has stones”
18:33 – Not quite sure why she or he keeps having these infections.
18:37 – You know, can you treat her stones or his stones?
18:39 – I will, like I said, send a urine culture.
18:43 – You will also try to treat that person
18:47 – if they’ve got infections with antibiotics.
18:50 – And so…
18:51 – What we’re hoping is that they wouldn’t end up with that infection afterwards.
18:55 – If that’s not been thought about,
18:57 – it’s something that would be worth talking to your urologist about.
19:01 – If you’ve got stones, and you’ve also got recurrent UTIs,
19:05 – you know you’re going to have a procedure done.
19:07 – Maybe just talk with your urologist
19:09 – ask them if they’ve been sending cultures.
19:11 – Because that would be the best way to figure that out.
19:14 – If you’ve got stones and those stones are being cleared,
19:18 – you know it’s unlikely that you would continue to have a UTI
19:22 – unless again another stone forms.
19:25 – So you know have a discussion with your urologist
19:27 – to try and send it off for culture so that you can know one way or the other.
19:31 – Melissa: Okay.
19:32 – Great and you mentioned that some bacteria release enzymes
19:35 – that then form struvite stones.
19:37 – What bacteria are most associated with stones?
19:40 – Dr. Scotland: So they include things like Proteus,
19:43 – klebsiella, pseudomonas.
19:47 – Those are sort of the major ones that we would see.
19:51 – Melissa: Okay.
19:52 – And if someone has those particular organisms on a result,
19:56 – does that mean they should be getting checked for kidney stones?
19:59 – Because there’s no…
20:00 – Dr. Scotland: It’s something to think about, certainly,
20:03 – because those tend not to be
20:05 – well I shouldn’t say that
20:07 – because sometimes with folks who have recurrent UTIs,
20:11 – they can evolve
20:13 – from collides, other types of bacteria,
20:16 – and sometimes the bacteria that causes your UTI goes back and forth.
20:20 – Melissa: Yeah. Dr. Scotland: Okay but,
20:22 – if somebody is consistently having
20:25 – Proteus infections for instance,
20:27 – it’s worth checking. Melissa: Okay.
20:30 – That’s interesting because a lot of people do report
20:33 – those organisms on their results so,
20:35 – that’s good information that they might want to take to their own doctor.
20:39 – The last questions that we got were around prognosis or long-term outlook
20:44 – once you have had treatment for kidney stones
20:46 – what are the chances that they will return,
20:49 – and is it possible to resolve permanently especially for
20:52 – people that seem to get them frequently
20:54 – Dr. Scotland: It turns out
20:56 – that about fifty percent of people who present with one kidney stone
21:01 – may never have another kidney stone again.
21:03 – Melissa: Okay.
21:04 – Dr. Scotland: But I should mention that
21:06 – that data is quite old now,
21:09 – and because we’ve seen an increase in prevalence in recent years,
21:13 – I have a feeling that fifty percent is probably lower at this point.
21:18 – But that still means that some people who have stones
21:21 – may never have another stone.
21:23 – and I tell them… So a lot of times, if I have a patient who comes in
21:27 – and you know let’s say, thirties forties, fifties even,
21:31 – and this is their first stone they’ve only got one stone I will tell
21:33 – I will tell them “there’s a chance that you may not form another stone”.
21:37 – Let’s try to work on what we call just general prevention,
21:40 – drink lots of water and other things that I might tell them
21:43 – based on the type of stone.
21:44 – Melissa: Huhm.
21:46 – Dr. Scotland: But everybody else unfortunately,
21:48 – who’s a recurrent stone former
21:50 – we have to really be a little bit more
21:53 – involved in their stone prevention plan.
21:56 – I certainly have patients who’ve had multiple stones who
22:01 – we’ve developed a plan that works for them
22:02 – and then they don’t develop more stones. Okay.
22:05 – But you have a percentage of people who will continue to have stones.
22:10 – What I should say though is that, even for recurrent stone formers
22:14 – you’re not necessarily going to be passing stones most multiple times a year
22:19 – or even every year.
22:20 – I would say most people who have stones would if they’re
22:24 – if they’re not having those stones
22:28 – managed with a prevention plan
22:30 – will probably form stones every few years or so.
22:33 – That’s not fun for anybody.
22:34 – And it’s something that we want to avoid.
22:37 – But there is a range in terms of
22:39 – how often you might form a stone, how many stones you even have.
22:43 – Some people come to me with two or three stones,
22:45 – some people come to me with 10 or 15 stones.
22:47 – So those people are definitely folks that I want to work much more closely with.
22:53 – Melissa: Right. Is that typically how long it would take for a
22:55 – for a stone to form, a couple of years?
22:57 – Dr. Scotland: It depends on what kind of stone you’re forming.
23:00 – So I keep going back to struvite stones but they can form in weeks.
23:04 – Uric acid stones can form in weeks to months.
23:07 – Calcium oxalate stones tend to take a little bit longer.
23:11 – So it really depends on the type of stone and…
23:15 – sometimes the type of patient.
23:18 – If you’re forming calcium oxalate stones and we think a dietary issue,
23:23 – it might take a little bit longer to form
23:25 – some people form calcium oxide stones for certain medical issues,
23:29 – those can form faster.
23:30 – So it depends on why you’re forming the stones
23:33 – and it depends on what kind of stone it is,
23:35 – and sometimes you have to work with your physicians based on those two factors.
