Every year, more than 500,000 people go to emergency rooms for problems associated with kidney stones, according to the National Kidney Foundation (NKF). And if you’ve ever had one, the intense pain you experience will ensure you’ll never want to have another one.

Preventing Kidney Stones

Every year, more than 500,000 people go to emergency rooms for problems associated with kidney stones, according to the National Kidney Foundation (NKF). And if you’ve ever had one, the intense pain you experience will ensure you’ll never want to have another one.

Our concierge family practice doctors at MD 2.0 in Jupiter want to give you the facts on this common disorder and tell you how to prevent them.

How common are kidney stones?

According to the NKF, kidney stones are becoming more common. The prevalence of kidney stones in the U.S. increased from 3.8 percent in the late 1970s to 8.8 percent in the late 2000s. This increase was seen in both men and women and in all races. Kidney stones are found in children as young as five years.

The NKF attributes the rise in kidney stones to several factors, mostly related to our increased consumption of high-salt foods, including chips, fries, sandwich meats, and even some sports drinks.

The lifetime risk of kidney stones is about 19 percent in men and nine percent in women, the NKF reports. In men, the first episode is most likely to occur after age 30, but it can occur earlier.

What is a kidney stone?

A kidney stone is a hard object made from chemicals found in urine, which contains various wastes. When there is too much waste in too little liquid, crystals begin to form and attract other elements that harden into a solid object (called “stones”).

The stone begins in the kidney, and it can either remain there or travel down the urinary tract into the ureter. If it’s not small enough to pass out with the urine, it can cause a back-up of urine in the kidney, ureter, bladder, or urethra, causing pain, as well as serious complications.

Although genetics play a role in whether you are predisposed to develop kidney stones, they can also occur in conjunction with other diseases such as obesity, diabetes, high blood pressure, and various infections. The NKF says other possible causes include too much or too little exercise, weight-loss surgery, drinking too little water, or consuming food with too much salt or sugar.

Symptoms of a kidney stone

The symptoms of a kidney stone can mimic those of other diseases and conditions, which is why they need to be confirmed medically. But in general, typical symptoms of a kidney stone include:

• severe pain on either side of the lower back
• vague pain or stomach pain that doesn’t go away
• blood in the urine
• nausea or vomiting
• fever and chills
• urine that smells bad or looks cloudy.

Because these symptoms can be a sign of other serious problems, it’s important to see us if you experience any of them. In addition, a kidney stone that has grown too large to pass through the ureter can not only damage the kidney, it can prove to be fatal.

How to avoid kidney stones

The best way to avoid kidney stones is to drink a lot of fluid, at least 64 ounces a day. Adding lemon or lime juice (but not sugar) can help acidify the urine and guard against stone formation.

“Nothing, nothing, trumps fluids,” Dr. Ralph Clayman, a professor of urology at the University of California, Irvine, told CNN.

“If you’re drinking three quarts a day and making two-and-a-half quarts of urine a day, that’s the best way you can protect and defend either against getting a kidney stone or, if you’ve had them, defend against getting them again,” he said.

The NKF also recommends you stay well hydrated, especially when you’re engaging in activities that cause heavy perspiration: saunas, hot yoga, or heavy exercise, for example. The more you sweat, the less you urinate, which allows for stone-causing materials to settle and bond in the kidneys and urinary tract.

The popular belief that consuming dairy products contributes to stone formation turns out to be a myth; in fact, the opposite is true. Eating or drinking three servings of calcium a day helps lower your risk. Soy and almond milk, however, contain high levels of a compound called oxalate, a known contributor to the formation of kidney stones, so consumption of these products should be limited or avoided if you’re prone to kidney stones.

The NKF also recommends avoiding such oxalate-rich foods as nuts, seeds, legumes, beets, tea, and chocolate.

Finally, high-sodium food and drinks can contribute to the formation of stones, so not only should you avoid salt, but also processed foods (which are high in sodium), as well as canned and pickled foods.

If you think you have a kidney stone, see us as soon as possible. We can confirm whether your symptoms signal a kidney stone or another problem. We can also prescribe pain medication and/or alpha blockers that will relax the muscles in the ureter. Most kidney stones eventually pass, but large stones may require surgery.

Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves.

What You Should Know About the Zantac Recall

Wal-Mart, CVS, Rite Aid, and Walgreens this month pulled the over-the-counter (OTC) heartburn drug Zantac from their shelves, over concerns that it contains a chemical possibly linked to cancer. Other countries, including Canada, France, Hong Kong, and India, have issued recalls for Zantac and its generic version, ranitidine.

This is a radical step that CVS said it was taking “out of an abundance of caution.” Is this an overreaction, or is it justified? Our concierge family doctors at MD 2.0 in Jupiter want to give you the latest information available about this popular OTC product and offer some alternatives.


The chemical in question, nitrosodimethylamine (NDMA), is a type of nitrosamine, a known carcinogenic chemical also present in small amounts in some processed and grilled meats, as well as water, dairy foods, and even some vegetables. This is the same contaminant that prompted the recall of various blood-pressure drugs earlier this year.

