# Kidney Stones



## Armymedic

For those of you who do not know, as of last yr, having multiple (more then two) cases of kidney stones is grounds for a perm med cat (PCAT), making you nondeployable and depending on your trade and rank, grounds for release.

Before I post up the article, I have to say that I agree with the policy. Having spent several hours sitting next to heavily medicated suffers of pain from kidney stones while on tour, I can say that the condition, while not life threatening is a drain on limited medical resources while in theater.

For this guy... Sorry, too bad. But I do agree with his comments highlighted in colour.

http://thechronicleherald.ca/NovaScotia/523087.html

Soldier fights discharge over kidney stones

By STEVE BRUCE Staff Reporter

Bombardier Bradley MacDonnell has gone six years without a flare-up of kidney stones.

The 10-year soldier says none of his three bouts of kidney stones from 1997 to 2000 required surgery or forced him to miss a day of work at CFB Gagetown in New Brunswick.

But the Canadian Forces are discharging Bombardier MacDonnell on Sept. 1, saying his condition makes him medically unfit for combat.

The Inverness native says he is being unfairly discharged and has filed a complaint with the Canadian Human Rights Commission.

"All attending physicians have agreed that I am not having any difficulties," Bombardier MacDonnell, a member of the 4th Air Defence Regiment, wrote in his complaint filed last week.

"I am a strong performer in my unit and trade. I am a member who excels at my job and have a bright future with thenadian Forces if permitted to retain my position.

Bombardier MacDonnell, 31, said the military has had a policy since 1952 that states that kidney stones are grounds for medical discharge. That policy is outdated, he said, and is not consistently enforced.

"The base urologist stated to me that he’s treating over 100 guys alone just on this base for kidney stones," Bombardier MacDonnell said in a phone interview. "I work with guys who have kidney stones. I brought this up numerous times with different doctors. They basically tell me that these guys are lucky and I am not, or they slipped through the cracks and I got caught."

Bombardier MacDonnell said he has received a phone call of support from a Cape Breton man who was kicked out of the Forces for the same reason in 1970.

He has also learned that a sailor in Halifax who suffered from kidney stones successfully fought a discharge and went on to be promoted and serve overseas.

And he said a woman in New Brunswick was allowed to re-enlist despite her history of kidney stones.

"They told me that if they retain me, it will set a precedent," Bombardier MacDonnell said. "But there’s already a guy who fought it and won, so why is that not precedent?"

One in 10 Canadians gets kidney stones, Bombardier MacDonnell said, and 90 per cent of stones are passed without complications, "as was the case with me every time."

To lessen the risk of a recurrence, Bombardier MacDonnell drinks at least eight glasses of water a day and limits his intake of protein and salt.

Were he to be deployed overseas, doctors have advised him that a CT scan could ensure the absence of any stones before his departure, and doses of potassium citrate could reduce the risk while he was away.

But the military, in ordering Bombardier MacDonnell’s discharge, said it couldn’t guarantee him proper medical attention in the combat theatre.

"The biggest issue for them is unlimited access to potable water," Bombardier MacDonnell said. "They’re saying they can’t guarantee water for their troops overseas, but recently they made a big deal about getting Tim Hortons (in Afghanistan).

"So they can supply Tim Hortons with water, but they can’t guarantee soldiers water?"

A military spokesman said the Forces would not comment on the case.

Bombardier MacDonnell’s immediate supervisor at Gagetown, Sgt. Ches Kean, told CTV News last month that the discharge makes no sense.

"For six years, I’ve had no issues with him whatsoever," Sgt. Kean said of Bombardier MacDonnell. "He has never missed a day of work, never missed an exercise, a deployment, anything."

Bombardier MacDonnell was up for promotion in 2003 but it was put on hold because of the Forces’ medical concerns.

"I joined the military wanting to serve Canada," he said. "Our troops go overseas and lay their lives on the line. But when they come back to Canada, soldiers are scared to go to the base hospitals . . . because they’re scared of losing their jobs."

He said he worries constantly about being able to provide for his wife Michelle, four-year-old daughter Melissa and infant son Aidan, who was born July 6, five weeks premature.

"We’ve been robbed of the excitement of having a new addition to our family," he said. "Every time we’d think about the new child that was coming, we’d think about me losing my job and what we’re going to do.

"The military always likes to talk about promoting family life. We committed ourselves to the Armed Forces, but the commitment is just one-sided."

( sbruce@herald.ca)



To this quote:
’Soldiers are scared to go to the base hospitals . . . because they’re scared of losing their jobs’

I say BS.


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## Bruce Monkhouse

Whether its correct or not 6 years later does sound like a large kick to the head though.  Lets see, we sat on our asses for 6 years and said/did nothing but now its an issue?....sounds like a huge helping of cock soup to me.


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## Adam

I'm with you Bruce thats BS.  If they discharge every troop with a Chronic condition there would not be anyone in the CF.
What about: Depression; High Blood Pressure, High Cholesterol, Arthritis......  All require daily Meds? Can the CF Guarantee a continues supply?


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## Armymedic

Adam said:
			
		

> I'm with you Bruce thats BS.  If they discharge every troop with a Chronic condition there would not be anyone in the CF.
> What about: Depression; High Blood Pressure, High Cholesterol, Arthritis......  All require daily Meds? Can the CF Guarantee a continues supply?



