Everybody must get stones..

September 27, 2005 1:52 PM

I've just returned from a renal ultrasound where I learned that I have a whopper of a kidney stone (.8 centimeters or something sitting just above my ureter, which explains my oft-complained of back pain (and testiness). I'm seeing my doctor tommorrow about my options, one of which was mentioned was surgery. But I'd like to know some more about what I'm in for and what questions I should ask. Thanks.
posted by jonmc to health (21 comments total)

Here's a good summary page, including questions to ask your doctor and treatment options. Good luck, and drink lots of water.
posted by monju_bosatsu at 2:02 PM on September 27, 2005

jonmc,

Go listen to your urologist and see. Lithotripsy may be workable, but you'll still have to pass the remnants. My guess is they may rec. retrieval via ureteroscopy. Either way, it's less than pleasant, but entirely do-able and will likely solve the problem.

Make sure the stone is analyzed. Some people make oxalic acid stones and can prevent recurrences with modified diets.
posted by docpops at 2:02 PM on September 27, 2005

Drink lots of orange juice. It helps to push your internal equilibrium away from that which forms kidney stones (one of the few things i remember from general chemistry- comes from a professor whose brother pushes out stones the size of golf balls without a second thought they're so bad).
posted by jmd82 at 2:06 PM on September 27, 2005

jmd82, not all kidney stones are formed the same way. My urologist has me avoiding lots of orange juice and other rich sources of vitamin C. Mine are the aforementioned oxalic acid based stones, which sucks for me as a vegetarian.

Don't hesitate to ask lots of pointed questions of your urologist too. Mine told me to avoid oxalates, but didn't have much good advice about what foods that would entail other than mentioning cashews, spinach and some other stuff. I had to do my own research. He also wasn't very cognizant of how this might affect one's overall diet.
posted by ursus_comiter at 2:16 PM on September 27, 2005

Recently, I found I had two kidney stones - one on each side. One was 1mm, the other 2mm. The 2mm one they broke up with lithotripsy. The other they said should just pass by itself (I think it has, but am not sure). The lithotripsy was a couple hours - mostly prep and recovery. They gave me some nice sedatives which just made me happy/sleepy. Had very little soreness afterward.

If the lithotripsy doesn't work, they can (ulp) go in to get them. I forget what this procedure is called, but you get a general anesthetic, and the fish the stones out with a kind of a net. Usually works, but sometimes not.

There's also a procedure called percutaneous nephrolithotomy. Seems a little more invasive. Actually, this site has a fairly complete list of procedures.

Good luck!
posted by ObscureReferenceMan at 2:17 PM on September 27, 2005

I had to pass two stones over the summer [one sent me to the emergency room]. My advice... stock up on vicodin and phenergan. Other than that, just go into it with a positive mindset and realize that you are about to experience a sensation like none other.

I'm 21 and vegan, but I don't know what caused the stones. Oh well.
posted by cloeburner at 2:21 PM on September 27, 2005

Good luck, Jon. Don't lose too much of your testiness, that's what we love you for.
posted by matildaben at 2:27 PM on September 27, 2005

The testies are nowhere near the kidneys, matildaben.

jon: I don't have anything to add to docpops' analysis, but I wish you good luck!
posted by ikkyu2 at 3:06 PM on September 27, 2005

Ow, jon! Sorry to hear that. Here's hoping for a complete and speedy recovery. And good drugs.
posted by fandango_matt at 3:19 PM on September 27, 2005

Jon, I've heard great things about lithotripsy, but of course, you and your doctor will have to decide on the best course of treatment. In the meantime, I wish you good luck and above all, Don't Panic! ®
posted by Lynsey at 3:28 PM on September 27, 2005

As someone who suffered a few years ago, you have have my complete and utter sympathy. I had five days of complete pain, like a javelin in the side. My innards spasmed and throbbed, and I pissed merlot. I didn't have a heart attack like Swearingen on Deadwood, nor did anyone put their finger up my ass, but it was exactly that kind of writhing. On the fifth day I lay on the floor, groaning and grimacing, in a hallway at one of the places I worked for an hour before finally giving in and going to the emergency room. The docs there did little for me; in fact, their inattention and carelessness about the whole affair made me send long scathing letters of rebuke to everyone involved. In any case, I had to pass the stone on my own at home. It meant long periods of feeling like I had to urinate but not being able to--but I still had to go to the toilet and stand there, just in case it wasn't a false alarm. In order to actually be awake and functional, I popped ibruprofen four at a time instead of taking prescribed Tylenol 4. The stones eventually passed (and I swear other bio-matter came out with one of them). I probably still have others but they have not been problematic. Longer version.

A number of women have smugly told me, "Now you know what it's like to have a baby." To which I always respond, "Yes, but you didn't have one five times in a week."
posted by Mo Nickels at 3:31 PM on September 27, 2005

Good luck, jonmc. I'll second the drugs, whatever procedure you choose.
posted by Rothko at 3:54 PM on September 27, 2005

My old man just called, he said that when he got his they sedated him and did some procedure that was painless, and ahalf hour he was comfortably eating lunch, he didn't know the name. He said that the "crushing," procedure was uncomfortable.
posted by jonmc at 4:18 PM on September 27, 2005

another vote for the drugs...been there twice now (every two years, it appears)... hurts like hell for days before they pass..... there is no way to make it sound nice......

