Kidney Stones And You

This was some information given to me by my friend, who is a lady urologist.

The risk factors for the formation of kidney stones are:

• dehydration
• too much sodium intake
• decreased citrate intake
• too much oxalate intake
• family history of kidney stones

this is the chemical structure of oxalic acid--the base is called oxalate

Here are some sources, but not all sources, of oxalate in the diet.

Raw VegetableOxalate content (milligrams per 100 gram serving)*

• Spinach   -  750
• Beet greens   -   610
• Okra   -  146
• Parsley   -  100
• Leeks   -  89
• Collard greens   -  74

Here is the source of that table, and is a very nice article: http://www.whfoods.com/genpage.php?tname=george&dbid=48

My friend says that there are some people who are so concerned about kidney stone risk that they never eat spinach unless they have some cheese for the calcium in the cheese to bind the oxalate so it is not absorbed through the gut. (this way it never reaches the kidney)

She also says that if you have low calcium intake, then your bones release calcium into the system. This type of calcium puts you at very high risk for the formation of kidney stones. So take your calcium supplements!

To decrease your risk, take lots of foods that contain Citrate--citrus fruits are very rich in them.

Certain teas are very healthy too.

Here is the common clinical presentation of stones in the kidney, and what is routinely done for patients who have them.

The first symptom is PAIN.

Kidney stones are pain that is 10 out of 10

(for reference, the labor pain of childbirth is 9 out of 10)

We have two kidneys, one on the right, and one on the left.

The adrenal gland sits on top of each kidney.

The aorta is on the right in this picture, and the vena cava on the left,

this image is as if the patient is facing you.

Here is a close up of the kidney

You can see the collecting system (the renal pelvis) in the middle of the kidney

The ureter drains the kidney and is the beige tube on the lower left

The ureter and kidney are very painful when they stretch.

This is either from actual stone with spasm of ureter around it,

or from blockage from the urine flowing out, creating back pressure.

Here is where the kidneys are located in the human body.

They are very deep, and placed towards the back.

The kidney stone is visible in the right kidney 

(on the left in this image, as the patient is facing you)

There are actually TWO stones.

Can you see them?

This is what some kidney stones look like.

I have also seen large ones that fill the entire kidney and are very spiky in appearance

These are called 'Staghorn' kidney stones.

Just to be sure everything is open, the urologist orders an IVP

or performs a retrograde study.

In the first, dye is given i.v. and filters through the kidneys into the urine (that is this photo).

In the second, the urologist injects dye up through the bladder all the way UP.

Lithotrypsy is the healing of stones by breaking them with intense sound energy.

Sometimes stones in the ureter cannot be removed because the sound will injure the delicate tissue.

Then a laser is used, usually a Holmium laser, in a different procedure.

This is a lithotryptor--on the lower right corner

Can you see the gel that is next to the kidney?

It has a series of shocks--sometimes thousands of them.

(The thing on the top is the c-arm for x-ray visualization of the stones as they break down)

General anesthesia is required for this procedure.

If you would like to know more about kidney stones, and how to avoid them, here is another excellent source:  http://my.clevelandclinic.org/urology-kidney/diseases-conditions/kidney-stones-oxalate-controlled-diet.aspx

Is there an Archangel Raphael healing code for the kidney stones yet? No.

How about Reiki for the condition? It can't hurt.

Is Reiki a substitute for medical care?

No.

Use your higher guidance, your inner knowing, to find out what it right for you.

Ah, yes, also, spirit wants me to share that often we place 'stents' or little tubes--in the ureters to keep the urine flow open and from blocking again. They are temporary and can be removed at a later time.

I hope this has been helpful to you.

Aloha and Mahalos,

Namaste,

Peace,

Reiki Doc

* = Adapted from the following sources: (1) United States Department of Agriculture, Human Nutrition Information Service, Agriculture Handbook Number 8-11, "Composition of Foods: Vegetables and Vegetable Products." Revised August 1984; (2) data gathered by LithoLink Corporation, a metabolic testing and disease management service for kidney stone patients, founded by Dr. Fredric Coe, a University of Chicago Medical School Professor, and posted on its website at www.litholink.com; (3)data presented by Holmes RP and Kennedy M. (2000). Estimation of the oxalate content of foods and daily oxalate intake. Kidney International(4):1662.

Something To Add: Silent Surgery

this is how I felt when I was asked to do 'silent anesthesia'

P.S. the hair is supposed to go INSIDE the bouffant cap, thank you very much!

Recently I had the opportunity to stretch my open mind and do anesthesia for a member of Scientology.