Sure, release them all... All 4 conditions you name above are worthy of a PCAT.

Better question, why keep them. Are they deployable? Is the CF a convalescence home? If they can't do their job effectively without daily medications, or tying up days of medical resources, what good are they?

Perhaps thier high BP, high lipids are systemic to thier poor physical fitness? How about a chit because their arthirits does not allow them to complete express testing? Should we keep them?

Its NOT BS. There is well thought out reasoning why the policy is in place.

And BTW, the previous policy was for one incidence of Kidney stones...now it is for multiple occurences. A small tidbit they fail to mention in the article.


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## Bruce Monkhouse

Armymedic said:
			
		

> Its NOT BS. There is well thought out reasoning why the policy is in place.
> And BTW, the previous policy was for one incidence of Kidney stones...now it is for multiple occurences. A small tidbit they fail to mention in the article.



.....I'm not arguing the sentence....I'm arguing that in this case [with just the facts I have] that the CF took waaaaay too long in due process. Sorry, but they have to suck this one up, IMO.


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## Armymedic

Roger that, Bruce. Six yrs is long, esp when you consider you are supposed to get a medical every 5 years on your #0th and #5th birthdays (and every 2 yrs after 40). In my mind there is a whole bunch of info not in the article.


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## The Bread Guy

As a non-medical expert, I'm curious:  is the "over 100" being treated for kidney stones for a base of this size/scale seem reasonable?  What literature I could find (mostly U.S.) talks about 3-5% (self reporting) ever having had kidney stones (http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/index.htm).


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## DartmouthDave

Hello,

Releasing a CF member because of kidney stones is stupid waste of resources.  In most cases, the same can be said of placing them on
a medical category.  

As for draining medical resources, hardly.  Most of these pt are taken care of in the civilian setting in Canada.  On deployment, having to give a little pain control and some fluid isn't a heavy workload until the stone passes.

With the manpower crunch why toss out or limit the careers of CF members?  

David


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## aesop081

DartmouthDave said:
			
		

> Hello,
> 
> Releasing a CF member because of kidney stones is stupid waste of resources.  In most cases, the same can be said of placing them on
> a medical category.
> 
> As for draining medical resources, hardly.  Most of these pt are taken care of in the civilian setting in Canada.  On deployment, having to give a little pain control and some fluid isn't a heavy workload until the stone passes.
> 
> With the manpower crunch why toss out or limit the careers of CF members?
> 
> David



Picture a guy having a problem with kidney stones at 20 000 feet, 1500 miles off-shore.  If this guy has a history of kidney stones, do you think its smart to keep employing him ?


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## Armymedic

cdnaviator said:
			
		

> Picture a guy having a problem with kidney stones at 20 000 feet, 1500 miles off-shore.  If this guy has a history of kidney stones, do you think its smart to keep employing him ?



Or even more currently realistic...

Out at the FOB, 100+ kms from the KAF, and the helo's can't fly for 3 days. ("Sorry Joe, I can't give you anymore Morphine cause I am down to the last 2 autoinjectors in camp").

You have fun with that.


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## medicineman

Or going one step further, taking said soldier and a medic out of the picture to look after them while they're hurling their guts out and curled up in a ball crying for mommy.  All this of course while everyone else is off doing their jobs and someone else has to fill in for the 2 already out of the picture, and so on and so forth.

MM


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## Adam

OK, I understand your point Medincineman.  But what about the troops with Asthma, Allergies, Migraines....... or Those chronic MSK injuries we all have.
I can understand Bombardier Macdonnell's frustration. Why have they dropped the axe on him.  We still employ troops in the CF that require or may require medical treatment at some point.


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## DSB

Each case should be looked at individually.  Some might merit category changes and others may not. 

DSB


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## axeman

lets see . i have had episodes of kidney stones . even in khandahar. sucked at the time i had more then 12 l of water in my system before noon so it wasnt a issue of having enough water.. i agree if they try to boot ppl that have had a few incidents of k stones , they had better be booting ppl with back troubles migranes and a whole list of other maladies .  it will be a fight and a full pension as i have developed  the stones after being in the mil . i agree that the bomber should fight his  dismissal. there should allways be enough ppl and support to tend for some one in that condition . if there is not we MUST rexamine the med system ...


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## rogsco

DartmouthDave said:
			
		

> On deployment, having to give a little pain control and some fluid isn't a heavy workload until the stone passes.
> 
> With the manpower crunch why toss out or limit the careers of CF members?
> 
> David



A little pain control? Guess again. And it is a big deal on deployment. Case in point would be a soldier in Afghanistan who suffered a bout of renal cholic (aka kidney stones) who took up an in-patient bed - because, no we can't "give a little pain control" and send them back to work - for 4 days. Required diagnostic imaging at a Role 3 facility which meant putting a Bison Amb crew on the road to get him there, and when he couldn't pass the stone and was on mutiple types of pain control meds had to be flown back to Canada.

No problem at all for deploying. There is a reason people get geographical and occupational restrictions placed on them when they have a chronic condition that can present a problem in employment other than garrison. Sometimes it means release.


