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Pfff.... kidney stones seem to be the least zebra Dx right know... Lisinopril, recurring but increasing severity, palpation or striking causes increase in pain, and increased activity causes pain.... reduced hydration has reduced volume, 'bad' water increases mineralization coupled with the lisinopril and the attendant hyperkalemia...
Tell Top he needs to drink more water dammit, especially with lisinopril and heavy physical activity.
the other Dx option is gouty arthritis in combination with arthroarthritis in the lumbosacral joint (multiple damage does not r/o this area even though it is not an initial joint for attacks in most cases) - same reasons as above - need to get the diff on them and run a couple of blood panels... K levels and Uric acid levels will be key in the r/o on this... but it's gonna suck with no lithotripsy available for relief if it is a stone....
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In the business of war, there is no invariable stategic advantage (shih) which can be relied upon at all times.
Sun-Tzu, "The Art of Warfare"
Hearing, I forget. Seeing, I remember. Writing (doing), I understand. Chinese Proverb
Too many people are looking for a magic bullet. As always, shot placement is the key. ~TR
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