The kinds of rolling stone I don't like
March 21, 2011 12:39 PM   Subscribe

Reducing panic/phobias before surgery to remove a kidney stone. Snowwwflakes inside.

So. On Friday I went to the health division at work because I thought I was having severe cramps/issues due to my period and basically just wanted something to take the pain away. They did some blood tests and a urine test. They then sent me to the ER because the red blood cells were too high to count.

Turns out the kidney stone that I thought came out over three weeks ago was actually still inside me.

Went to the urologist today. They want to do surgery (Lithotripsy, I believe he said) on Friday. I thought it wasn't invasive, but apparently they have to shove something up my urethra (I'm female, btw) and put in some stents.

Okay. So. Problem is. I suffer from severe emetophobia.

Here's what's going through my head:

1. If I have the surgery, maybe the general anesthesia will make me sick when I wake up
2. If I keep drinking tons and tons of water, maybe the kidney stone will move much more and THAT will make me sick
3. If I start to get severe pain again and I take these painkillers, maybe THOSE will make me sick.

I should mention that I have yet to be "sick" (knock on wood five thousand times) with the exception of two alcohol-related incidents in which I was barely conscious.
And I have taken many many medications as an adult without side effects. Back then I was on medications for anxiety/panic... so I wasn't such a nutcase like I am now.

But even with this logic, I'm still having panic attacks and obsessing over this.

I've had about 1-3 panic attacks a day since Friday. Anytime I feel somewhat uncomfortable, I fear that I'm going to sick in relation to this stupid kidney stone. I'm not worried about complications with the surgery or the pain but I'm afraid of throwing up.

Basically I need some reassurance that I can get through any/all of this without getting sick. I know that everyone is different and you obviously cannot guess that I will/will not get sick.

Or maybe some ideas on how to handle the panic.
(Currently not insured; I'm on a waiting list to see therapist)
posted by KogeLiz to Health & Fitness (13 answers total)
Best answer: Did you mention your extreme phobia to your urologist? Perhaps she could also prescribe something for your anxiety?
posted by crankylex at 12:50 PM on March 21, 2011

I will reassure you that you can get through this!

I would recommend that you apply the techniques of visualization and relaxation that are prescribed for other phobias. Check the airplane phobia and claustrophobia websites for tips. You need to learn to derail the panic attacks, which, essentially, are all the same across the phobia spectrum. And which you know very well are imaginary! The longer you indulge them, however, the more deep-seated they become.
posted by RJ Reynolds at 12:54 PM on March 21, 2011 [1 favorite]

I went through this last fall, I ultimately had to have lithotripsy done twice.

Let me put it to you this way: If I hadn't gone in for the first lithotripsy operation, they wouldn't have found that the stone was obstructing the ureter on my left side, and that the kidney was infected to the point of being septic.

As sore as I was afterwards, it's very much a dull pain, and after being on painkillers for a month straight, I got through the first recovery just on advil.

(ultimately, I was too infected to remove the stone the first time, and they put in a stent and put me on nuclear antibiotics, I had to go in for the second operation two weeks later to remove the actual stone)

I didn't throw up, not even once.
posted by Oktober at 12:56 PM on March 21, 2011 [1 favorite]

Best answer: When you discuss this with your doctor, you can also float the idea of preemptive anti-emetics. They are very effective and may be indicated in this situation. Of course, your doctor will be the one who has enough information to decide.
posted by charmcityblues at 1:06 PM on March 21, 2011

Absolutely bring this up to your doctor! You might even go with, "I am sure I am going to throw up!" rather than explaining the phobia. Doctors don't want you to throw up on them, either, believe me. And, as charmcityblues says, there are anti-emetics that can help. The last thing you need right now is to be having anxiety attacks on top of your kidney problems. Call up the doctor's office today and explain your issues!
posted by misha at 1:42 PM on March 21, 2011

Response by poster: Thanks for the advice, personal experiences so far.

I neglected to mention, When I was at the ER, I asked for an rx for anti-emetics.
It helps curb my panic slightly. I've only had to take two pain killers since the last trip to the ER. Both times i only took half and took one of these anti-emetics with it.
They gave me something called Promethazine - apparently it's mostly for allergies or something... so seeing that it was mainly used for nausea made me feel less at ease.
But in any case, I took one of each about an hour ago and so far I feel fine... and pain has subsided.
posted by KogeLiz at 1:49 PM on March 21, 2011

Best answer: IANAD, but once upon a time I worked in surgery as an orderly.

Lithotripsy is a fairly quick procedure, and it's one of the better procedures in that pain after surgery is usually lower than pain before surgery, and this alone can make post-op much easier.