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## Cansky

As much as I believe this should be a case by case basis, as alot of other conditions mentioned are.  I was discussing this with the MO (doctors) the other day. The biggest concern is if you can't pass the stone.  If your out on PRT and this happens, its a surgical emergency.  Now we need to find surgical resources.  So where would that be role 3 Kandahar, Dubai, or Germany.   Then the repat back to Canada for final recovery and then finding someone to replace this soldier.  So it does become a much larger issue.


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## medicineman

Adam said:
			
		

> OK, I understand your point Medincineman.  But what about the troops with Asthma, Allergies, Migraines....... or Those chronic MSK injuries we all have.
> I can understand Bombardier Macdonnell's frustration. Why have they dropped the axe on him.  We still employ troops in the CF that require or may require medical treatment at some point.



First off, apologies for the late reply - I've been pretty cranky lately with school and such and didn't want to get rude.

Alot of things are supposed to be on an individual basis - "supposed to be" being the operative word group.  There are some conditions that get a blanket coverage, stones being one of them.  Having said that, for the most part, you'll find that people with those and the aforementioned conditions aren't often getting in as easily and if they are, they are on their way out if they are becoming a liability and can't be controlled.  And yes, even people with MSK problems - if they are having more light duty days than normal ones, they are getting the categories (eventually - some later than others of course).  It comes down to this - service before self.  If it's getting to the point where the good of the many is being outweighed by the good of you, then it's time to go.  If you have a condition that, if it acts up, will not only be man hour intensive but manpower intensive to look after in both actual care delivery, extraction and replacement, then perhaps it's time to think about another job.  What is happening in the end here is that the system is catching up with people.  Some would argue it's happening too slow for some and fast for others, but it is happening nonetheless.  When you only have "x" number of bodies, they can pick and choose who stays and who goes.  I know I sound like I'm towing the party line, but that's the reality of it.  Alot of people think that once you're in, they can't get rid of you - but they can and the courts have upheld the CF's right to do this.

MM


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## probum non poenitet

Your argument:


			
				Armymedic said:
			
		

> Better question, why keep them. Are they deployable? Is the CF a convalescence home? If they can't do their job effectively without daily medications, or tying up days of medical resources, what good are they?


The testimony according to the article:


> "For six years, I’ve had no issues with him whatsoever," Sgt. Kean said of Bombardier MacDonnell. "He has never missed a day of work, never missed an exercise, a deployment, anything."


Six years and no problems ... doesn't sound like a convalescent home to me.

On the one hand you have a recruiting system and training system screaming for experienced people to keep the machine rolling in _*wartime*_.

On the other hand you have a medical system eager to clean people out that _might_ have a problem _if _ they went on ops.

We shouldn't be launching experienced combat arms NCOs if they are still functional. 
Yes, if he was on a FOB in a dust storm during a firefight and got kidney stones, that would be bad. So would being stung by a scorpion or falling off the back deck of a LAV and breaking a leg. Or getting heat stroke for being out of shape (a whole other can of worms).
You have to balance the likelihood and severity of an injury hampering operations versus the benefit of keeping an experienced member, either in a deployed or domestic role.
"Kidney stones twice? You're gone ..." Too peacetime mentality for me, we don't have the luxury of being that picky.

I say judge each case on its merit, and it sounds like the bomber in the article could somehow be employed by the CF. Considering the state of manning in our combat arms, I think there's an excellent chance he could find useful employment.

On a related issue, I hope the medical system uses imagination when it comes to employing our recovering wounded. There are lots of admininstrative and instructional jobs that amputees, hearing impaired, broken backs etc. could do. 
I hope we don't cut away those that are stil willing to serve. It would be a waste of experience, dirve, and talent in many cases.

So thinks me.


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## Donut

Well, the system doesn't agree with you.

Universality of service:  If you're not deployable, you're not employable.  And, with the new cap on accommodation length (3 yrs tops, I believe, correct me if wrong), that's being enforced more rigorously then in the past.

Given that we are at war, perhaps exceptions can be made for a period for instructor cadre or domestic employment and the like, but not for things like deployments.

Precisely because we're at war we can't take chances on avoidable  conditions that will cause us to lose personnel in the line companies, expend assets and resources to transport him, expose those same assets to harm, and not have them available for an unavoidable  medical mission, like removing an injured soldier from the field.

And specifically on the topic of stones, a very senior medic once told me, while managing a pt, "Once a stone former, always a stone former."

DF


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## aesop081

ParaMedTech said:
			
		

> If you're not deployable, you're not employable.



I've heard that many times and i swear by it



> And specifically on the topic of stones, a very senior medic once told me, while managing a pt, "Once a stone former, always a stone former."



My dad is living proof of what you said.  had stones, was good for 15 years, then all of a sudden......


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## probum non poenitet

ParaMedTech said:
			
		

> Well, the system doesn't agree with you.


Believe me, it's not the first time!  It takes a while, but the system usually comes around to reason. ;D



			
				ParaMedTech said:
			
		

> Precisely because we're at war we can't take chances on avoidable  conditions that will cause us to lose personnel in the line companies, expend assets and resources to transport him, expose those same assets to harm, and not have them available for an unavoidable  medical mission, like removing an injured soldier from the field.



Point well made and well taken. 



			
				ParaMedTech said:
			
		

> Universality of service:  If you're not deployable, you're not employable.



My response: armies adapt to changing realities or perish.
I maintain that there _*may * _ come a time in the next few years where we have simply run out of 100% healthy leadership to fill 100% of the overseas slots. Compromises may have to be made.