The forms were intimidating. a three-page letter from an expert on Silent Surgery, and a one-page letter from the patient basically telling me what to do. I did my best to stay quiet and to avoid the specific agents requested. The patient did fantastic! But  just in case you are curious, no, they were not a celebrity in any way. (Even if they were I couldn't tell you ; )  )

So for the Anesthesia Community in General, For the Silent Surgery Education and Advertisement Department of Scientology, and for the Energy Healers out there, let us proceed to 'Something To Add'.

Here is the 'deal': 

engram: a mental image picture which is a recording of time of physical pain and unconsciousness.

Scientologists don't want them.

They want to stay 'conscious' and 'free of pain'.

Reiki Doc Says: 

The concept that everything is 'heard' and 'not remembered' during surgery is correct. The patient 'knows' everything that is going on, but later has no access to those memories. That's why I don't let people talk trash about my patient, as if anyone would in the first place. But I watch for this.

For staying 'conscious' options, I think regional anesthesia is an excellent choice. Lower extremity and some less invasive abdominal procedures are able to be done under spinal, epidural, or regional blocks such as a femoral three-in-one, sciatic, popliteal, or ankle block. Some upper extremity procedures may be done under axillary block, inter scalene, or Bier block. 

The only drawback with regional anesthesia that is not epidural or spinal is that local anesthesia causes seizure when absorbed too rapidly or injected intravascularly. Small doses of benzodiazepine are routinely given to raise the seizure threshold as added safety against seizure in case of inadvertent rapid absorption of local anesthetic.

Scientology also recommends 'bilateral TAP blocks' for abdominal pain post-op. I have never seen one of these done and would have to look one up before I did one. I wouldn't advise that for post-op pain control. Pain pumps (little spring-loaded slow drip drains filled with local anesthesia) are preferred in this and many thoracic cases. 

General Anesthesia

Scientology Says:

NO! Well actually, no:

• Barbiturate
• Etomidate
• Ketamine
• Benzodiazepines (midazolam, alprazolam, chlordiazepoxide, temazepam)

Again, this is to avoid the engrams.

Otherwise unconsciousness with general anesthetics, propofol, and narcotics is 'okay.

Reiki Doc says:

OK! I'm on it!

Barbiturate--we can't even get Sodium Pentothal for lethal injections by the state. It is no longer made, I believe. This is a non-issue. Years ago, we gave methylhexital for ECT (electroconvulsive therapy) because it gives a better seizure than propofol. Now it's usually propofol.

Etomidate--one dose isn't going to suppress the adrenals much. Those studies were done when etomidate was used for ICU sedation. (plus many elderly are adrenocortically suppressed and have no knowledge they are. I give steroid bolus to all over seventy just in case, it's cheap and preventive.) 

Etomidate is used when the patient is very unstable and might die if given propofol to go to sleep. Typically we use Etomidate for emergencies only. Chances are in an elective setting and good health, it would not be used.  You might want to think about the risk to benefit on etomidate in the situation of emergent, life-saving surgery where a patient is in hemodynamic shock.

Ketamine--This is used in veterinary medicine, too. It is a 'dissociative anesthetic', the patient 'knows' what is going on but 'doesn't care', much in the same way a frontal lobotomy is known to do. There can be terrible hallucinations in adults if no benzodiazepine pre-med is given first. A powerful painkiller, ketamine is used in changing dressings and bathing burn patients who have frequent procedures. It is also often mixed with propofol for long facial plastic surgery procedures under 'MAC'. The only time I would use ketamine clinically is the violent patient that might hurt me (i.m. like a tranquilizer dart), and the dying patient who needs blood pressure to go UP instead of stay level like etomidate on induction. You might want to think about situations where life is at risk and give the okay on ketamine in this instance.

Benzodiazepines--are used to decrease anxiety in surgery, especially pre-op. I can take them or leave them, but in cases of cardiac disease, propofol would frankly kill the patient if I only gave that. I use a large dose of versed and fentanyl to keep blood pressure stable. You might want to re-think risk to benefit on this one for alcoholics (withdrawal in hospital can be fatal), anxiety disorder, and cardiac disease.

On The Healing of Surgery:

Scientology says: 

Surgery is a necessary evil that is full of pain and has to be controlled.

Reiki Doc says:

Surgery is a time for deep healing that is personal for each patient involved. For RELIGIOUS ACCOMMODATION we are pleased to provide what care you request. 

However, surgery can be a time of great joy and service in the healers involved. Many have been called to the healing specialties out of great love for humanity and desire to 'give something back'.  Provided that the patient is sufficiently under general anesthesia, there is little risk of 'pain' being experienced while 'unconscious' so the engram, in my opinion, has little chance to form. The pall and sense of restriction in that room for the length of surgery created feelings that were not 'light' for everyone involved in the procedure. I ask you to question, 'where is the healing when the energy is not favorable to the optimum function of the team at work on the patient in the O.R.?' It's just a thought, whatever you decide is okay with me.

