Dear Bellinger Shire
22 June 2021
My air conditioner has kidney stones!
Little compacted brown balls, of course picked up in our regular cleaning. As my air conditioner is designed to bring in a proportion of fresh filtered air, with HEPA filters, I suspect that as it compress and moves that air it forces out some specs of dust, which then attract and stick to other specs. They roll around a little in the airflow, compacting like Nona’s meatballs, and slowly drop to a place where they are visible.
This is a process that happens in lots of parts of your body. You can get stones in your gall bladder, kidneys and urinary tract, salivary glands, pancreas, appendix, even in the fluid spaces that cushion the middle of your brain.
Stones in various organs don’t just arrive and drop – they form by accretions. Like salt or limestone crystals in a cave, or even a snow flake that starts with the tiniest of dust particle, then molecules of water stick, freeze quickly, attract more, until beautiful patterns emerge, invisible, ethereal, ephemeral, though slimy if they blow up your nose.
A pearl is a stone of accretion after a little spec of something got into an oysters eye and really pissed it off enough for it to throw beautiful slakes of glistening, well …–pearly, cement over it.
It’s partly because no fluid in the body contains pure water. Every fluid is fluid so that it can be moved along to achieve a purpose and carry its passengers – the minerals, molecules and proteins that do a job. However when any part of us gets dehydrated the concentration of a dissolved substance starts to build up.
Chemistry 101: virtually every solute (that’s the material dissolved in a fluid) will precipitate (that is, drop out of the solution) and form crystals or solids at a certain critical concentration, (which is a unique property of each solution). We even call rain precipitation – you could consider water vapour is dissolved in air until the molecules come together in a critical mass and fall as drops.
Some people/families are stone formers – there is some genetic reason why crystals form more often in their fluids – and they would want to take heed.
The problem with stones in a body is that they block the flow of the fluid they are in. And your body’s tubes really hate being blocked. The muscles around every little passage in your body will start to push harder to squeeze the stone through, which sometimes makes the stone more stuck, but it all ends up in lots of pain and loud noises. (Sounds a bit like parliament?)
In other words stones are really painful and need early detection. Most people have heard of gallstones. Your liver (just under your right ribs) filters blood, does lots of cool chemical stuff, packaging up poisons and waste products into a liquid called bile, which then gets squirted along a tube into the gall bladder, which looks a bit like an old cockie’s purse. Now if you don’t know what a cockie’s purse is I would prefer you look it up yourself as this is a family program.
The bile (that icky green stuff you may have vomited up after a really, really bad night out), is concentrated and then squirted along the bile duct, past the pancreas (under the left diaphragm) and into the small intestine – especially when there is a fatty meal. Bile helps digest fats, helps absorb some vitamins, gets rid of some wastes, deodorises and colours your faeces. You may think that seems a bit rich until you have carried a bedpan from someone who has a sick liver. If we live long enough most of us will have a little gallstone or 10 before we die. The problem with having +++ fatty meals is that there is a lot of bile being produced, and concentrated, and being sent on its way with gusto. There is a bigger chance of forming those stones and them getting stuck. A stuck up gall bladder then stops everything and allows bacteria to come up from the intestine to set up a dangerous infection. Generally we have to treat the infection, then wait till it all settles before the now “stuffed” gall bladder can be removed. There is more than 1 price to pay for all those cream donuts!
Kidney stones can be made of calcium, uric acid, oxalic acid, or any combination.
Your kidneys play a vital part in making sure the vital mineral – calcium – is kept at a vitally steady level in the blood. They wash out the excess calcium. But if there is not enough water to help wash it, crystals start to form. When the stone is dislodged and moves, that’s when the pain starts. There are 3 narrow points in the road where it gets stuck. People often say “renal colic” is a man’s only real opportunity to share a woman’s experience of childbirth pains.
Big stones can form in the urinary bladder. I once knew a person who had survived multiple fractures. But the massive bony turnover ended up washing through a lot of calcium. We found a bladder stone about the size of a fist. That was never going to come out naturally! The youngest stone formers I knew were, ironically, pearling boat staff off the Pilbara and Kimberley coasts. They had dodgy water and didn’t drink enough in the heat.
There are also glandular reasons why some people have too much calcium, which then forms stones. They may have a “mole” on one of the 4 little Parathyroid glands in the neck, which then over activates. Fortunately parathyroid treatment now is relatively simple and safe.