I could pull out my finger puppets and Etch-a-Sketch and show you my awfully clever formulas - but they won't post - so let me just say that I believe it is vital that we hang on to everyone _*useful * _ (not perfect) who can fill a slot - including many of those we would have medically released 10 years ago.

Someone with kidney stones can still train recruits in Canada. Every (x) years they may keel over and get whisked to the local MIR. No biggie. A bit of a strain on the system, but far less of a strain than recruiting and training an experienced NCO from scratch.
And far less of a strain than having NO instructor, and having 10 recruits waste away in PAT Platoon in Shilo or Wainwright or Gagetown, or the ilk.

This is thinking out of the box, and may be offensive to some, as it admits we are 'lowering standards.' But the alternative is less personnel which equals more tours for those left.
Take a look south of the border to see what repeated trips to combat can do - the U.S. may face a personnel (even draft) crisis in the next few years, and it would be imprudent to think we may not find ourselves in a similar position one day.


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## rogsco

probum non poenitet said:
			
		

> On a related issue, I hope the medical system uses imagination when it comes to employing our recovering wounded. There are lots of admininstrative and instructional jobs that amputees, hearing impaired, broken backs etc. could do.
> I hope we don't cut away those that are stil willing to serve. It would be a waste of experience, dirve, and talent in many cases.
> 
> So thinks me.



Health Services provides/arranges for appropriate care for serving members, reviews the condition of the soldier in comparison to the CF generic task statement and based on that assigns a medical category and medical employment limitations. It is not the Health Services job to decide how or if a soldier with medical limitations is employed. The recommendations are made and the chain of command decides on employment, accommodation, release. The CF generic task statement is not a medical document, it lists the tasks all CF members are supposed to be able to perform, regardless of trade. If there is a job for a soldier with medical limitations that is appropriate they can be accommodated (by the CoC and career manager) for three years.


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## rogsco

Passing a kidney stone is not as simple as being "whisked off to the MIR". The pain can be debilitating and the member will more likely be whisked off to the local ER with possible hosptial admission to manage pain and other complications. A stone with obstruction can lead to serious complications requring immediate involvement of the urologist (a specialty not available in theatre).  The recurrence for kidney stones after a first occurence is 15% within the first year jumping to 40% at 5 years and more than 50% at 10 years. The majority of patients pass their stones without complication other than pain, but you can't use a magic lens to figure out who will be fine and who won't.

Making the soldier non-deployable is risk managment. Just like teaching soldiers to not play with scorpions and to be careful around vehicles, to hydrate well and to maintain a good level of personal fitness.


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## GAP

I thought they used ultrasound to break up kidney stones?


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## Gunnar

Only in the  US.  Still classed as an experimental procedure here, I believe. (IANAMP)

Plus, not all stones can be broken up that way.


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## teltech

Nope, I had stones broken up using lithotripsy (sp?) - ultrasonic shockwaves that break up the stones. Had that done in '92 in London (ON). No problems since (knock on wood). The procedure is well established here, the only issue is waiting times. :brickwall:


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## nsmedicman

For the most part, I don't believe in the "if you're not deployable, you're not employable" theory. But that's just my opinion, being an inexperienced army reservist, who has never deployed.  ;D

As far as I am concerned, our recruiting and training systems are crying for instructors as it is now. Why not employ certain candidates from some medical categories as instructors? Yes, they can still serve on a day to day basis, but they can't deploy due to a certain medical condition. In that case send someone who is healthy, with a less chance of requiring treatment while in theatre. 

For example:

We have an infantry sergeant in his early 30s, with say, 15 years service, who has suffered from kidney stones in the past (purely an example). Yes, this guy should not be able to deploy out of Canada; in case his stones reoccur, and he needs to be evacuated for futher care. It is much easier to save resources, and just deploy someone else who is theoretically "healthier". But why wouldn't that same infantry sergeant be able to serve as an instructor at Battle School, BMQ/BOQ, or leadership courses. The CF has 15 years and thousands of dollars invested in this person's education and training. This guy has most definitely deployed multiple times in the past. His experience at this point would be invaluable to the young troops just in the beginning of the their military career. Why would we throw all that away, because of a case of stones that he had seven years ago? This could apply to a Med Tech, Combat Engineer, or many other employment options within the CF.

Sure, this sergeant's career aspirations would be limited, but at least he would be able to serve out his career in a profession that he still may have a strong attachment to. 

Paramedics, police officers, and firefighters all have very physical jobs. I know of many members of the three professions that have been allowed to move on to administration or educational positions, because of a physical limitation. Why should the military be any different?

Just my $0.02...


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## Blackadder1916

nsmedicman said:
			
		

> For the most part, I don't believe in the "if you're not deployable, you're not employable" theory.....
> 
> Why not employ certain candidates from some medical categories as ...



Well, I’m sure that some soldiers with restrictive medical categories are being employed extra-regimentally as instructors, RSS, in administrative and staff positions and doing damn fine jobs.  But at what point does the CF have to say, “thank you, good-bye”.  A medical category is only a means of indicating the physical or geographical limitations that exist for a specific individual. As was mentioned before, the medical authorities do not employ nor recommend employment; it is the CoC and career management wallas who do that.  But let’s take your example of the Sgt.