Before surgery do not eat or drink anything for the time stated, usually around 8 hours before surgery. Try to keep on liquids only for 12 hours. Do not have anything in the morning before surgery unless instructed (such as medication and a tiny bit of water to choke down a pill). This will help with post-op.

Call your doctor and let them know that you have emetophobia. More importantly, tell anesthesia that you have emetophobia. The anesthesiologist and anesthetists are the ones who ultimately have the best chance of stopping any or all of it. They would rather dose you with anti-emetics than deal with you having post-op issues. They may also give you other medicines to calm you before and after surgery, so that if you do wind up getting sick, you might not really notice or remember it.

Lastly: Phenergan happened to be my favorite anti-emetic/anti-nausea drug both as an orderly and patient. It's biggest side effect is drowsiness and sleepiness, which makes for lots of sweet dreams.
posted by Mister Fabulous at 1:55 PM on March 21, 2011 [1 favorite]

Yeah--lithotripsy is not bad. The only vomiting I ever had with kidney stones was after trying to tough one out without medication. I got an anti-emetic when they were giving me piles of vicodin, and it worked a charm.

Nthing to tell the doctor. They will very likely do whatever they can to have you not make a fuss. The general anaesthetic was not in the least bit nauseating to me, though.
posted by LucretiusJones at 2:09 PM on March 21, 2011

The Relief Band is also supposed to be quite effective at reducing post-surgical nausea.
posted by holterbarbour at 4:21 PM on March 21, 2011

Best answer: I know exactly what you are feeling! I've had a history of doing the exact same thing, whenever I've felt any slight discomfort I panic so terribly that usually it ends up making my stomach even more upset, and that makes the anxiety even worse and on and on. With regard to your immediate situation, I would do like everyone has said, speak with your md and tell them about your anxiety, and separately tell them you are scared that the sedatives will make you sick. They should be able to solve that before its a problem. If you decide to opt out of the procedure and try to pass them you can ask for a medication to counteract the nausea with the pain meds, I work in pharmacy and its definitely common to have those medications paired. I will say with regards to long term, once you get back on insurance I would speak to your md. I've had that problem my whole life, and just thought I was out of luck and was going to be like that forever. However, I told my doctor I had a lot of stomach issues and I thought it may be anxiety related, but I didn't want to take anything that would sedate me, like benzos. After a bunch of tests to make sure I didn't have any real issues they ended up prescribing me an SNRI (seratonin/norephinephrine reuptake inhibitor) , which can be used for depression or anxiety issues (i've never had any depression issues). I wasn't too keen on being on a daily medication at first but I have to say it has worked wonders. Occasionally I still have problems but nothing like before, and its possible something similar could help with yours long term :)
posted by Quincy at 4:35 PM on March 21, 2011 [1 favorite]

Data point: I had the kidney stone and the lithotripsy.
The pain and nausea from the pain of the stone were worse than the procedure.
I agree: inform the doctors of your fears.
posted by Drasher at 5:31 PM on March 21, 2011

Best answer: About 20 yrs ago I started having panic attacks during particular medical exams. Here's what I ended up doing:

1. started a "relaxation practice" - doing progressive muscle relaxation exercises and deep breathing exercises every day, similar to this site's recommendations: Relaxation Techniques for Stress Relief

2. did specific visualization exercises about the exam situations - imagining every step in detail and stopping to use the relaxation techniques at each step so that I stayed calm

The relaxation exercises really pay off if you do them regularly and thoughtfully. I ended up retraining my reflexes for those situations, and if I start getting upset or feel a panic attack coming on, I'm able to derail it by doing the breathing exercises. The regular relaxation exercises also reduce your overall stress hormone levels, which means you're less sensitive to the stimuli that trigger the panic attacks. It may sound woo woo, but I swear, it works if you put in a little time and regular practice. I still use these techniques a few times a year, and it always helps.

Make sure the nurses and drs you see that day know you're afraid of this, esp your anesthesiologist. He/she can check on you post-surgery and give meds for nausea if you're a little green. I don't think you're that unusual, my best friend has the same problem, so don't let that keep you from telling everyone both pre- and post-op about your phobia.
posted by hms71 at 8:28 PM on March 21, 2011 [1 favorite]

I heard from a hospital nurse that the new go-to drug for nausea is Zofran. She said it's better than Phenergan or Compazine. Ask for that?

Also, have you ever tried a benzodiazepine for anxiety? Perhaps some Valium or Klonopin the night before and day of the surgery would help you out. Ask your doctor if it's appropriate for you. You mention you're uninsured - I know my generic Klonopin is like $8-9 for a month's worth at Walmart.
posted by IndigoRain at 3:01 AM on March 22, 2011

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