Furthermore, when individuals are trained in energy medicine, vast amounts of healing can be harnessed for the benefit of the patient, no matter what the religion, as health is a divine right and all of humanity is deserving of this gift.

From Me to You:

Thank you for taking me outside my comfort zone. After doing anesthesia for so many years, I had no clue there was any medical 'interaction' with your religion. I consider myself informed and will strive to do whatever possible for the comfort and care of your patients.  It is my hope that my expertise in anesthesia that I shared with you today will help put more of your patients at ease in the future.

After all, Love is the Solution For Everything! 

Do you not agree?

Mahalo and Aloha,

Reiki Doc

While You Were Sleeping: What I Do for a General Anesthetic

What happens after you get the "margarita" and forget everything else but Pre Op Holding? In case you were curious, let's walk down the hall to the Operating Room together.

I have sedated you, but not too much. Unless you are a nine-month old baby or smaller, I am going to ask you to scoot from that gurney to the O.R. Table.  Chances are you are bigger than me and the Filipino nurses that are in the room to help you.

I make small talk as I hook you up to the monitors. The data that I get is vitally important. Those are the hemodynamics of you awake. When your vitals approach this during surgery, I am going to deepen your anesthetic. I also have you breathe oxygen. This is Pre oxygenation. This buys me time while I am looking down your throat getting the breathing tube in. If you are claustrophobic, you can suck on the end of the circuit like a Peace Pipe. It doesn't matter how you get it, just fill your lungs with O2. For children, we smear lip smacker into the mask so it smells like cherry first. Sometimes I do this for adults, but often times they do not like a fragrance besides new plastic.

When I am ready, I ask you if you are ready to go to sleep. Then I ask you to pick a nice dream. I tell you you are going to wake up with no pain and no nausea, and with your whatever body part you are having fixed, fixed. Some people like to count backward from one hundred. I always let them think they have set a new world record when they count.

How do I know you are asleep? Well, you stop talking. Your eyes stare, and then close. You might yawn real big. But the test is that I tickle your eyelashes. Unconscious people do not flinch. Try it! You will see a little flutter on the eyelid on someone who is asleep but not unconscious-like your partner or child. Just touch the ends of the eyelashes lightly in a sweeping motion. After this I tape the eye shut so that my stethoscope and badge will not scratch your eye while I intubate or insert an LMA. Also so your eye will not dry out during the case.

I also mask you at this point. Can I get you to breathe while you are out? Sometimes I have to put in an oral airway, a piece of hard plastic that gets your tongue off the back of the throat and lets airflow through. Sometimes I have to hold the mask with both hands and have someone squeeze the anesthesia bag. If I can't breathe for you when you are sleeping, that is not good. If you have sleep apnea, this is likely to happen, cannot mask. Sometimes if the airway assessment is not favorable, I keep you breathing on your own and put the breathing tube in while you are numb and sedated but not asleep with a fiber optic scope.

Assuming I can ventilate, I open your mouth and insert a larygoscope, taking care not to catch the lip between the metal and the teeth. I look for the vocal cords. Sometimes I have a great view. Most times I have the nurse push on the Adams apple so I can see. I put the breathing tube through the cords under direct visualization. I do all these steps I thirty seconds or less. I blow up the cuff and connect the breathing circuit to the anesthesia machine and your endotracheal breathing tube. I look for an end tidal carbon dioxide waveform on the capnograph.  I tape the breathing tube in place and put a big roll of cotton for you to bite instead of my tube.

I set the anesthesia machine to breathe for you and start the anesthesia gases that will keep you asleep. During surgery, I watch all of your vital signs. I treat nausea and pain before you even wake up. I place lines if needed. I monitor fluid input and output carefully. Yes, I keep track of how much you pee! I also watch oxygen, carbon dioxide, hemoglobin, and electrolytes. All this in addition to making sure your anesthesia is enough for all the changing parts of the operation, if something is going to hurt that the surgeon does, I deepen the anesthesia first before your surgeon does that. Basically I even everything out as your surgery affects your blood pressure and heart rate.

At the end, I stop all anesthesia. I get you breathing on your own. You have to be awake enough to cough and not choke on your own spit. Then I take out the tube. I watch you closely to make sure you are exchanging air. And I give the signal for the team to roll you on the gurney. I walk with you to the recovery room, and give my report to your PACU nurse that will be taking care of you.

All this and Reiki too!

Namaste,

Reiki Doc