I typically don't take medication, but was popping pills as quick as I could.....

good luck, jonmc..... and hang in there....
posted by HuronBob at 4:54 PM on September 27, 2005

Jon--

Ask if lithotripsy is an option. You may have to undergo it several times. Likely they will place utereal stents during this period. If so, expect irritation but the stents allow the ureters to heal while stone is being beaten to a pulp with lithotripsy. The other option (depending on the size of the stone) is percutaneous nephrolithotripsy. This is usually used for bigger stones and it's a "bigger deal". I would ask how many perc. nephrolithotripsy they do a year, and what the success rate is if they suggest this procedure. If they suggest lithotripsy, ask how many treatments they expect you'll need, (each one requires going under anesthesia) and the likelihood of coming out with stents (stents are temporary).

You want to ask them to send the stone off for analysis. This will then show the composite and the doctor can better advise you on the cause. Some people are just more likley to get them.

I'm an OR R.N.. None of the above is medical advice. Just suggestions on what to ask about and scenarios I have encountered.
posted by 6:1 at 5:04 PM on September 27, 2005

jon, I'm gald you finally got to the doc, I wish it weren't the way it is, good luck.
posted by OmieWise at 6:02 PM on September 27, 2005

ursus_comiter- gotcha. Thank you for the correction!
posted by jmd82 at 6:31 PM on September 27, 2005

I'll second the recommendation to try to get the stone analyzed. A number of years ago my Dad decided that he should cut down his coffee intake. The problem was that as his coffee intake went down, his tea intake went up. Soon after, 2 kidney stones followed over a relatively short interval. He managed to catch the second one, they had its composition analyzed, and he was told that it was high in oxalates. They gave him a list of foods high in oxalates, and sure enough tea was on that list. He cut out the tea and has been stone free ever since.
posted by epugachev at 6:59 PM on September 27, 2005

jonmc,

I'm literally (TODAY) at the other side of this. Don't play tough guy and show that you can handle the pain. This is true torture. Take whatever meds you get offered. There is no danger of this being medical advice, since I'm a patient.

I'll try to summarize.

March - pain 5/10 (I recognized the discomfort from 5 years prior).

Films show: 3 stones... 8mm, 13mm and 9mm.

Your stone was about the same size as mine (large, but not giganormous)

Pronosis. Stones less than 4mm pass about 80% of the time on their own.
Greater than 8mm pass less than 10% of the time. Surgical intervention was going to be necessary.

These were the options presented to me.
1) Extra-corporeal lithotrypsy. Soundwaves that get translated to the stone, fragmenting it to being small enough and then excreted. This process is pretty easy, overall. I mean I could handle doing it on a friday and back to work within a week.

2) laser lithotrypsy. They go in (YES, A TUBE GETS PLACED IN YOUR WINKEE)..and shatter the stone that way. It's be a truly painful and horrible experience.
The advantage of this, is that they can tell exactly what goes on.
A stent (holding open the bladder, preventing scarring that would cause further complications).

3) Laproscopic surgery. Go in via the back, very small hole, remove or crush the stones that way.

4) general surgery. They try to avoid this as much as possible.

Those are presented in the order of difficulty and invasiveness.

I had done #1 twice (may and july) and still had a problem. My stone was nestled into a diverticulum (a small pouch) off the edge of the kidney

#3 was not an option - as my stone was so high up that there was a 30% chance of hitting a lung.

#2 was the process that happened 8 days ago. I'm still recovering (and off from work)
Really horrible. Like pissing sandpaper that's on fire and covered in battery acid after. The stent was really, really uncomfortable. And when it was removed today I had a horrible reflex cramping that's going on right now (pain 9/10)

Good news:
They're going to drug you up in the mean time without any reservation. Opiates, percocet and others will be dealt out by the handful. Be aware, Schedule III narcotics require hand delivery of prescriptions. Don't put yourself in a position where you don't have drugs to make it through a weekend.

I'll repeat myself - Don't play tough guy and show that you can handle the pain. This is true torture.

Questions you should ask:
What can be done about the pain
What plan of action are you going to take?
How well will your plan of action deal the stones (sucess rate?)
How much work will I need to miss?

If anything sounds complicated, get a second opinion, right away. it's likely that they'll agree, but if you feel that anything invasive (#2 on..) at least get someone else to reassure you.

Afterwards, given the size of the stone, they'll probably want to do a 24hr urine analysis to see if they can determine a reason that your body chemistry is creating the stones. They can come from a number of sources (so, suddenly drinking lots of orange juice is not a good suggestion) Don't worry about this now.
posted by filmgeek at 8:34 PM on September 27, 2005

ps. the stent gave me horrible problems - it came out fine...but I had horrendous cramping. Almost went to the hospital it was so severe.
posted by filmgeek at 8:35 PM on September 27, 2005

Mo: I know someone who has passed both a kidney stone and a baby, and claims the first was more painful. Certainly I didn't enjoy having a kidney stone.

They may offer you morphine. Yes please.

I asked about having my stone broken up by ultrasound. (I'm sure it was much smaller than yours -- 3mm maybe?) The doctors were loth to do so, because that meant it couldn't be analyzed.

Getting the stone out the urethra wasn't nearly as bad as getting it down the ureter (up west of the belly button). The recently inflamed urethra than spent a day sending false "you have to pee" signals. It's annoying but nothing like the ureter step, easily the worst physical experience I've ever had. (It was also annoying to travel with a pee-soaked strainer.)

Mainly I want to stress that the actual passage of the stone isn't such a big deal, so you won't be living in fear "the worst is yet to come".
posted by Aknaton at 9:30 PM on September 27, 2005