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Woman with big kidney woes, little cash, rescued


Frances Mackall has been rescued just as she and her oversized kidney stone were sliding through a crack in the American medical system.

The rescuer was a doctor who read about her in a newspaper.

Mrs. Mackall, 32, had suffered intermittent pain from the kidney stone for a year and a half, but didn't qualify for state medical assistance because her family's income of $915 a month was more than twice the allowable income for such assistance.

Villareal Mackall, her husband, receives a Social Security disability payment of $610 a month. Daughter Maria, 4, gets $305 a month as a child of a Social Security disability recipient. They have medical insurance, but Mrs. Mackall doesn't.

Enter the Maryland Kidney Stone Center, which uses a #i nonsurgical treatment to break up kidney stones.

"When I read the story in November, I thought it was pretty pathetic that people who need treatment can't get it," said Dr. Marc Siegelbaum, medical director of the center in the 6100 block of Falls Road.

"It jumped out at us," said Alan Weisman, administrator of the center, owned by a consortium of four hospitals -- Sinai, University of Maryland Medical Center, Greater Baltimore Medical Center and Union Memorial -- and 28 individual investors, including some doctors. "So we got in touch with her to see what we could work out."

Dr. Siegelbaum offered to contribute his services for Mrs. Mackall's treatment. The for-profit center charged her $3,000.

"Mr. Mackall and I shook hands, and I said he could pay us what he could when he could," Mr. Weisman said. No down payment was required.

The center provided free transportation from the Mackalls' apartment in Essex to the center, and in December Mrs. Mackall got the treatment.

"Unfortunately, the stone was so hard and so large that we got only half of it," Dr. Siegelbaum said. The remainder was removed last month.

The treatment is done with lithotripsy technology. The patient is moderately sedated, then lowered by a mechanical sling into a bathtub filled with warm water.

Electrical shock waves -- as many as 2,200 in 30 minutes -- are generated from a device at the bottom of the tub. The stone disintegrates into sand-sized particles, which are discharged through natural processes through the ureter, the tube that connects the kidney to the bladder. Because of the sedation, the patient feels no pain.

The center has treated about 4,400 patients since it opened in July 1986. It currently treats about 600 patients a year. Average ,, cost is $4,000, including the urologist's fee.

It recently added a laser tripter, used to disintegrate particles that have lodged in the ureter.

Each of Mrs. Mackall's treatments took about 90 minutes, from start to recovery from the mild sedation.

Untreated, Mrs. Mackall's stone could eventually have caused serious damage to the kidney, Dr. Siegelbaum said.

"It's a relief to have it out," Mrs. Mackall said. "I worried about what it was going to lead to."

Before lithotripsy was introduced 10 years ago, most kidney stones were removed surgically. Now most are removed by the shock treatment, which, Dr. Siegelbaum said, is not for everyone.

"Pregnant women, people with pacemakers and people who weigh more than 280 pounds are among those who have to be treated by some other method," he said.

"Also, it's absurd to treat a stone which is small and causing you no trouble," he said.

"And if you have sudden, severe pain commonly associated with kidney stones, don't come here," he said. "Call your doctor or go to the nearest emergency room, because it's an altogether different treatment than the one we offer."

Kidney stones usually are made of calcium deposits and develop when the urine contains an excessive amount of calcium or other minerals, including uric acid, phosphates and carbonates. The problem can ordinarily be controlled by diet and medication.

Some people are more prone than others to kidney stones. "Mrs. Mackall has about a 60 percent chance that she will develop another stone," Dr. Siegelbaum said.

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