Kidney stone and no insurance...What can I do?
May 8, 2013 6:28 PM   Subscribe

I don't have insurance and I seem to have collected a kidney stone. Already seen a doctor, but what more should I do?

I'm just going to start out by saying that I'm scared witless.

Started out with pain yesterday afternoon that kept me awake practically all night. It got so excruciating by this morning that, after driving to work and cancelling my classes, I took my rolling, crying self to a critical care clinic because I know they're cheap. The doc shoved around on my stomach and back and checked my urine...turns out that I had blood in my sample and am presenting as a kidney stone patient. They don't have scanning machines or ultrasounds there, so he gave me anti nausea meds, Percocet and something to encourage urination, with the admonishion to go to the hospital tomorrow if the Percocet doesn't do much. Basically, supposed to wait and see whether I pass it, and if that doesn't look like its happening, hospital up.

I do not have any insurance at all. I'm in the US, 30 years old, a lady, drink too much coffee and smoke cigarettes but exercise semi regularly and eat well. I can't afford all the fancy scans--I barely afforded my scripts today. I'm trying to make the Percocet last longer by also smoking marijuana (it's ok, I live in WA state), but I know it's going to run out before I want it to nonetheless. I have 18 more pills left.

The doc couldn't give much information as to when this will be over. Basically, a couple days to a week, and I swear I'll die if this takes a week. We have no idea how large it is and whether it'll actually pass at all. So, I have a couple of questions:

Should I be running head first into the debt of going to a hospital anyhow? I feel like I must be sorta ok if a doctor felt comfortable sending me home with some pills and orders to drink water, but I'm spooked anyhow. He said that I needed to hospital-up if I stopped peeing, but still felt as if needed to, and/or if the pain increases (I can't imagine that pain being worse than it was, so ok sounds reasonable).

If it turns out I am physiologically able to "flush it out", will that part hurt worse than it has thus far? I can manage the kidney pain with the medicine, but I'm afraid of the pain being worse right before it gets better, and running to the hospital (($$$$$)) just to expell it into their toilet instead of my own.

Should I be smoking pot? Will that make it worse somehow? I'm scared and angry about the no insurance thing, since it functionally means I lack access to the contempory method of treatment. Would bassy loud music placed against my torso help, or is it not vib-ey enough? How about a Hitachi Magic Wand? I'm desperate here, and admittedly a little loopy. I hate pain, and this is really scary.
posted by zinful to Health & Fitness (16 answers total) 2 users marked this as a favorite
Poor sweetie. It's terrible, isn't it? So many of us have been there.

You might be able to pass it without pain. My first stone I had all the terrible abdominal pain, then actually passed it without even noticing. (This was while I was in the hospital, being monitored and doing a urine catch with a fancy strainer.) A different time I needed surgery after trying for a month (!) to pass one. So there's really no way to say.

The brassy music and wand? Well, it's not going to break up the stone, if that's what you mean. But maybe it'll give you some relief? Or psychological relief? Other ideas: heating pads, hot baths.

Do drink LOTS of water. Do eat what you can, so those pain pills don't make you barf. The pot - judge yourself. Is it helping your pain? Or is it making you feel extra sensitive?

The hospital: the best thing to know right now is that hospitals dig payment plans. A family member went through a complicated surgery without insurance, and paid the hospital $25 a month. Forever. But the hospital really didn't care. As long as she paid that $25 a month they were cool.

Lastly, who's keeping you company right now? You need a little babying...from a significant other, friend, family member. Call on someone. Lean on someone. Now's the time.
posted by BlahLaLa at 6:37 PM on May 8, 2013 [3 favorites]

I would suggest getting an imaging test. Your kidney stone may not pass on it's own and that should show if it's stuck.

Agreed with the above, figure out a payment plan. They will work with you. Most hospital financial staff are nice, they deal with it all the time.

Also yes, lots of water. From now on you need to keep up on drinking more water. Get yourself a good water bottle and a Brita pitcher or something, keep a water notebook if you have to until you get used to it. You can check online for how much water you should drink for your weight. You should be urinating every few hours and urine should be lighter to clear. If your urine gets dark or you can't urinate, that means going to the ER.

