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Do you really have kidney stones?

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Every day, there are patients who come to my office, or visit the emergency room or other doctors’ offices, with the diagnosis of kidney stones. These patients had some pain in the abdomen and were sent for an ultrasound. The ultrasound result said they have kidney stones and they believed it. It is understandable that patients believe it because they are not doctors; however, doctors should know a little better.{{more}}

The fact is, most kidney stones are asymptomatic; i.e. most people who have kidney stones do not even know that they have them. In addition, most patients who have abdominal pain do not have kidney stones. Abdominal pain due to kidney stones is fairly specific, because the kidneys are located in a specific position, and unlike the organs in the abdomen, they do not have a special covering. They are behind that covering called the peritoneum (pronounced peri-toe-nee-um); so kidney pathology does not usually produce abdominal pain, unless the process causes so much swelling that the peritoneum in front of them is stretched. This usually happens with cancers and chronic infections, not stones.

Kidney pain occurs in the flank or loin, also called the small of the back. It is a boring pain that, if due to a stone, usually implies the stone is passing. A small solitary kidney stone, rarely, if ever, causes pain unless it is passing down the tube, creating an infection in the kidney or creating blockage of the kidney. If it is passing down the ureter or creating a kidney infection, then the diagnosis is easy. If it is not small enough to pass, but it is creating an obstruction, then it is big enough to do such. Stones that are big enough to block part or the entire kidney are easy to see on ultrasounds or plain X-rays of the belly.

Let me therefore summarize; if you are told you have a kidney stone because you had some belly pain, then be very skeptical, not necessarily because the ultrasound is wrong, but because the diagnosis is wrong. It is not usually the radiologist (the ultrasound doctor) to blame, as he or she just reports on what he/she sees on the ultrasound and tries to make sense of what he/she sees, based on what your doctor wrote on the paper he/she gave you to do the test. In other words what the radiologist “sees” is partially dependent on what your doctor tells the radiologist.

The diagnosis is wrong because your doctor maybe did not take the time to elucidate the belly pain properly. This includes several questions about the pain, then pressing on the belly and listening with the stethoscope. If he or she does not do this, then be very careful of going for an ultrasound. Your doctor has a better chance of telling what’s really wrong than the ultrasound. Yes! A good doctor is better than an ultrasound. The problem is that most doctors have come to trust the machine and not the basic principles of medicine and science that these machines are based on.
 
If your doctor did not ask you questions like where is the pain (and he or she actually wanted you to show him/her), how does it feel, does it move, is there fever, loss of appetite, nausea, vomiting and diarrhea, then find a doctor who will and save your money. There are many good doctors (especially the older and more experienced general practitioners and general surgeons) who will take the time to examine you properly and get the diagnosis right and save you money in the long run. Much more on this next week!

For comments or question contact:
Dr Rohan Deshong

Tel: (784) 456-2785

email: [email protected]

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