Dear Doctors: I had such bad abdominal pain that my husband took me to the ER. I was told I was passing a kidney stone. It took two days, and it was excruciating. What are kidney stones? Is there anything I can do to keep this from happening again?

Dear Reader: A kidney stone is a bit of solid debris that can form due to a buildup of salts and minerals within the urinary tract. It can range in size from a grain of sand to a small -- or not-so-small -- pebble. It is estimated that 1 in 10 people will pass a kidney stone during their lifetime. Although this can occur at any age, it is most common in people age 30 and older.

As you have discovered (unfortunately!), passing a kidney stone is often very painful. This is because the stone can become stuck on its journey to exit the body. When stones leave the kidney, they pass into the ureter, which is the tube through which urine moves to the bladder. The walls of the ureter are not elastic, and thus cannot yield to a foreign object. When a kidney stone gets stuck, it can cause the ureter to go into spasm, which can cause significant pain.

When a kidney stone is unable to move, the resulting blockage forces urine to back up into the kidney. This leads to mounting pressure that causes widespread pain in the region of the belly, groin and back. Blockages can also lead to infection.

Symptoms include fever, nausea, vomiting, urine that is cloudy or has an unpleasant odor, urinary urgency and blood in the urine. Treatment begins with the use of medications to manage pain, plus hydration to help pass the stones. Larger stones and those that are impacted may require shockwave therapy. This breaks the stone into particles that are small enough to move through the ureter. In very difficult cases, surgical options may be considered.

Anyone who has passed a kidney stone, or knows of someone who has, will be motived to make lifestyle changes to decrease their risks. The first step is to drink plenty of water. This prevents the urine from becoming concentrated, which leads to development of the crystals from which kidney stones are formed. It is also important to pay attention to diet. This is particularly true for someone who has already passed a kidney stone.

Kidney stones fall into several categories. The most common are made up of calcium and oxalate, a natural compound found in vegetables, fruits, nuts and grains. Foods high in oxalate include spinach, walnuts, beets, sweet potatoes, chocolate and tea. It is also important to limit foods high in purines. These contribute to the formation of uric acid, which is associated with the formation of another type of kidney stone. Foods high in purines include red meat, organ meats and shellfish. Alcohol consumption also plays a role in the formation of kidney stones. Your health care provider can help you with the lifestyle changes needed to decrease your risk of kidney stones.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I was in a car accident, and an X-ray showed I had two broken ribs. A second X-ray taken a month later showed I also had a cracked rib. Why didn’t that show up the first time? Why isn’t there more that can be done for a broken rib other than being told to rest? It’s very painful.

Dear Reader: Fractured ribs are one of the most common traumatic injuries. More than 300,000 people visit the emergency room each year with a broken rib, and up to 45,000 wind up spending time in the hospital as a result. The most common causes are a car accident, as happened in your case, or collisions during contact sports. Older adults, whose bones can become frail, are at increased risk of a rib fracture during a fall.

As with any bone in the body, ribs can be bruised, cracked or broken. When this occurs, the muscles and cartilage that hold the rib cage together can also be damaged. The most common site of a rib fracture is the outer curve of the rib, where the bone is weakest. The ribs in the middle of the chest are most likely to be broken. In severe trauma, it is possible for a broken rib to injure the lung. Breaks in the lower ribs can injure the spleen, liver or kidneys, which can be life-threatening.

Diagnosis begins with a physical exam, and can often also include an X-ray. A cracked rib, also known as an incomplete fracture, may not be immediately visible. It is only once the damaged bone has begun to heal, which involves the deposit of specialized cells known as osteoblasts, that the damage to the rib may become visible on an X-ray.

Symptoms of rib injury include localized pain that can be severe. The rib cage glides open a bit with each breath and flexes in response to motion, each of which can also trigger pain or discomfort.

The fracture you are now dealing with shows your rib cage was doing its job. It protected your heart, lungs, liver and other vulnerable tissues from the blunt-force trauma of the car accident. However, the architecture of the rib cage, a light and flexible lattice of bone, muscle and connective tissue, puts limitations on caring for a fracture. Your rib cage needs to be able to expand and contract in order to permit breathing. Unlike a broken arm or leg bone, fractured ribs cannot be stabilized in a cast.

The primary treatments for rib fractures are medications to help manage pain and inflammation and instructions to limit movement. Depending on the severity of someone’s injury and the number of ribs involved, healing can take from six weeks to several months. Once the initial pain has been managed, the challenge becomes limiting motion and activity so that the affected bones are not reinjured.

Recently, researchers have been looking into using an injectable adhesive to stabilize the broken bone. As healing takes place, the adhesive would be absorbed by the body. The approach remains in the research phase and is not yet available.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: I’ve been seeing a lot of news stories about whooping cough. Is there really another illness that we need worry about? What is whooping cough, and how do you get it? What is the treatment? I thought this was something that had pretty much gone away.

Dear Reader: Whooping cough is a highly contagious upper-respiratory infection. Also known as pertussis, it poses a particular threat to infants.

You’re hearing about it right now because the disease is on the rise. As of mid-September, there have been more than 14,500 confirmed cases of whooping cough in 2024. That’s more than four times higher than at this same time last year. The illness is also spreading at its fastest rate in five years.

The precautions observed throughout the COVID-19 pandemic led to a marked decrease in several common upper-respiratory infections, including whooping cough. However, now, with those safeguards largely relaxed, the United States is seeing a resurgence of those illnesses. Missed vaccines during the pandemic years, along with a recent increase in vaccine hesitancy, have led to a significant drop in protection against the disease.

Unlike the flu, the common cold and COVID-19, which are all caused by viruses, whooping cough is a bacterial illness. The culprit is a type of bacteria known as Bordetella pertussis. It typically spreads via the droplets emitted when an infected person coughs or sneezes. It is also possible to become infected by touching a surface contaminated with live bacteria, and then touching your nose or mouth.

Symptoms of whooping cough, which range from mild to severe, begin anywhere from five days to three weeks after exposure. The disease often begins with a runny nose, watery eyes, slight fever, sneezing and a sore throat. The distinctive cough that gives the disease its name usually appears about a week later. The Bordetella pertussis bacteria binds to and paralyzes the cilia, which are the fine, hairlike structures that line the airways leading to the lungs. This not only permits the buildup of mucus, but leads to inflammation that causes the airways to swell. The end result is a deep, hacking and frequent cough that can last for several months.

Infants 1 year old and younger are at highest risk of infection. They are also more likely to develop severe illness, which can require hospitalization. Older adults, people with preexisting health conditions and those with compromised immune systems are also at increased risk. Some people who become infected may not get sick at all. However, even without symptoms, or only mild illness, they remain infectious and can spread the disease for at least two weeks.

Treatment typically focuses on several antibiotics that target the bacteria. In order to be effective, though, treatment needs to begin as soon as possible after infection. Unfortunately, nonprescription cough medications are not effective in easing the hacking cough.

Vaccination remains the best safeguard against whooping cough. Vaccines known as DTaP and Tdap are effective against a trio of targets: whooping cough, diphtheria and tetanus. It is important not to allow these to lapse.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)