23:40 – Melissa: Okay and you’ve mentioned water a couple of times for prevention
23:44 – are there other things that people can be doing in general
23:47 – to try to prevent stone formation?
23:50 – Dr. Scotland: So water in general like I mentioned,
23:52 – and you know I keep saying water but really it’s a lot of water.
23:55 – and so we tell people, depending on size
23:59 – I tell people anywhere from two to three liters of water a day
24:03 – is what you should be drinking.
24:05 – So we’re talking about eighty five to ninety ounces.
24:09 – It’s a lot!
24:11 – But you know the water can be in the form of actual water,
24:15 – fruit, you know juices,
24:17 – although I don’t recommend drinking lots of juices
24:19 – because there’s lots of sugar associated with juices.
24:23 – Some people will drink soda which I-
24:26 – I don’t recommend that you drink soda every day
24:30 – but if you’re gonna drink soda,
24:32 – I tell people to drink the lemon type sodas.
24:37 – Mostly because they contain something called citrate
24:40 – which brings me to the next thing that I tell people so,
24:42 – for most calcium-based stones,
24:44 – for folks who have uric acid stones,
24:47 – for folks who have cysteine stones,
24:51 – we will ask them to try to increase their cictrate intake, so what’s citrate?
24:56 – Citrate is a basic form of citric acid
25:00 – which is found in citrus, fruits like lemons, limes, grapefruits,
25:04 – oranges, tangerines, mandarins, cantaloupes, those types of things.
25:09 – So we will tell people who have either a low citrate in their urine
25:15 – or who have stones that we think would benefit from increased citrate intake
25:21 – to try that in their diet, up to an including taking medication
25:24 – that contains citrate or that can convert citrate in their body.
25:31 – Another thing that I will do is depending on the type of stone
25:35 – and depending on what you’re telling me your diet is,
25:38 – I may tell you to cut down on your meat intake.
25:41 – I’m not saying you have to stop eating meat,
25:43 – but I will tell people to try to cut down on how much meat they’re eating.
25:46 – And again, when I say meat I mean all types of animal products.
25:50 – Not just red meat.
25:54 – But really the two major things that I tell people are water and salt.
25:58 – Most types of stones that you form will benefit from decreased salts.
26:04 – Melissa: Okay.
26:05 – Dr. Scotland: So I tell people that
26:08 – a lot of times it’s not the salt
26:10 – that we ourselves are putting into our food with the salt shaker
26:13 – A lot of times it’s the food that we’re eating out of the home,
26:17 – so at restaurants, at food trucks,
26:20 – you know they use a lot of salt,
26:22 – because salt is you know flavorful. Melissa: Delicious.
26:26 – Dr. Scotland: The other thing that we notice is that
26:28 – if you’re buying things from the grocery store that’s in a can,
26:31 – a bag, a container of some sort,
26:34 – there’s probably a fair amount of salt in there
26:37 – because it’s a good preservative and it’s very cheap.
26:40 – shadow details are CT scans but that’s primarily what we will do.
26:42 – So I ask people to look at how much sodium
26:43 – is in the back of their favorite foods that they get from the grocery store
26:47 – and just to keep their sodium intake down.
26:50 – Melissa: Okay. In terms of diet,
26:52 – is there any research to show that a vegetarian
26:55 – or vegan diet might be better?
26:59 – Dr. Scotland: Not necessarily.
27:00 – And the reason I say that is because
27:03 – yes, we’re talking about decreasing your meat intake
27:06 – and that’s helpful for certain types of stones
27:09 – certain types of patients
27:12 – But you know, you have some patients
27:13 – who are vegetarian or vegan
27:15 – who eat a lot of really healthy green leafy vegetables,
27:18 – lots of nuts, lots of berries which again as I mentioned
27:21 – can be high in oxalate.
27:23 – And so unfortunately there’s not a very easy yes or no to that question.
27:28 – It all depends on what kind of stones you form
27:31 – and what kind of diet you are taking,
27:34 – and you may have to work with your urologist, your nephrologist
27:38 – or even a dietitian sometimes to help you get on a diet that
27:43 – can prevent your stones while keeping you healthy.
27:45 – Melissa: Okay. Is there any association between kidney stones
27:49 – and an increased risk of cancer?
27:52 – Dr. Scotland: There’s no data to support that, no.
27:54 – Melissa: Okay. Well that was the last question aside from
27:58 – a couple of questions about whether patients can see you,
28:01 – are you taking new patients at the moment?
28:04 – Dr. Scotland: Well I am.
28:06 – But I should mention that I’m booking really far out.
28:10 – But I am an endo-urologist and so I do take care of patients primarily with
28:16 – kidney stones and with BPH which is an enlarged prostate
28:20 – I do tend to see lots of patients who come in for those reasons.
28:25 – and some patients who come in for recurrent UTIs as well.
28:30 – That said, if there are patients without kidney stones who have recurrent UTIs
28:35 – there are several of my colleagues within the department
28:38 – who are FPMRS,
28:40 – Female Pelvic Medicine and Reconstructive Surgeons
28:43 – who are also very skilled at taking care of patients with recurrent UTIs.
28:50 – Melissa: Right, well we’ll share a link to your website
28:52 – with the video when we publish it.
28:54 – Dr. Scotland: Fantastic, thank you.