Tiny stones cause boulder-sized pain for deployed servicemembers

Published April 11, 2008
By Staff Sgt. Mareshah Haynes
332nd Expeditionary Public Affairs

BALAD AIR BASE, Iraq -- Battlefield warriors, in peak physical condition, the toughest of the tough, are being brought to their knees, writhing on the floor in tears and pain.

The culprit -- tiny kidney stones.

Surgeries to remove the small calcium deposits are the most common non-trauma related surgery performed at the Air Force Theater Hospital here, where approximately 20-30 patients each month are treated for nephrolithiasis, commonly known as kidney stone disease, said Col. (Dr.) John Mansfield, 332nd Expeditionary Medical Operations Squadron urologist.

Kidney stones don't only hurt individual servicemembers, they also hurt military operations.

"During that time frame [when passing a stone] the troop is out of the mission; they're incapable of working. In fact, stones are so severe that if there's a pilot we know who has a kidney stone, they're grounded until they're stone free. It could dangerously interrupt what they do for a living," Doctor Mansfield said.

Kidney stones are formed in the kidneys and cause pain for the sufferer when the stones fall into one of the sufferer's ureters, the tube that carries urine from the kidneys to the bladder. The ureters are about the diameter of a pencil and the urine opening is about the diameter of a sharpened pencil lead. The average stone seen at the AFTH is about the size of a pea.

Symptoms of kidney stone disease often occur without any notice and include sudden and severe pain on the side of the lower back, vomiting, nausea and blood in the urine, said Doctor Mansfield, who is deployed from Scott Air Force Base, Ill.

Maj. (Dr.) Paul DeFlorio, 332 EMDOS emergency room staff physician, is one of the first doctors to attend to patients with kidney stones when they come into the emergency room, as they normally do.

"People are literally writhing in bed with pain," said Doctor DeFlorio who is who is deployed from Lackland Air Force Base, Texas. "They feel nausea and the sensation to urinate, but they can't. Some people have blood in the urine, which really frightens them, so they have a lot of anxiety. Predominately, there's a lot of pain. People liken it natural childbirth."

Kidney stones affect both men and women, but are more prevalent in men ages 20-40 years old, Doctor Mansfield said.

Eighty percent of the patients [seen at the AFTH] are male and patients come from all branches of the Armed Forces, Doctor Mansfield said. "Most commonly, patients have a [family or personal] history of stones. Patients who have a history of stones have a higher risk of making stones here in Iraq."

Deployed servicemembers have an increased risk of kidney stones because of several factors.

"Stones are more common in places where it's hot and dry," Doctor Mansfield said. "It's generally the lack of water intake. The combination of the hot climate, not enough liquid intake and anyone who has had a history of prior stone disease is at high risk for making more stones."

Other risk factors include excessive calcium, salt or protein intake from foods or supplements.

"Those protein shakes that are popular with body builders lower the pH of the urine and put people at risk for kidney stones; they need to watch those things very carefully especially if they have a history of kidney stones," Doctor Mansfield said. "Also avoid a lot of salt and calcium."

A Soldier deployed to Camp Cropper, Iraq, Army Sgt. Robert Mosher, 345th Support Battalion based out of Oklahoma, recently experienced a case of kidney stone disease and was away from his unit and his mission for seven days while he was treated and recovered in the AFTH.

"It was uncomfortable," Sergeant Mosher said. "I didn't go in [to the clinic] at first, but by [April 1] it was the worst pain I'd ever had, ever. It felt like I'd been in a 12-round fight and they worked me over pretty good in my kidneys."

Sergeant Mosher's stones were small enough, 6-7 milimeters, to be treated with laser surgery and the stones were broken into smaller pieces and then removed from the ureter.

He said he had never had a kidney stone, nor does he have a family history of stones. He believes the stones were caused by his diet, which he is planning to change.

Though the risks may be high for servicemembers, especially in the desert climate, kidney stone disease is preventable.

"By far the most important thing our [servicemembers] can do to prevent stones is to increase their fluid intake and produce more urine everyday," Doctor Mansfield said. "Our servicemembers, on average, need to produce 2.5 liters of urine per day. As it gets hotter and we lose more fluids through our skin when we sweat, we need to drink more to produce those 2.5 liters a day."

"If we can save one troop from having kidney stone disease, we're doing a world of good," he said.