Patient Story: Stephen Wheeler
Lifestyle changes, personal guidance are key to kidney stone care at Concord Hospital Center for Urologic Care
Stephen Wheeler of Concord had surgery in 2015 at Concord Hospital to remove multiple kidney stones, but his care didn’t end there.
Stephen now participates in Concord Hospital Center for Urologic Care’s Kidney Stone Clinic, where nurse practitioner Cassie Delude and registered dietitian Kathy Burzynski designed a personal treatment plan that includes exercise and guidance to steer him away from foods that can help form more stones. It was not a one-size-fits-all plan, for Stephen also is lactose intolerant and has diabetes.
Stephen, 45, meets with Cassie and Kathy every few months to review his progress and tweak his plan, if necessary. At a session in April 2016, everyone was impressed. Stephen had lost weight, his test results had improved dramatically, he was not at increased risk of forming new stones and was an active partner in controlling his kidney stones and diabetes, without new medication.
“This hour I spend every few months with Cassie and Kathy really puts me on track and I think the results really speak for themselves,” Stephen said. “Each time I’ve come back, the numbers have dropped more and more to where they need to be.”
In May 2015, Steve went to Concord Hospital’s Emergency Department in intense pain. A scan revealed his kidney was “littered with stones.” He had no idea stones had been forming or that his diet was helping form them.
Dr. Scott Fabozzi of Concord Hospital Center for Urologic Care removed all but a few of the tiniest stones that were likely to pass on their own. Then Steve went to work with Cassie and Kathy to help prevent more from forming. With their detailed guidance, he has changed his life.
Steve has calcium oxalate kidney stones, the most common type, so his personal treatment plan was designed to lower calcium, oxalate, sodium, animal protein and his blood sugar, among other things. He needs to control blood sugar because of his Type 2 diabetes, for which he takes medication. But he hopes to wean himself off that with Cassie and Kathy’s help.
At the April session, most of the levels were down from his previous visit several months earlier. Some were cut in half. A review of X-rays showed no new stones had formed and that tiny ones that remained after surgery had not grown or moved. All good news.
Cassie suggested either monitoring the remaining stones with X-rays and considering treatment if they grow and move toward the ureter, where they could cause a blockage or seeking treatment earlier to break them into smaller pieces so they might more easily pass on their own. She left the decision up to Steve.
For the second half of the session, Kathy delved into the details of Steve’s diet, reviewing how previous suggestions had improved Steve’s test results. For instance, to help control his diabetes, Steve had been eating kale and snacking on nuts. The problem is that kale and nuts contain oxalate, which helps form the type of kidney stones affecting Steve, and some nuts contain salt, which pushes sodium levels higher. He began eating celery and carrots instead.
Because he is lactose intolerant, Steve hadn’t been drinking milk. With Kathy’s suggestion, he began drinking small amounts of milk and almond milk with meals. Calcium in the milk binds with any oxalate in food and is excreted in stool without reaching the kidneys and leading to new kidney stone formation.
Additionally, Kathy asked detailed questions about what Steve had been eating for breakfast, snacks, lunch and dinner; how much water he had been drinking; how many times a week he was visiting the gym – and for how long.
Cassie and Kathy noted his sodium level was up a little. Steve explained that he had been traveling quite a bit and had been eating more processed foods, which tend to be high in salt. Kathy noted that even the salads Steve likes when eating out may not be healthy.
She showed Steve a smartphone app called GoMeals that lists nutritional information for specific restaurant menu items. She looked up one of Steve’s salad favorites and shared with him that it contained 1,300 milligrams of sodium, more than half of recommended maximum sodium intake for a day. Salt often is in the salad dressing, she said and suggested Steve look for oil and vinegar instead.
As a diabetes educator, Kathy also is helping Steve look for ways to lower his blood sugar and stop his diabetes medication. His tests already had revealed a 70-point drop and she offered more suggestions, including exercise.
Steve is reassured to have Cassie and Kathy working closely with him to keep him on track. But they are quick to point out that while they can make suggestions, Steve is in control of his test results and his health by the choices he makes.
Steve felt a sense of accomplishment about his dramatic test results. So did Cassie and Kathy.
“It makes me feel good that you were able to do this and we were part of it,” Kathy said, as she gave Steve a high five.