Mineral metabolism center provides relief for disorders of 'stones and bones'

By Robin Russell

Vincent Gallagher was just a teenager when he suffered his first kidney stone. Back then, he endured an open surgery to remove it, leaving a “saw-cut” scar from back to front.

Mineral Metabolism
Dr. Khashayar Sakhaee, who heads up the Bone Clinic in the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, discusses treatment options with osteoporosis patient Frank Buell.

Five years later, at 22, he developed a second kidney stone. His doctor at the time gave him an injection of the painkiller Demerol and the stone passed naturally in a few hours.

But the stones kept coming.

He tried lithotripsy, in which high-energy shock waves fragment the stone into particles that can pass spontaneously. He underwent minimally invasive surgery to remove two stones, but within just a few months, several more began forming in his kidney.

The surgeon finally gave up.

That’s when Mr. Gallagher, of Plano, turned to a clinical study led by Dr. Charles Pak, then director what is now the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research.

Mr. Gallagher, now 42, was diagnosed with absorptive hypercalciuria, or excess calcium in the urine due to increased absorption of calcium from the intestine. Through a combination of medications and a change of diet, he’s been symptom-free for several years.

And that’s no small thing.

 “I would prefer to be shot,” he said of the excruciating pain associated with kidney stones. “You’re doubled over. It builds up, you’re in pain and you know there’s nothing you can do about it. You’re going to have three to four hours of pain.

“But the worst is the vomiting,” said the Mr. Gallagher, a construction estimator. “That’s when you want to be in the emergency room.”

Patients such as Mr. Gallagher find much-needed relief at the Center for Mineral Metabolism and Clinical Research, which specializes in disorders of “stones and bones.”

The Stone Clinic, headed by Dr. Margaret Pearle, Professor of Urology, focuses on the medical management of nephrolithiasis, or kidney stones.

The Bone Clinic, headed by Dr. Khashayar Sakhaee, Chief of Mineral Metabolism, focuses on the treatment of osteoporosis and a wide variety of bone disorders.

Frank Buell, 82, of Dallas, knows about osteoporosis. He was referred to Dr. Sakhaee by his urologist after the hormone treatment he was taking for metastasized prostate cancer resulted in loss of bone mass. “The drug was keeping me alive but had some bad side effects,” he said.

He now has annual bone density scans and takes the prescription medication Actonel to strengthen his bones. Because a bad back prevents Mr. Buell from exercising much, Dr. Sakhaee recommended he try resistance training for his hands, which he does.

Mr. Buell credits Dr. Sakhaee for helping his bone loss condition to stabilize. “He does a lot of research in osteoporosis, and he is very highly regarded. I think he’s helped me a lot,” he said.

Some patients are referred because of rare bone and mineral disorders. Joy Alderman, 59, of Chandler, Texas, a rural community outside of Tyler, said her doctors there were not familiar with X-linked hypophosphatemic rickets, an inherited disorder of bone metabolism. She was referred to Dr. Bridget Sinnott at the mineral metabolism clinic when she needed further bone mineral expertise prior to a hip replacement surgery.

Dr. Sinnott, Assistant Professor of Internal Medicine, prescribed a combination of phosphate supplements and a special form of vitamin D.

“I see a big difference,” Ms. Alderman said. “I’m much stronger and am able to walk around better. I really think it’s helping, and because it’s progressive, it’s important that we get a handle on it.”

Patients also may opt to participate in the latest mineral metabolism research through clinical trials at the center. These clinical studies help researchers better understand the biological and chemical processes involved in osteoporosis and kidney stone formation, which leads to improved treatment and even prevention for these disorders.

For kidney stone patients such as Mr. Gallagher, that means long-awaited relief.

“This is the greatest place ever,” he said. “It’s by far the best medical staff anywhere. There’s top-notch research, and just the way the people interact here. You can tell when people enjoy themselves, and as a patient, you notice that.”

Today, Mr. Gallagher is a patient of Dr. Naim Maalouf, Assistant Professor of Internal Medicine, who said kidney stones are formed when salts and minerals in the urine stick together. One in every 20 people develops a kidney stone at some point.

Mr. Gallagher had to make changes in his diet, including increasing his daily water intake, and he continues to take medication.

“I drink an awful lot more water now,” he said. “It took a long time to learn to do it, but I’m getting used to always getting hydrated. Now I drink two to three liters a day.”

He also avoids foods that are not good for his kidney disorders, including dark sodas, tea and dark green vegetables.

But there’s an upside to that, he added: “I don’t have to eat broccoli.”

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Dr. Pearle holds of the Dr. Ralph C. Smith Distinguished Chair in Urologic Education.

Dr. Sakhaee holds the Laura Kim Pak Professorship in Mineral Metabolism Research and the BeautiControl Cosmetics Inc. Professorship in Mineral Metabolism and Osteoporosis.

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