Uric acid is a natural by-product of metabolism – that is, the turn over of the tissues of your body – keeping it up to date. It also gets washed out in the kidneys. Once again not enough washing and the crystals start to precipitate. If they do so in joint fluid they form needle shaped… needles. This is called gout, and hurts like stink. We used to think that high uric acid was a product of rich food, but mostly the tendency to gout is familial. Still, the crystal deposition can be set off by dehydration, injury, vibration, and lack of movement. Kidney uric acid stones, fortunately, can sometimes be dissolved by changing the acidity of your urine – something that often naturally happens with vegetarians.
Oxalate is a natural chemical that is found in some leafy plants. Celery leaves and silverbeet are high in oxalate. Some of the vitamin C we take in is metabolised to oxalate, but there is a massive difference in scale, and essentially not relevant.
Urinary tract stones can be a hiding spot for bacteria and need to be excluded in a person with recurrent urinary tract infections.
Medical/scientific learning also grows by accretions. An Hypothesis starts on an observation, then a pattern is observed, a statement made, searches performed, measurements, experiments to seek to verify the observation, comment invited from peers, intense debate as to the relevance and veracity of the observation, further experiments to try to replicate the original and therefore support or deny the hypothesis, with polishing, chipping away and then rebuilding to a hopefully more resilient and cohesive explanation – that we call a Theory. Even then there can be radical turns in the theory as a new layer of evidence, but more importantly the interpretation thereof, is brought forward with enough weight and technical rigour to be accepted by the society of peers as a viable pearl.
So it is with last week’s announcement of another change to our vaccine program. For opinions/reactions on this I would invite you to check in on Dr Normal Swan. He is much freer to commentate than this little obscure country GP.
It took tens of millions of Covid vaccine doses to throw up the observed pattern of the still very rare clotting disorder TTS. Now the technical advisory group has decided to apply a new threshold of super caution and they have changed the cut off for the AZ vaccine to over 60. They again base this on the complex calculation of the current perceived risk of catching, then dying from the disease in Australia – until last week very small – against the perceived risk of a healthy person taking a vaccine and developing a nasty complication -tiny.
The mortality of the “TTS” vaccine related disorder is now very, very low – a few per cent of a handful per million, but its frequency is reported as higher than first thought. So, the announcement we had on Friday is that 40-59 y/o will now be offered the Pf vaccine. 60 y/o and above will continue to be offered the AZ vaccine. The advice we have is that this new regime will be available from the Federally funded Covid19 clinics, and over the next few weeks may be available from the State Health hubs (ie Coffs Hospital).
Please look up the Federal Health vaccine eligibility checker to work out where you fit, and where to get a vaccine.
It is hoped that there will be enough of both vaccines in the country.
So, this brings up some very obvious questions.
Firstly I would like to state that this week I will be VERY HAPPY to get my second AZ vaccine. The evidence is that complications with the second shot are even more exceedingly rare, yet it establishes a very good immune response that lasts.
The advice is that anyone who has had a first AZ vaccine should complete the course with a second AZ vaccine. Again the risks from the second dose are vastly smaller and the side effects much milder. But please don’t put it off as the effectiveness starts to wane at 4 months without the second shot. And we now have issues in South/Eastern Sydney with the new highly infectious “Delta” Strain.
We are advised not to “mix and match” at this stage for the primary immunization. You may have heard that this is a topic of controversy. Once again Australia’s advisory team is taking a cautious wait and see approach. There are trials in some countries initially suggesting that mixing brands might be better, but that is early stages. Some of the trials are forced by expediency – ie a clear and present danger with supply constraints. I suspect it will be the go with boosters in the future, not now, not yet here.
It took a long time with kids vaccines to be sure that putting mixed antigens together into the same shot is safe. Even though we all hated giving little kids multiple shots per session.
Researchers have to establish that the idea of combining different brands:
1 is safe;
2 does not generate unexpected or worse side effects;
3 does still generate an effective immune response;
4 and that desired primary response lasts.
So far we have heard promising noise on 1 and 3 but cannot be confident on 2 and 4.
Meanwhile the pandemic roles on toward us.
Sadly, I did see some disappointing articles over the week on Indonesian cases with bad outcomes from still getting the disease after having the Sinovac vaccine. It is not licensed or available in Australia. One case was a martyred frontline doctor.
Yes, the changing landscape is confusing. Yes, we would have loved to be able to deliver a simple and clear package of info. The best/safest plan will probably be evident in about 2 years. So please check with your own pearl, or ruby, or Sapphire etc of a GP who has had layers of knowledgeable accretions laid down after plenty of metaphorical bits of grit in the eye, yet still has some lustre – hopefully. Because all this is just one (unsponsored) opinion on the issues to hand.
Dr Trevor Cheney