The Career Manager received notice that Sgt X has a permanent med cat that precludes him from deploying operationally.  X is one of the 200 Sgts for which he is responsible.  If he wants to keep him in the Army and employ him he has to find a spot for him. Well, it can’t be in any of the operational units (let’s say that is about 60% of the positions), so that leaves approximately 80 positions.  Now, let’s say these posn for his MOC usually have an annual turn around of 25%.  One can expect to remain in-situ about 4 years.  Therefore on the face of it, there is the possibility that one of 20 jobs will be available to X without having to mess with the posting plot too much.  Now the boss tells him that the school wants people with recent ops tour experience.  But wait, there are three other Sgts with received similar med cats this year who also want to stay.  As well as the one who requested a compassionate posting to the school due to family health reasons.  And there are the 3 who received the same consideration the year before and are expected to have 4 years before retiring.  Oh, and there are those 2 from the year before that and the……Where does it stop? And then he must respond to the grievance that MCpls are not being promoted because Sgts with med cats are blocking the slots.  And then there is the grievance from the Sgt who says he can’t get posted to CFB XYZ because all the slots are being taken by Sgts with med cats.   In an organization as large as the CF, how do you make the decision that X gets to stay and Y has to go?  There is a reason for medical categories.

I will undoubtedly get flamed by some for using an example that highlights the bureaucracy of the organization. But the Army (to a great extent) is, has always been and always will be a bureaucracy in which we (well, not me anymore) have to exist.


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## big bad john

http://www.theglobeandmail.com//servlet/story/RTGAM.20060901.wxkidneystones01/BNStory/National/home

Soldier with kidney stones fights forced retirement
JILL MAHONEY 

From Friday's Globe and Mail

Despite the government's pledge to boost the military, a soldier with 10 years of experience is being discharged because of kidney stones. 

Bombardier Bradley MacDonnell is fighting the decision, saying he hasn't had a kidney-stone attack in six years. And even if he had another, he says it would scarcely affect his ability to do his job. 

"We have an environment right now where the Canadian Armed Forces is crying. Their retention is low in the Forces [and] they are losing all their experienced soldiers," said Bombardier MacDonnell, 31, who is based at CFB Gagetown in New Brunswick. 

"I'm being discharged for something that's just totally ridiculous." 
 Bombardier MacDonnell, who has also filed a human-rights complaint, knows of other soldiers with the same condition who have not been ordered released from the military. Some, both past and present, are supporting him. 

One of them, Rick Toupin, was allowed to remain in the military until his retirement in 1992, despite having two bouts of kidney stones about three years apart in the 1980s. The Forces even offered him a 12-year extension. 

"It isn't uniform across the board. They make different decisions for different people," said Mr. Toupin, a former sergeant who wrote a letter to Defence Minster Gordon O'Connor in support of Bombardier MacDonnell. 

The military ombudsman's office, which is investigating Bombardier MacDonnell's case, wants the military to apply its policies evenly, spokesman Darren Gibb said in an interview yesterday. It has previously handled a handful of complaints from people in similar situations. 

"We understand that comments have been made that there are individuals with kidney stones who have been allowed to stay in and that sort of thing, so we . . . call on the Canadian Forces, because it's a fairness issue, to apply the policy consistently," he said. 

The Forces do not take action if a soldier has had one occurrence of kidney stones, military spokeswoman Tanya Barnes said. However, two or more incidents usually mean a soldier cannot complete certain duties, which violates the military's policy that all soldiers must be fit and ready to deploy anywhere, at any time. The cases of soldiers with such employment limitations are automatically reviewed, a process that can result in discharge. 

"We do have many members who have had one incidence of kidney stones but they . . . can still do what they were hired to do. They're still employable, deployable and medically fit to serve," Ms. Barnes said. "However, repeat occurrences of kidney stones are a total other situation." 

Bombardier MacDonnell, who is scheduled to be discharged on Sept. 24, has had three kidney stones: in 1997, 1999 and 2000. The married father of two said he missed a half day of work because of the first incident, and was able to work while taking painkillers during the other two.


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## 284_226

I've read all the comments in this thread, and thought I'd toss my own $0.02 worth in...

As someone with 21 years service (and still counting - for now) in the Navy and Air Force, I've got to admit that there's definitely something wrong with the policy.  As others have alluded to, the policy is definitely NOT being applied equally across the board.

I was diagnosed in Sep 05 with three small stones in my right kidney, and two small stones in the left.  I got two treatments of ESWL (lithotripsy) in October, and as far as the X-ray could tell, I was clear of stones afterwards.  In March 06, I had another attack, which was diagnosed with Base Halifax's new CT scanner - which showed two small stones in the left, with a single fragment remaining on the right.  The radiologist told me that it was entirely possible that they "missed" the stones (~2mm in size) with the ESWL treatment, and that they were the same stones as before.  In April 06, I had another ESWL on the left kidney, while they didn't treat the right side due to the small size of the fragment.  Again, I was checked with an X-ray, which showed things as being clear.  Followup with the urologist indicated that he wasn't in a position to diagnose me as a "chronic stone former", nor was he prepared to treat me with medication or diet change since he didn't have enough information from blood tests/urinalysis.