Last month, the U.S. Food and Drug Administration (FDA) issued an alert reporting that some random Zantac samples it had tested contained NDMA.

The alert warned that it found low but “unacceptable” levels of NDMA, but stopped short of recommending a recall of the product. It did, however, recommend that patients who take the drug regularly consider switching to an alternative medication.

Zantac alternatives

Because each person is different and reacts to various drugs differently, the marketplace has produced a number of medications made to treat heartburn, or gastroesophageal reflux disease (GERD). This includes Pepcid (generic name famotidine) and Tagamet (generic name cimetidine), which are in the same family as ranitidine but so far have not been found to contain NDMA.

This class of drugs is known as H2 receptor blockers, which work by reducing the amount of stomach acid secreted by the stomach lining. They normally reduce or eliminate heartburn within about an hour.

Then there are the popular proton pump inhibitors (PPIs), including Prilosec (omeprazole), Nexium (esomeprazole), Protonix (pantoprazole), and Prevacid (lansoprazole). PPIs work by blocking and reducing the production of stomach acid, and take longer to work than the H2 receptor blockers, often several weeks.

And of course PPIs carry their own possible risks when used long-term. These include higher risks for kidney disease, fractures, dementia, and cardiovascular problems, including heart attacks.

The old standbys that preceded both H2 receptor blockers and PPIs are the OTC antacids like Tums, Maalox, and Rolaids. While they can cause either constipation or diarrhea in some, they are generally safe to use.

Lifestyle changes

But what can you do about the pain of heartburn (an aptly named condition)?

Start with lifestyle changes.

1. Identify triggers

Some people can tolerate chocolate, tomatoes, spicy foods, alcohol, garlic, citrus foods, ginger, and other foods with no problem at all. Those who are prone to GERD, however, quickly learn to avoid such triggers, either under certain conditions or in certain combinations or all the time. Greasy, fried, and fatty foods are also well-known contributors to heartburn, as are fizzy drinks and tobacco smoke. Know which foods to avoid.

2. Lose abdominal weight

Excess weight carried around the middle can constrict internal organs, causing upward pressure on the stomach and forcing acid upward into the esophagus, triggering heartburn. The same is true for constricting clothing such as tight waistbands or girdles. Even a heavy meal can have this effect, especially right before bed. Try to eat dinner at least two hours before retiring for the night.

3. Sleep on a slant

Either elevate the top half of your bed or sleep propped up on pillows to keep stomach acid from draining into the esophagus. Some people also find relief by sleeping on their left side, which also tends to keep acid contained in the stomach.

4. Reduce stress

Among other ill effects, stress can lead to an increase in production of stomach acid, and thus an increase in GERD. Try relaxation or meditation techniques, hobbies, or just slowing down in general as much as possible.

Home remedies

There are dozens of heartburn remedies that many people swear by including apple cider vinegar, aloe juice, and baking soda mixed in water, which will neutralize stomach acid. These or others may work for you.

If you have questions about Zantac or any other heartburn medication you’re taking, feel free to ask us, especially if you’re worried about the recall. And if heartburn is a continuing problem for you, be sure to let us know. It could be masking an ulcer, which requires medical treatment.


How To Stay Safe in Scorching Temperatures

We’re not even halfway through summer yet, and we’ve already seen record-high temperatures here in south Florida, which can bring dangerous health impacts. The two most serious are heat exhaustion and heat stroke. Our concierge doctors in Jupiter want to remind you of ways you can keep your family safe as temperatures soar.


What to watch for

The Red Cross warns that some people are more at risk of developing a heat-related illness. These include: people aged 65 and older, who are less likely to sense and respond to changes in temperature; people with chronic medical conditions, who may be taking medication that can worsen the impact of extreme heat; infants and young children; and, outdoor workers and athletes, who may be more likely to become dehydrated, particularly in extreme heat.

When keeping an eye on the weather forecast, here’s what the various warning terms mean:

  • Excessive Heat Watch: Conditions are favorable for an excessive heat event to meet or exceed local Excessive Heat Warning criteria in the next 24 to 72 hours.
  • Heat Advisory: Heat Index values are forecasted to meet locally defined advisory criteria for the next one-to-two days
  • Excessive Heat Warning: Heat Index values are forecasted to meet or exceed locally defined warning criteria for at least two days.


Consequences of extreme heat exposure

Such excessive heat as we’ve been experiencing recently can lead to life-threating heat exhaustion and heat stroke. Most people have heard these terms, but may not fully understand what they mean. We want to explain the differences between the two, because the treatments for each are different.

Heat exhaustion

The Centers for Disease Control and Prevention (CDC) says muscle cramping might be the first sign of heat-related illness. It lists the warning signs of heat exhaustion as:

  • heavy sweating
  • weakness
  • cold, pale, clammy skin
  • fast, weak pulse
  • nausea or vomiting

If you or someone you’re with experiences these symptoms, you should move to a cooler location, lie down and loosen your clothing, apply cool, wet cloths to as much of your body as possible, and sip water. If you have vomited and it continues, seek medical attention immediately.


