Phone: 512-238-0762

Fax: 512-341-7370

August 29, 2020

Summer Stones: Dr. Lucas Jacomides on Kidney Stone Formation and Emergency Removal

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost Donna Lee.

Donna Lee: 

Hello everybody.

Dr. Mistry: 

This is a men’s health show. I am a board certified urologist.

Donna Lee: 

And I’m a board certified cohost.

Dr. Mistry: 

You’re certifiable, that’s right. This is a men’s health show that we’ve had for about the last year. We really appreciate our KLBJ news radio friends and engineers for making this show a reality.

Donna Lee: 

Especially Daniel and Kelly who put up with us.

Dr. Mistry: 

That’s right.

Donna Lee: 

Thank you guys!

Dr. Mistry: 

That’s right. And take all the fodder from our likely FCC violations that are on a weekly basis.

Donna Lee: 

That’s true.

Dr. Mistry: 

For those of you that are new to the show, we talk about a variety of men’s health issues. A lot of which are below the belt. We have a practice, the show is brought to you by our practice, NAU Urology Specialists, established in 2007.

Donna Lee: 

And that’s like 13 years ago.

Dr. Mistry: 

I know.

Donna Lee: 

You’ve been around a while. I see it all in your grey beard.

Dr. Mistry: 

Thank you for that. We’ve grown. We’ve grown quite a bit as a practice. We now have multiple offices. We have four amazing physician providers. We have mid level providers and all sorts of things that allow us to provide a more holistic approach. And I think that what we do here is different than other people do.

Donna Lee: 

I do too. Especially with the services we have on site.

Dr. Mistry: 

That’s right. Why don’t you tell people about our practice?

Donna Lee: 

Our practice is located in Round Rock, North Austin, South Austin, and Dripping Springs, Texas, which is very, very cute. Our phone number during the week is (512) 238-0762. You can email your amazing questions to armormenshealth@gmail.com or you can visit our website and send in an inquiry inquiry to armormenshealth.com. You can also see Dr. Mistry’s smiling, happy face right there, next to mine.

Dr. Mistry: 

I had a patient this week that insisted that he meet Donna Lee before he walked out of there.

Donna Lee: 

Yeah, he was so nice. I gave him a t-shirt and a bunch of cards about the show. So all his friends should tune in. His name is, he said, Joe, he said to say hi.

Dr. Mistry: 

Oh, very good.

Donna Lee: 

Hi Joe.

Dr. Mistry: 

Hey, Joe. Today we have Dr. Lucas Jacomides, the newest and greatest of the new additions to Jurassic park.

Donna Lee: 

What? You’re the newest and greatest of the new?

Speaker 2: 

That’s right.

Dr. Jacomides: 

But the older ones…

Donna Lee: 

Not the old.

Dr. Jacomides: 

I’m the oldest and semi-greatest.

Dr. Mistry: 

That’s right. That’s right.

Dr. Jacomides: 

Like a dinosaur, a fossilized relic of the past.

Dr. Mistry: 

Dr. Lucas Jacomides is a board certified urologist, a member of our amazing team here, has quite a long and storied urologic past. Where’d you train?

Donna Lee: 

Not Baylor.

Dr. Jacomides: 

I trained, not Baylor, at the university of Texas…

Donna Lee: 

So did he train at all? Is that what you’re going to say?

Dr. Jacomides: 

….Southwestern Medical School.

Donna Lee: 

Also notable.

Dr. Mistry: 

You know, always growing up here in Texas, there’s been this knowledge that Baylor was the number one medical school in place to train in the state at least. And that, at least people that went to UT Southwestern thought that they were number two, at least.

Dr. Jacomides: 

It’s better to be number one than step in number two.

Dr. Mistry: 

That’s right. That’s right. Being the second biggest urologist group in town, I have a lot of respect for second best. So Lucas, you were a part of the Baylor Scott and White mega structure for many years, and you had a, like a pretty senior position in their medical staff is that right?

Dr. Jacomides: 

It was a very senior position, in fact, I’m still semi-involved in their administration in some weird capacity, but somehow I’m still on their medical executive committee. So shout out to everybody. Hopefully they won’t take away my voting privileges.

Dr. Mistry: 

Well, it’s great that you get to kind of bring that perspective of what it’s like to be, you know, what I consider the more personalized private practice approach versus a larger organization that has multiple specialties that are somewhat more integrated. I’m sure that you have some insight into kind of when a patient’s looking for a doctor, why a private practice may suit certain kinds of patients?

Dr. Jacomides: 

You know, I started out my career in a big multi-specialty clinic before I moved to Austin and not hospital employed. And it seemed to check a lot of boxes. You know, I think there are some huge advantages, of course, in just having everything under one big structure. And then there’s also some inherent disadvantages that people just feel like they’re just getting down an assembly line. That they’re not necessarily, I mean, there were plenty of good doctors where we worked. You didn’t have to try that hard, I guess, to earn your business and earn your reputation. People just sent you patients, and they were just told that this guy is the best or this lady is the best doctor. And I think the patients are savvy enough to say, you know, “Are they, though?” You know, they’re going to do their homework. And I think, you know, private practice, starting my own practice two years ago, and then joining yours four months ago, you realize that nothing’s for granted and…

Dr. Mistry: 

You gotta work every day, right?

Dr. Jacomides: 

You gotta to work every day and you got to, you got to earn those stripes. So, you know, and, and it’s, uh, and every, every encounter with your primary care providers, you have to make sure they go back and tell them, Hey, this guy’s pretty okay. He’s going to take good care of me.