I had my 6 month TCat review last week, and the GP recommended another 6 month TCat.  He ordered another CT scan, which revealed that the two stones on the left had fragmented into four smaller stones, which were still in the kidney.  The fragment on the right had not moved.  The GP, until then, had been telling me that if it turned out that I was a "recurrent stone former", then I would likely be headed for a PCat and release.  Now, with all of the radiologist reports indicating that the stones I have _now_ are likely still the same stones I had before, with no new stones - the GP changes tangent and tells me that since I had *multiple* stones (even if it was only a single occurrence), that I'll still likely be put up for a PCat and released.  I've got an appt with the urologist next week to see what _his_ opinion is on the situation - but he's already told me that he thinks it's absolutely ridiculous that the CF is releasing people for kidney stones - and he's the Chief Resident of Urology.  The GP stated that even if I was cleared of stones, and able to be treated with medication/diet change, nothing would be different - in spite of the fact that a pre-deployment CT scan would reveal any problems, and a clear pre-deployment scan would likely mean I'd be safe to deploy because it's an impossibility for stones to form in under three months, so six months is a no-brainer if it's being properly treated.

Let's not even discuss the fact that I'm in a trade that has very few deployed personnel (UAE/Alert), and the few positions for deployments have young fellas tripping over each other to volunteer for them.  21 years of experience in two different tech trades, supervisory experience, instructional experience, and everything else out the door because someday I *might* be faced with a deployment.  How about worrying about it if it happens?

About all I can add is that if I'm shown the door, I won't be going quietly.


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## rogsco

It doesn't matter if your civvy urologist is a Chief Resident (which means resident nearing the end of training). Has he ever been instructed/familiarized with the CF generic task statements? Military physicians are expected to be able to apply the principles of the CF employment IAW the generic task statement to the medical category system and determine limitations (a system that includes review by more than one physician and then by an AR/MEL board).

Doesn't sound at all to me like your primary care physician "changed tangents" at all, but rather that he adjusted to the medical picture as it unfolded. You indicate that you have stones on both sides, not just one - multibple stones - as opposed to the original diagnosis of unilateral stones. You also indicate that you have had mutilpe attacks (consistent with the stats already presented in this thread), but you don't think its likely that you might have an incidence if deployed despite having stone fragments present? I'm no urologist, but I don't think you can accurately state that it is impossible to form stones in 3-6 months, given the complexity of stone formation, your predisposition and that you have fragments in place. Either way a PCat is likely and you may be destined for release. I'm sure you will indeed raise a fuss, perhaps you can join the CHRC case that you were advocating for on another post?

Opinions are my own and not indended to be construed as medical advice or diagnosis. I wish you well with your outcome.


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## MedCorps

Here are some stats to think about on the subject of urologic stones.   Think about these numbers in relationship to deployment. 

12% of people will have a urologic stone condition once in their life. 

Stone formation occurs 3 times as often in males, normally from 30 to 50 years old 

There are some genetic, medications, other medical conditions that make you more likely to form stones. 

People in mountains, deserts and jungles have a higher frequency of stone disease.  There is also an increased incidence of stones during warm months of the year for any geographical location. 

People who are in sedentary jobs have a higher frequency of stone disease. 

Decreased water intake is associated with higher rates of stone formation. 

If you are one of the unlucky 12% people who has a bad go with the old stones, there is a 33% chance you will have a second episode within the next 365 days and a 50% chance that you will have another episode in the next 5 years. 

Something to think about... 

Cheers, 

MC 

For more reading: 

Seftel A, Resnick MI: Metabolic evaluation of urolithiasis.  Urologic Clinics of North America 7:159, 1990 

Drach GW: Urinary lithiasis: Etiology, diagnosis and medical management in Walsh PC, Retick, AB, Stamey TA & Vaighn ED (eds): Campbell's Urology, 6th Ed, vol 3, Saunders 1992

Borghi L, Meschi T, Amato F, et al: Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: A 5-year randomized prospective study.  Journal of Urology 155:839, 1996


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## 284_226

rogsco said:
			
		

> It doesn't matter if your civvy urologist is a Chief Resident (which means resident nearing the end of training). Has he ever been instructed/familiarized with the CF generic task statements? Military physicians are expected to be able to apply the principles of the CF employment IAW the generic task statement to the medical category system and determine limitations (a system that includes review by more than one physician and then by an AR/MEL board).



Understood, and yes, I've brought him up to speed on how the MELs affect the different factors in the medical category assigned.  He disagrees with the assignment of some of the MELs (treatment by a specialist more frequently than 6 month intervals/be within 48 hours of major medical), or at least he's of the opinion that it's far too early to be even thinking of assigning MELs that harsh.



> Doesn't sound at all to me like your primary care physician "changed tangents" at all, but rather that he adjusted to the medical picture as it unfolded. You indicate that you have stones on both sides, not just one - multibple stones - as opposed to the original diagnosis of unilateral stones.



No, I said that the initial diagnosis was bilateral stones (3 right, 2 left).  At that time, the GP assigning the TCat indicated that I had absolutely nothing to worry about unless I developed a recurrent stone formation problem.  No mention whatsoever was made of multiple stones being a concern.  Don't worry, I paid very close attention to what words were being used.



> You also indicate that you have had mutilpe attacks (consistent with the stats already presented in this thread), but you don't think its likely that you might have an incidence if deployed despite having stone fragments present?