Experience: Had/(have?) chronic UTIs and 2 kidney infections.
posted by Crystalinne at 6:46 PM on May 8, 2013

Smoking pot will not make this worse. It might not make it better, though.
posted by kamikazegopher at 6:47 PM on May 8, 2013 had a bad run in with kidney stones last year. What I learned is that the attack occurs as the stone tries to pass from the kidney into the bladder. Once it is in the bladder, the pain should diminish substantially. In my experience, there was NO PAIN passing the stone. In fact, if I wasn't given a screen mesh to catch it while urinating I probably would not have noticed it.

My attack occurred in the middle of the night (very common because we tend to be dehydrated at that time). I took myself to the ER that morning in extreme pain. I was scanned which confirmed the stone and given some meds. And I passed the stone later that evening. So the entire process from attack to passing the stone was about 24 hrs, but your time may vary.

I will say this. The advantage of going to the hospital and getting a scan is that they can determine the size of the stone and whether or not it needs to be physically broken up to pass it. As your doctor said, having a large stuck stone blocking the urinary tract can be dangerous, and I am sure extremely painful.

And drink LOTS of water. I drink a large glass right before bed to stay hydrated through the evening. But yes...I usually have to make 1 trip to the bathroom in the middle of the night but that is an OK price to pay to avoid another stone.

Good luck...this to shall pass!
posted by Seymour Zamboni at 6:48 PM on May 8, 2013 [2 favorites]

Pills and water and waiting is kind of the thing that happens with a kidney stone. I've been there, and it makes you want to die. I'm sorry you're going through it, but the pain is de rigeur for this kind of thing. Been there, and I never want to be there again.
posted by xingcat at 6:48 PM on May 8, 2013 [1 favorite]

Have had a couple kidney stones so can totally sympathize - misery! I did not get a scan with one - was pregnant at the time. You want to make sure you don't develop a kidney infection since that can make you very sick. So - take your temperature every few hours while this is going on too. If you run a temp you should definitely at least go back to walk in clinic. As long as you can manage pain and keep hydrated and fed you can go for a few days - if those things - particularly pain management and staying extremely well hydrated - become a problem you should go to the ER I'd think.

I did not notice passing either of mine - once they get into your bladder you're usually ok unless they are really big. It's often advised that you pee into a strainer to try to catch the thing because its make-up can give useful information about how to avoid future stones. Some kinds would result in being told to change your diet. Sorry - I can't remember the useful details on this part.

Feel better and do get some moral support while you're going through this!
posted by leslies at 6:55 PM on May 8, 2013 [1 favorite]

Been there twice... I found that 800 mg Motrin was more effective in relieving the pain than the narcotic pain reliever the Dr. suggested.

Lots of water, hang in there, this too will pass.
posted by HuronBob at 7:10 PM on May 8, 2013 [1 favorite]

If you need to see a doctor again, perhaps this would be useful - it's a database of health centers for people without insurance:
posted by needs more cowbell at 7:33 PM on May 8, 2013 [2 favorites]

I've had them two times, in my anecdotal experience... 1st time I went with the surgery 2nd time with pain medications. Both times it took me about a week to recover. The meds where obviously less intrusive. This may or may not work, but the second time I started drinking a lot of acidic liquid. (lemonade, cranberry juice etc) with the hope that it would break up the stones faster. that may or may not have helped.

In the future (as it is likely I will get them again) I plan on skipping the ER completely and getting my Dr to give me strong pain medications.

Hard to notice them when they actually pass.

good luck, sorry for your pain
posted by edgeways at 7:37 PM on May 8, 2013 [1 favorite]

I'm an emergency department doctor, but not your doctor and cannot comment on your specific case. But I can give you some information in general on patients with kidney stones that you might find useful:

- For stones less than 5mm, the treatment is pain medication and time. (And some people use Flomax, which is probably the other script you got). That's regardless of what insurance you have.