Heat stroke

The signs of heat stroke are:

  • high body temperature (above 103 degrees)
  • hot, red, dry, or moist skin
  • rapid and strong pulse
  • possible unconsciousness.


This is a medical emergency. Call 911 immediately. While waiting for the ambulance, move the person to a cooler environment, and try to reduce the person’s body temperature with cool cloths, or if possible, a cool bath. Do NOT try to give fluids.


Staying safe in the heat

Here are steps you can take to avoid experiencing either of these serious conditions.

  • Limit outdoor activity. The sun is hottest from 11 a.m. (D.S.T.) to 3 p.m., so try to stay indoors, or at least in shaded areas, during those times. If you must be outdoors, take frequent breaks, preferably in air-conditioned environments, and, if possible, take cool showers or baths to cool down.
  • Dress appropriately. Wear loose, lightweight, light-colored clothing. Wear a hat with a wide brim.
  • Drink water frequently, from two to four cups of water every hour. Don’t wait until you’re thirsty to drink, because by then you’re already started to dehydrate. Monitor urine color: If your urine is dark, you’re not drinking enough water. Urine should be light yellow or clear. And avoid alcoholic drinks, which can not only impair judgment regarding time spent in the heat but also dehydrate you.
  • Never leave children or pets in cars for any amount of time. Also check on animals frequently, ensuring they have access to shade and plenty of cool water.
  • Check on family, friends, and neighbors who do not have air conditioning, who spend much of their time alone, or who are more likely to be affected by the heat.


Keep these safety tips in mind as you enjoy the outdoor fun in summer, and check with us if you feel more bothered than usual by the heat. This could be a sign of a medical condition that warrants investigation.

jupiter family doctor

How To ‘Break the Grip of the Rip’

This week is National Rip Current Awareness Week, so our concierge doctors in Jupiter want to acquaint you with this common, often-deadly, phenomenon. The National Weather Service (NWS) has already reported 17 surf zone fatalities nationwide this year, including one in Jupiter, and another nearby, from rip currents. The beach, while beautiful, needs to be approached respectfully.

An average of 100 people die in rip currents every year, and nearly 80 percent of all rescues—30,000 a year—made by lifeguards at ocean beaches are from rip currents. Although they can occur at any time, they are especially prevalent when the ocean is churned up with powerful offshore storms.

But bad weather is not necessarily a requirement for developing a rip current. Great weather for the beach does not always mean it’s safe to swim, or even to play in the shallows. Rip currents often form on calm, sunny days.


What is a rip current?

Rip currents are often incorrectly called “rip tides.” A tide is something different: a very gradual change in the level of water, occurring on a regular basis over a period of hours.

A rip current is a powerful, narrow channel of fast-moving water that can rush at speeds of up to eight feet per second, pulling swimmers away from the shore out into open water. They usually extend through the line of breaking waves, but can flow a hundred yards or more offshore. They can be as narrow as 20 feet or as broad as several hundred yards wide.

Often referred to as “undertow,” rip currents don’t actually pull swimmers under the water. The strongest pull is actually felt about a foot above the bottom of the ocean’s floor, which can knock your feet out from under you, making you feel you’re being pulled under, even though you’re not. But because of the current’s power, as the shoreline rapidly recedes, swimmers panic, struggle, exhaust themselves, and drown.


How to spot a rip current

Rip currents are most prevalent at low tide, when the water is already receding from the beach. They are also more likely to occur with a strong onshore wind.

Though often difficult to discern from the shore, some of the telltale signs are:

  • an area with a noticeable difference in the color of the water, caused by sand and sediment being churned up by the water;
  • a line of foam, seaweed, or debris moving out to sea; or
  • a place where the waves aren’t breaking, but has breaking waves on either side.


Remember, though, that many rip currents are completely invisible. The only time you can be certain there are no rip currents hidden in the water is if there are no breaking waves. No waves, no rip.


How to ‘Break the Grip of the Rip’

jupiter family doctorThe U.S. Lifesaving Association (USLA) warns that not even Olympic swimmers can swim against a rip current, because the pull is simply too powerful. According to the USLA, the most important thing to do when caught in a rip current is to remain calm. This helps you conserve energy and think clearly. Realize that you will not be pulled indefinitely out to sea; remember that most rip currents dissipate within a hundred yards of shore.

  • Don’t fight the current. Swim out of the current in a direction following (that is, parallel to) the shoreline. Once you’re out of the current’s pull, swim at an angle through the waves back to shore.


  • If for some reason you can’t reach shore, draw attention to yourself: Face the shore, wave your arms, and yell for help.


  • If you see someone in trouble, get help from a lifeguard. If one is not available, call 911. Throw the victim something that floats and yell instructions on how to escape. Remember, many people drown while trying to save someone else from a rip current.


Finally, never swim at a beach without a lifeguard nearby. The USLA reports that the chances of drowning at a beach with a lifeguard are 1 in 18 million.


If you have concerns or questions about this or any other health-related topic, please feel free to contact us.

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