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 That policy is outdated, he said, and is not consistently enforced.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.

 

[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.

 

[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?

 

[Armymedic]

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.

 

[Bruce Monkhouse]

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.

 

[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.

 

[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).

 

[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

 

[aesop081]

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 ?

 

[Armymedic]

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.

 

[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

 

[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. 

 

[DSB]

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

DSB

 

[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 ...

 

[rogsco]

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.

 

[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.

 

[medicineman]

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 

 

[probum non poenitet]

Your argument:

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.

 

[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

 

[aesop081]

  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......