-Take the bag out, it's a biohazard bag, and there's a jar. -I love this! -I know,
that was my lunch today coming down. -Oh God! I didn't realize how big this was. -What's here in
my left hand is a stone that formed in a patient's bladder. -It's forming around this medical device.
-So all we could do at that time because she was so sick was to temporize her, so I placed
a stent. The stent went from the bladder up to the kidney to almost drain an abscess that was
in the kidney. This stent now has been in there far too long. And then it looked like there was an
egg in her bladder. That was so unusual and large that at first I thought, "There's no way that
could be a stone, it must be something that was in her pocket, in her pants when they took the x-ray.
Uh, no. -Human pearl! Wow, that's not a jewel that I would want to want to wear... For those
lucky enough that have never had a kidney stone attack, definitely one of my top three
most painful experiences of my life. I've had labor contractions, too. Those come and
they go. But one of the hallmarks of the kidney stone pain is absolutely unremitting, constant,
quite significant pain. And you're writhing around
and you're going into all different positions. -The pain
comes from the fact that, if the stone is in the upper part of the ureter blocking the kidney, that
urine that the kidney is still making can't get past it to the bladder, so the pressure builds up.
I've read a couple articles about people who swear that going on a roller coaster helps
them pass stones. A) Is that true? And B) even if it is true, is that
medically advisable? -Well, if there's an emergency room nearby,
then it's advisable. You don't want to go on a roller coaster, have a stone move, and then
have to drive six hours home right right that would be so that'd be a consideration oh my god
yeah the cross-section of the kidney right if you look at that the hollow of the kidney lies
below the opening to the ureter and some lies above it right so those stones in the lower pole
gravity will kind of tend to hold them in place a roller coaster or any other kind of thing yeah
it can jar you enough to take a stone that's kind of behaving itself and have it pass so
yeah i mean that that would you want to do that i don't know i would just leave it be i don't
really need any more excuses not to go on roller coasters but at least i have another one to add
so one of the things we mentioned is the smell of this and you mentioned that this is because it was
also made of bacteria but in general the human body doesn't smell that great even a living body
when you open it up if you would normally take out a stone that was like calcium-based once it's dry
it's not going to smell right are you telling me first of all this is a colony of bacteria
and minerals that have surrounded this so it's almost not just surrounded but even within wow
so has anybody ever cultured that to figure out like is it like penicillin we know so the most
common bacteria are going to be bacteria that are what we call urease splitters so they have
the ability to alter the chemistry of the urine and promote stones so proteus is one
and pseudomonas so these are bacteria that like use your body's urine against you yeah that's
badass wow terrifying now goodbye yeah so this is going to be a matrix of the mineral component
and the organic component right but this is a direct result of the surgical procedure like
if they hadn't happened yeah not to cut you off but if she didn't have that stent sitting in the
bladder as that nidus for the mineralization to occur she wouldn't have developed okay now
could somebody who didn't have a stent it could form but it's not as likely that's right okay
much much more common for that to occur up in the kidney so bladder as a little public health
message here let's talk a little bit about because one thing you said that i wanted to touch upon was
that this individual had sepsis in their blood so their blood was infected with the bacteria right
is that deadly yeah that can be okay um and one of the more common procedures that we as urologists
are called upon to do urgently is a patient comes into the emergency room they have high fever
complicated urinary tract infections suspicion of sepsis cat scan shows some obstructing stone
that needs to be you know moved out of the way and drained so we'll put up a stent so
it's very common that this is a procedure we do generally then that's followed by seven to
ten days of antibiotic recovery of the patient and then an outpatient surgical procedure which
is fairly straightforward but in the throes of that infection yeah people can become septic and
people can die or they can lose limbs sepsis is no joke sepsis is no joke there's no joke now let's
talk about stones and death without sepsis so are stones in and of themselves can they be because in
this case the stones would have been the indirect causative agent of death because of the sepsis but
can stones themselves be a direct cause of death i would say the only way that would happen
is you know fortunately most of us are born with two kidneys two healthy kidneys
so you would have to imagine a situation where a stone fell out of the right kidney into the ureter
blocked that kidney at some other time well that one was still there a stone drops out of
the left kidney blocks that yurt or two patients don't know it they become sicker and sicker and
then die of kidney failure okay so that's one way that's one way but sepsis is the more likely risk
posed by a stone but when we see a first-time stone person in the er the common reaction is
oh my god i didn't know what was happening i felt like i was going to die and then i was afraid i
was not going to die yes right that this pain is just going to continue it was so brutal so
you can almost feel you know that upheaval the dry heaves right the vomiting yeah the inability the
smell's not happening right here right i'm really getting uh this is all coming back to me and in
a ways that are interesting and also quite unpleasant but let's talk about too like
can people be genetically predisposed to getting stones and one of the things is you mentioned that
stones could perhaps be a comorbidity of other things so you mentioned the uric acid stones right
is that have anything to do with gout yeah sure okay so so the inability to metabolize
uric acid efficiently so that can lead to uric acid stones and that can be an inheritable trait
right the rarest type of stone and the hardest stones density wise are called cysteine stones
they're very rare and if i'm not mistaken the defect in the metabolism of cysteine that produces
