DEAR DR. DONOHUE: My husband had kidney stones four times this past year. Twice I had to take him to the ER because he was in such pain. His doctor has him drinking lots of water, but has not given him anything else. Should he be on medicine or a diet? – T.P.

ANSWER: About half of the people who have had a calcium kidney stone, the most common kind of kidney stone, will have another within 10 years of the first episode. Four stones in one year might not win the world’s record for your husband, but it is quite extraordinary.

I am positive your husband’s stones were analyzed for their chemical composition so that the right directions could be given to him. I’m going on the assumption his were calcium oxalate stones, the usual suspects. It seems logical to put a person with such stones on a low-calcium diet, but that actually encourages more stone formation. As calcium levels drop, oxalate levels rise, and high oxalate concentration in the urine promotes stone formation. Sometimes doctors tell their patients to go easy on oxalate foods: chocolate, nuts, beets, rhubarb, spinach, strawberries and wheat bran.

Fluid intake is most important for stone prevention. Your husband should sip water and other fluids throughout the day. He needs about 3 quarts (about 3 liters) of fluid daily. He’ll know that he’s getting enough if his urine is clear or pale-yellow. As far as medicines, thiazide water pills prevent calcium from entering the urine, and they’re something that might be considered for your husband.

Your husband needs a special investigation. He forms stones so often that it raises the suspicion something is upsetting his calcium balance. One condition is hyperparathyroidism. The parathyroid glands, behind the thyroid gland in the neck, make a hormone that raises blood and urine calcium levels. This is one condition worth considering for your husband’s most unusual history.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from

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