Dr. Mistry: 

You know, what’s interesting is those of us that work in the community, we have to work at multiple different hospitals. So we get really a good slice and taste of what this town has to offer. At this time of year, we’re hitting a lot of emergency rooms and those emergency room visits are for one major thing: kidney stones.

Dr. Jacomides: 

I saw five different hospitals on Saturday. And that was, and I wasn’t even on call all those hospitals, just sort of just cause…

Donna Lee: 

You were walking by?

Dr. Jacomides: 

…I’m bored. I need the business. You know, you know. I hurt myself five different times. It wasn’t even for me providing care.

Dr. Mistry: 

That’s funny. My joke about this town, we have so many urologists that when a kidney stone drops there’s four urologists running to go find and take it out.

Dr. Jacomides: 

We’re ambulance chasers, but in a different way, kidney stone chasers.

Donna Lee: 

So how was he related to kidney stones? Cause I know we talk about getting hotter. How does that relate?

Dr. Jacomides: 

My personal record one day was eight on a June day. Just people kept dropping in left and right. And maybe they formed them earlier, but they sure seem to drop them in the summer. I always use the example of 10th grade chemistry, for those of you out there who made it to 10th grade. I, you know, and so when you put a little sugar in the water, it dissolves, right? If you put a lot more sugar in the water, it precipitates, it comes out. And so the way you get it back in solution is you add more water. So in the summertime, we’re out and about, we’re more active if we’re not being isolated by Covid and whatnot. And we’re just doing more stuff outdoors. And what little amount you had to ingest gets precipitated if you don’t get dehydrated. So unless there’s a reason not to, I tell my stone formers two to three liters a day is what actually needs to leave your body. So if you drink two or three liters a day and sweat out half of that, then that’s not going to leave your body. And then you’re going to concentrate your stones and you’re going to make bigger stones. And then you’re going to see us.

Donna Lee: 

Two to three liters. That’s a lot.

Dr. Mistry: 

You know, when I think about kidney stones and a lot of people’s experience with them, a lot of people have had a stone and they pass it. So I think some of our listeners may think that that’s a natural thing that’s going to happen. That almost regardless of the size or regardless of the person that stones are going to be ultimately passed. Although the pain is terrible and having to run to the emergency room is terrible, there are stones that don’t pass. Right?

Dr. Jacomides: 

Right. You know, we typically use the cutoff of five millimeters. You know, it doesn’t seem like a big number until you’re trying to pass it through a four and a half millimeter ureter, but it doesn’t mean you can’t pass a bigger one that I’ve seen even little people pass 12 millimeter stones before. Not without difficulty, but they have. And I’ve seen people go into kidney failure with two millimeter stone. So, but five is kind of the cutoff we use. And you know, we give you a trial passage cause hopefully, you know, if you’re doing okay, we’ll give you a shot to do it. And if you’re not doing okay and namely the big things to remember are infection and obstruction and stone. You can have a stone, you can have a UTI, a urinary tract infection, and you can have an obstruction, but you can’t have all three. That’s a potentially life threatening event. That’s right.

Dr. Mistry: 

And so those are going to be instances in which you’ll need an immediate operation. So if you’re at home and you think you’re passing a stone and you have a fever that is an automatic no-no and you need to be seen immediately in the emergency room. And if you’re interested in being taken care of by us, you know, call us for an appointment. But if you have a fever, we’d rather you just show up in the emergency room and us and us come see you there. When we talk about operating on somebody in an emergency setting, what are we usually talking about?

Dr. Jacomides: 

Sometimes all we can do is put a stent in, a little tube that goes from the kidney to the bladder and cool off and get the obstruction relieved, and then live to fight another day. But if we’re going to go quote “get the stone,” usually we just go up and get it. We go up through whatever genitalia you may or may not have, and then we go into the bladder, up to the ureter, get to the stone, either take it out in one piece or break it up in laser fragments and take up those fragments one by one. People also talk about shockwave lithotripsy or sitting in the bathtub is what historically used to be. I still remember those days. I’m old enough to remember something that resembled a hot tub and how we did…

Dr. Mistry: 

A bathtub? You are old!

Dr. Jacomides: 

…back when we let the dinosaurs again. That’s the lesser invasive, but sometimes can’t be done in an emergency setting because you have to set something like that up. And then finally there’s even stone surgeries that are so big that have to get done through a small hole in the back. So that’s a, that’s an admission overnight and then usually a little bit more of a recovery.

Dr. Mistry: 

So for those of you out there, especially during summer months, if you think you’re experiencing a kidney stone, but don’t have a fever, call us first. A lot of times we can hydrate you here in the office. A lot of times we can give you pain medication and image you without going to the emergency room, and staying out of the emergency room at times like this is a really good idea. It helps relieve their congestion and really makes your job of getting diagnosed and treated cheaper, easier, and we would encourage any one of you out there that think you’re suffering from stones, either chronically or acutely to give us a phone call and let us take care of you.

Donna Lee: 

That’s right. You can call us during the week at (512) 238-0762. You can email us at armormenshealth@gmail.com Our website is armormenshealth.com and you can check out our free podcasts wherever you listen to podcasts on iTunes, Alexa, SoundCloud.

Dr. Jacomides: 

What’s our numbers right now, as far as podcast downloads?

Donna Lee: 

We’ve gotten over 10,000 downloads. Y’all how’s that happening?

Dr. Jacomides: 

That’s incredible.

Donna Lee: 

Thanks so much for joining us, Dr. Jacomides.

Dr. Jacomides: 

Thanks. Drink up, everybody!

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The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at Armour men’s health.com.

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