these stones i think is also inheritable okay but the majority of it's just you know
lack of hydration dietary you know things either too much of a stone producer or too
little of things that help prevent stones can all lead to a situation where a stone forms
well that segues perfectly into let's talk about how can we prevent stones from happening
now in this case this is more of a please get medic please follow up with your doctors yeah
listen to them get the medical advice don't wait too long but in general for other stones
too what are some ways that we don't have to see i mean i love seeing you as great but
i don't want to see you in the patient capacity so what do i need to do what does somebody need to do
so regardless of the type of stone you make hydration is the key there are laboratory studies
that we can do so if you had a single stone and they removed it and your scan at the time showed
that there were no other stones they probably said look drink more water we'll see when we see you
but if they had done that scan and you had six or seven other stones in each kidney
now they're going to consider you a kidney stone former and they're going to look
what is going on metabolically in your system and we start with where those stones develop
which is the urine so we collect a day's worth of urine and we send it off to a lab and it'll
give us a printout as to what that patient's stone risk factors are are they hydrating
enough do they have too much oxalate in the urine is there calcium in the urine too high
is there acid-base balance too low is the urine too acidic uric acid all those kind of things are
looked at so we can get kind of a fingerprint of someone's urine and then use that to to coach them
and and first measures always hydrate more and let's address some of these dietary things oh yeah
i remember getting that list of all the things i'm supposed to avoid and i'll be honest i mean
chocolate yeah coffee and tea so like three of my four food groups uh and then healthy things right
nuts dark green leafy i mean like yeah i like i love spinach it's like what yeah so have i
reduced my caffeine consumption yes make sure i up my water consumption but yeah it's it's
a little challenging uh so maybe just don't don't get them right keep high that's a great point too
because studies have shown you might not want to hear this but once you've had a stone you're
more likely than me who's not yet had a stone to have a second stone yes i think the odds are that
unless you've made any behavioral modifications yes the likelihood of you having another stone
is fifty percent in the next you know five to seven years right so hopefully you're mitigating
if i've made it past that five to seven years i think it was like 2 000 oh you should be good i'm
good you're good so is there anything else we want to say before we seal this puppy back up in its
bottle because no let's just do that let's just do that right now because all right you want to take
the please do the honors so i think one of the things i don't know how they're gonna decide to
that might be a follow-up video with lowell because i've never experienced a stone like
this it's the first time we've ever had a stone that is this type of material that has a stent
attached to it and smells this bad but you know what i think i was thinking of is i'm wondering
kind of like what the ph of that is one of the things that's good is that alcohol for the most
part is neutral ph obviously we would never put that in formal and i think people don't realize
it's actually a slightly acidic okay we never do anything with gremlins we can avoid it so we'll
probably so alcohol should be fine do a little alcohol i'm concerned about the how granular it
is if i want to rinse it in water how much am i gonna i don't think you're gonna lose too much
to be honest with you i think you'll lose just a small amount if you rinsed it okay and you know i
don't think it's at risk of kind of crumbling okay and dissolving and then how we're going to display
it is going to be really interesting too so this is something again we don't know how we're gonna
deal with this one we might decide if it's stable we'll put it in a jar and it'll be a wet specimen
or we'll put it in the alcohol get it kind of cleaned up dry it out see how it is another thing
i would be concerned about is it's fairly wet yeah if it's too too dry you know sometimes they have
to be careful if they're too dry they just crumble yeah right you know i talked to some of my friends
who are conservators of like art conservatives yeah right and so sometimes i'd be like i've got a
challenge for you how would i preserve this how about and they're like it's not a painting it's
like you know i might reach out to them because ultimately it's it's the raw material too but this
is interesting because i'll be curious to know what percentage is made out of the dead bacteria
right a colony what is percentages made out of the minerals i'm going to save these pieces right here
you know what and i'm going to put those and i'm going to sample them and i'll see if i can do any
analysis yeah great these are all things we loved but thank you so much oh yeah my pleasure i mean
i hope you had a good time i did i did i like this whole kind of approach this is this is new
and then you gave us a great challenge i can't wait to leave that on lol's desk and we are
not going to tell him about how much it smells and so he's going to get to experience that
all that tyrell on his own why because i can right good because i'm a horrible horrible person
so but thank you so much for watching this has been another really interesting very exciting the
and the smelliest yes well good to the today it's been our smelliest unboxing to date so you have
the prize for that and thank you so much i'd shake your hand but really no let's not do that okay all
right well until the next unboxing whatever that will be thank you for watching and don't forget
we always tell them to stay disturbingly informed so stay disturbingly informed
all right that's not too bad now this opened up this too yeah now that it's opened up in this
you know what i noticed the jar stinks i think oh the drop i'm doing the um thing from your
mouth yeah i'm doing the thing where i learned to change your diapers your baby's diapers no i used
to go work in the morgue i worked in the doing forensic anthropology so they sent me into the
the bays that were uh never going to get clean where the decomps were
and that's when you just come out and you reek you just there's nothing you can do about it