No, that's not what I said.  I said that if I were able to be successfully cleared of stones, then it becomes a matter of whether I can be kept free of stones.  A clear predeployment CT scan, medication to impede the formation of stones, combined with the fact that stones cannot form in under three months should be sufficient to allow me to deploy for six months worry-free.  If I can reach a stone-free state, work on preventive measures, and then six months down the road I've got them back again, then I'll be quite content to admit that all preventive measures have been taken and that I'm no longer suitable for service.



> I'm no urologist, but I don't think you can accurately state that it is impossible to form stones in 3-6 months, given the complexity of stone formation, your predisposition and that you have fragments in place.



I've been assured that stone formation is indeed impossible in under three months, and that's doing everything possible wrong (ie. insufficient water intake, high protein diet, low/no citrate in the diet).  The "fragments in place" is something that I agree would have to be resolved before being cleared to deploy.



> Either way a PCat is likely and you may be destined for release. I'm sure you will indeed raise a fuss, perhaps you can join the CHRC case that you were advocating for on another post?



If the PCat does come down the pipe, I will raise a fuss for no other reason than the fact that I'm proud of the 21-year career I've had with the CF until now, and I don't think I'm ready to be put to pasture just yet.  I'm supporting the CHRC case mostly because there are a lot of injured CF members that don't have the luxury I have of being able to fall back on not one, but two highly marketable skill sets.  I'm in no fear of not being able to find work.  It does concern me that members who have little more than "Death Tech" to offer on a resume are simply offered "priority hire" with the Public Service.  That's not good enough for our people, especially when every other Canadian is guaranteed better by law.



> Opinions are my own and not indended to be construed as medical advice or diagnosis. I wish you well with your outcome.



Thanks, it's appreciated.


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## SupersonicMax

cdnaviator said:
			
		

> I've heard that many times and i swear by it



I don't agree with it.  And my Flight Surgeon eighter..   This is why we have Occupational and Geographical category.  Let's say someone working in the IT field (let's say a sig op) happens to become geographically restricted because he requires certain care.  Why not employ him in a desk job if this desk job is availlable and the guy is qualified for it?  Wouldn't that be a more intelligent thing to do?  That way, you get an extra "fit" guy to be deploy (the dude that was doing the job before our sig op got his G5 cat). I though this was why we had different category.  The forces used to be Fit or Unfit.  It isn't like that anymore.  V CV H O G A cats gives a quick glance at the state of a person (without revealing too much about the person's condition) and a career manager can determine where a guy could be employable at his best.  Now, if there are no opening for a person holding a certain category in a near future than yes, this guy would be totally un employable.  But other than that, he would still be usefull to the forces.  Don't forget, not everyone needs to deploy.  We need people back home to support our operations.

Max


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## misratah500

Had one back in 2007 or 2008 can't quite remember. Doc said if I had one more it was PCAT and release. Then I heard the policy changed back then that we didn't release people for chronic kidney stones. Now I'm hearing there is a window in between stones like 5-7 years. I'm approaching this window or already past it if it exists. 

I'm just curious if anyone could give me the low down on kidney stones and what's the current policy. I've only had one and it was 7-8 years ago. Just worried if I have another one down the road I'm hooped.


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## PMedMoe

Just before my release medical, I got my TCAT info back from DMedPol and the MO told me that they use the risk matrix as opposed to arbitrary times.  My Med Cat went to a G3 which still met universality of service and my trade specs.

Here's the link for the matrix: http://www.forces.gc.ca/en/about-policies-standards-medical-occupations/caf-medical-risk-matrix.page

Even though I was given the "over 50% likely to occur within 10 years" category, I was green because even on a deployment I could still get to level 1 med tmt within 72 hours.  Someone with diabetes, for example, might not fare so well.  Kidney stones aren't going to kill you; you'll just feel like dying.   


That being said, he also told me that they will not recruit someone with a history of renal colic.


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## GTFX

Has anyone recently been offered a job who has or has had kidney stones? 

I've read everything related to kidney stones you guys have to offer... Just wondering if anyone personally has beat the system so to speak.  Thanks

Sent from my SM-G920W8 using Tapatalk


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## PMedMoe

GTFX said:
			
		

> Just wondering if anyone personally has *beat* the system so to speak.



Do you have a history of kidney stones and did you disclose this info on your medical?


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## mariomike

GTFX said:
			
		

> Just wondering if anyone personally has beat the system so to speak.


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## Blackadder1916

PMedMoe said:
			
		

> Do you have a history of kidney stones and did you disclose this info on your medical?



From his posting history.



			
				GTFX said:
			
		

> The reason I was asking is because I did my medical 3 weeks ago and me having a 1cm kidney stone came up and I thought that was it for me and then just on Friday I got a call from Garda about my references.. I don't want to get my hopes up.. But I'm assuming this means my medical passed and in insanely record time by the sounds of it?


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## ModlrMike

Just so that we all have the same reference point here...

Generally a kidney stone less than 4.5mm will pass by it self, albeit with some degree of pain. Stones between 4.5mm and 7mm will frequently get stuck in the lower part of the ureter, most frequently where it joins the bladder which is the narrowest part of the system. These stones always hurt... a lot. A 10mm (1cm) kidney stone is freaking massive, and will require a ureteric stent and lithotripsy to remove. A 10mm stone in the ureter is not going anywhere without help, and is a urologic emergency.

