Kidney stones

Dr. Miller: Do you eat with a lot of salt? Or do you add salt to your food after it’s
cooked?

Mr. Cuevas: Sí. Siempre uso el salero cuando como. Me gusta que mi comida esté bien sazonada.

Dr. Miller: You know, Mr. Cuevas, reducing your sodium intake can decrease your risk
of having hypertension in the future. Long-term hypertension can harm the heart, brain,
and kidneys very badly.

Mr. Cuevas: Lo he intentado, doctor. Pero es muy difícil porque me encanta comer carne. Si usted

cree que podría ayudarme con el dolor, entonces sí, lo intentaré.

Dr. Miller: Yes, Mr. Cuevas. It’s for your own good. I’m going to take your temperature.
Please, raise your arm so I can place this thermometer under your armpit.

Dr, Miller: You are having a fever of 100 degrees. Now, I’m going to feel your abdomen, okay? Tell
me if you feel any pain.

Mr. Cuevas: Ouch, eso duele!!!

Dr. Miller: I’m sorry to make you hurt, Mr. Cuevas. We’ve finished with that. Now I want
you to get undressed from the waist down, put on this gown with the opening in front,
and sit on the table, please.

Mr. Cuevas: Estoy listo, doctor.

Dr. Miller: I’m going to examine your groin and check for enlarged lymph nodes.

Dr. Miller: Hmmm... Now I’m going to palpate your groin with my fingertips in a circular motion.
Okay? I can feel your lymph nodes swollen.

Mr. Cuevas: ¿Y por qué?

Dr. Miller: There can be many reasons. But, from what you’ve been telling me about
your symptoms, I suspect that what you have are kidney stones. I still need you to have
some testing done and then come back to see me to review the results.

Mr. Cuevas: Creo que mi padre también lo tenía. ¿Crees que heredé las piedras de él?
Dr. Miller: Family history is a risk factor, but there’s no definitive and single cause for
kidney stones. Stones form when mineral deposits and salts crystalize in your kidneys
clumping together. When your stones are moving or passing through your ureter and
bladder, it causes many of the symptoms you’re experiencing.

Mr. Cuevas: Lo suponía. ¿Tiene cura? ¿Un medicamento, un remedio, o algo que me cure? Porque
es muy difícil vivir con esto.

Dr. Miller: We will give you treatment depending on the type of stone you have. You can
take care of them at home by drinking plenty of water, taking antiinflammatory
medication, and alpha-blockers to pass the stones.

Mr. Cuevas: Si los cálculos son demasiado grandes para atravesar el uréter y la vejiga, puede puede
someterse a un procedimiento llamado litotricia extracorpórea por ondas de choque para
romperlos.

Dr. Miller: I want you to have a urine culture to check if you have any germs or bacteria
in your urine that might be causing you a UTI. Do you think you can give us a urine
sample today?

Mr. Cuevas: Sí, doctor. Puede que me resulte difícil, pero puedo intentarlo si bebo un vaso de agua.
A ver qué pasa.

Dr. Miller: Sure, thank you. I also want you to have a blood test to see if you have large
amounts of uric acid or calcium concentrated in your blood and to see whether your
kidneys are functioning appropriately.

Dr. Miller: I also want you to schedule an abdominal and pelvic x-ray to see exactly
where your stones are located in your urinary tract.

Mr. Cuevas: Por cierto, esas pruebas no son dolorosas, ¿verdad? No hay ningún riesgo o efectos
secundarios?

Dr. Miller: It’s possible you feel a slight discomfort lying on your back or your side, but
you can take pain medication beforehand. Almost all procedures come with a risk, Mr.
Cuevas, but these are usually minor and the benefits outweigh the risks.
Dr. Miller: In the case of x-rays there’s a slight increase in the risk of having cancer due
to the exposure to low levels of radiation. They might give you a special dye called
contrast medium to produce sharper images of your urinary tract and kidneys.

Dr. Miller: Side effects of this contrast dye include: hives or rashes, itching, nausea, or
lightheadedness. Also, some patients report having a metallic taste in their mouth after
the procedure.

Dr. Miller: Severe reactions rarely occur. X-rays are safe. You have nothing to worry
about, Mr. Cuevas.

Mr. Cuevas: Bueno, tenemos que probar de cualquier manera. ¿Cuánto cuestan las pruebas?
¿Cuándo puedo hacerlas? No tengo seguro.

Dr. Miller: You can do them here. I’m not 100% sure about the price, but it’s around 200
to 350 dollars. Some health centers offer low-cost x-rays for about 50 to 100 dollars.

Dr. Miller: You may want to ask about it to my assistant, Ms. Perez. She speaks
Spanish and she can direct you to the financial department and give you financial
assistance, okay?

Dr. Miller: I also want you to set a follow-up appointment with me as soon as you’ve
done all your tests. The nurse will come in shortly to draw your blood and show you
how to collect a urine sample. Do you have any questions or concerns, Mr. Cuevas?
Anything you didn’t understand or you want me to explain again?

Mr. Cuevas: No doctor, claro como el agua. Muchas gracias.