Kidney Stones

[probum non poenitet]

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

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.

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.

 

[rogsco]

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.

 

[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.

 

[GAP]

I thought they used ultrasound to break up kidney stones?

 

[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.

 

[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:

 

[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...

 

[Blackadder1916]

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.

 

[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.

 

[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.

 

[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.

 

[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

 

[284_226]

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.

 

[SupersonicMax]

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

 

[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.

 

[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.

 

[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

 

[PMedMoe]

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?

 

[mariomike]

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

 

[Blackadder1916]

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

From his posting history.

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?