Stones in the renal pelvis, or the body of the kidney frequently pose no problem, but sometimes migrate to the ureter. 

If you are a kidney stone former, then you will likely be refused enrollment. If you are currently enrolled, then the risk matrix applies and you may be retained or released based on the risk you face.

Kidney stones are nothing to mess around with. Renal failure can kill you!


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## GTFX

Thanks Mike, you pretty much confirmed everything. Well I tried and sometimes life doesn't go your way. 

Sent from my SM-G920W8 using Tapatalk


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## mariomike

GTFX said:
			
		

> Well I tried and sometimes life doesn't go your way.



Well, let's wait and see. Good luck!


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## PMedMoe

Blackadder1916 said:
			
		

> From his posting history.



Thanks.


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## Deleted member 89807

Hey Guys

A few of us were discussing kidney stones today in the Galley while discussing eating healthy and things like high protein diets. I did a bit of research but could only find old posts and stories about CAF member with kidney stones. I seen examples of people being released and some people having no effect on their career or ability to deploy. I also seen that the policy back in 2000 was release after two or more cases of them. It seems that the policy of this is either constantly changing. Does anyone know what the current policy in 2018 is for such a thing?

People are allowed to re-apply if they go five years without a stone, but at the same time they can release you or change your geographic category because its over a 50% chance of reoccurring within 10 years. Seems redundant to hire someone who has been five years clean when they still have a 5 year windows with now an even greater risk of it happening.

At the same time, about 20% of people will have a stone in their lives, seems like a lot of military personnel to lose over the mere chance of it MAYBE happening again. The likelihood of a kidney stone seems on par with a infinite number of things that can happen to a solder/sailor to make them temporarily unable to serve (broken bones, sprains, non permanent illness etc)


Thanks


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## Blackadder1916

Gcnav said:
			
		

> At the same time, about 20% of people will have a stone in their lives, seems like a lot of military personnel to lose over the mere chance of it MAYBE happening again. The likelihood of a kidney stone seems on par with a infinite number of things that can happen to a solder/sailor to make them temporarily unable to serve (broken bones, sprains, non permanent illness etc)



It's been a few decades since I had to look at the statistical incidence of  kidney stones in the population served by Canadian military health providers (it had to do with analyzing whether to get an U/S lithotripter for NDMC).  If I remember correctly it was a statistically insignificant number; at least not enough to justify the expensive equipment.  While the incidence of kidney stones in the general population may be 5% to 10% that doesn't necessarily directly transfer in the same percentage to the Canadian Forces population, so it's "not a lot".  With a generally young, healthy population there are not as many individuals who present with the same risk factors as in the general population.

In one study of CF personnel deployed to Afghanistan between Feb. 7, 2006, and June 30, 2011 who required treatment for a nontraumatic general surgical condition, renal colic (kidney stones) was identified as the most common condition.

http://canjsurg.ca/wp-content/uploads/2015/09/58-3-S78.pdf  (go to page S135)


> Methods: We studied all Canadian Armed Forces (CAF) members deployed to
> Afghanistan between Feb. 7, 2006, and June 30, 2011, who required treatment for a
> nontraumatic general surgical condition.
> 
> Results: During the study period 28 990 CAF personnel deployed to Afghanistan;
> 373 (1.28%) were repatriated because of disease and 100 (0.34%) developed an acute
> general surgical condition. Among those who developed an acute surgical illness,
> 42 were combat personnel (42%) and 58 were support personnel (58%).  Urologic
> diagnoses (n = 34) were the most frequent acute surgical conditions, followed by
> acute appendicitis (n = 18) and hernias (n = 12). We identified 5 areas where intensified
> predeployment screening could have potentially decreased the incidence of in-theatre
> acute surgical illness.
> 
> . . . Urologic diagnoses (n = 34) were most frequent, including renal colic (n = 24), . . .
> 
> . . . None of the patients with renal colic previously had
> documented attacks in Canada. The development of renal
> colic on deployment may be linked to the heat, the physical
> exertion required of soldiers and dehydration. . . .


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## Deleted member 89807

thanks for the link, its an interesting read. So were these members released after? or considered unable to deploy again?

is the policy for release or being undeployable still after two or more attacks?


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## 211RadOp

In 2003 my Sgt had them while in Afghanistan.  After clearing it up there (he finished the tour) he did get them again for a number of years.  He ended up passing away in 2013, but was still serving at the time.

(Edit to correct some info)


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## PMedMoe

Things may have changed since I released in 2015, but at the time one of the MOs told me that they would not release serving members for kidney stones and that they would not consider new applicants who had a history of them.  I have no idea whether the "five years" since an episode was stipulated or not.


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## mariomike

PMedMoe said:
			
		

> Things may have changed since I released in 2015, but at the time one of the MOs told me that they would not release serving members for kidney stones and that they would not consider new applicants who had a history of them.  I have no idea whether the "five years" since an episode was stipulated or not.



For reference to the discussion,

Turned down for medical reasons - Can I reapply? 
https://army.ca/forums/threads/86542/post-846945.html#msg846945
OP: "I applied last year to the regular forces and was turned down for medical reasons, because of kidney stones. Does that mean I will never be allowed in or can I try again?"


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