- For stones >=5mm, they are less likely to pass spontaneously. It can still happen but it is less likely, especially the bigger the stone is. These are the stones that may require treatment with surgery or lithotripsy. Such treatments are not used for small stones, they are not necessary. Lithotriptors use shock waves to break up the stones and they have special machinery that focuses the waves on the location of the stone. No kidney stone is going to be cured with a home vibrator or music. Can you imagine playing music at a stone and having the stone break into pieces? I think that was the Percocet talking, my friend. If a person has a large stone that cannot pass spontaneously, there is no other way to get it out aside from treatment by a urologist.

- Typically, we CT scan anyone who has never had a stone before. People who have had stones in the past do not need to get CTs every time they have a stone. There is one other way that you can be fairly certain you're dealing with a stone and how much it's obstructing the ureter, aside from CT scanning and aside from checking for blood in the urine (which isn't always present). If you have an ER doc who is familiar with ultrasound use (not all of us are), your ER doc can scan your kidneys with the ultrasound at the bedside to see if the kidney is swollen from the stone obstructing the ureter. You are more likely to find someone who can do this at an academic medical center. The ultrasound does not usually cost money because ER doctors doing ultrasounds is a pretty new thing and in most hospitals, we cannot get privileged to charge for it. However, the ultrasound cannot be used to visualize the stone itself, just to look at the effects of the stone on the kidney. In any case, this would mainly be done to just confirm the diagnosis of kidney stone, not to decide a course of treatment for the stone.

Major dangers with stones: not being able to keep down fluids and keep down your meds, getting an infection with the stone (i.e. fever), pain worsening despite the Percocet, or not urinating. Patients who have these symptoms should probably not bother going to a walk-in or urgent care, because of the potential need to be admitted to the hospital.

I would also note that an office visit with a urologist would likely be much cheaper for a person than going to the ER. However, the urologist may refuse to see a person who doesn't have a kidney stone confirmed on CT scan. And an outpatient visit isn't appropriate for anyone experiencing worsening or new symptoms without a definitive diagnosis.

Final word to the wise: remember that trying to "cut costs" by avoiding appropriate medical workups and treatment can seriously backfire on you when your medical condition deteriorates due to inappropriate care, and you end up hospitalized or worse.
posted by treehorn+bunny at 7:38 PM on May 8, 2013 [14 favorites]

If the Percocet stops helping, or if you start running a fever, or if you're still feeling this after several days, or if you start to feel at all worse in any other way, go to the hospital. I say this as a fellow someone with no insurance and no money. Here's why: some years ago, when I also had no insurance, I started having the intense pain and nausea that I associate with a kidney stone. I'd had one before and figured it'd be miserable, but it would pass. It did not, and I basically ended up in the worst-case scenario.

The pain let up somewhat, and I soldiered on, ignoring the occasional spikes of pain and figuring that things were ok. After about three days of this, I went from "in pain and occasionally crying but mostly functional" to "nearly unable to stand up, feverish, and miserable." After calling around, I got a friend to drop me off at a doctor who did a sliding scale. Waited in the waiting room for a while, feeling dreadful, and finally got called back. Within five minutes, they'd called the hospital to let them know that they were sending one of their nurses over with a severely ill patient who needed to be seen immediately. They put me in a wheelchair and wheeled me to the nurse's personal car, and she just about flew to the hospital.

Turns out my fever was 104 (I didn't have a working thermometer and didn't know), my pulse was over a hundred, and I had a massive, massive kidney infection. I don't remember most of what happened, other than that I was in the hospital, intubated, and then heavily sedated. I was in the hospital for almost a week, and even with the limited amount I remember, it was one of the single most unpleasant experiences of my life.

This is not the typical course of things for people with kidney stones, especially ones that turn out to be smallish, but I leave it here as a friendly (if scary) reminder that if things seem to be getting worse, just go to the hospital. I've yet to be in a hospital that doesn't have some sort of assistance program for people without insurance, and even if they don't, this probably isn't something to fuck around with.
posted by MeghanC at 7:51 PM on May 8, 2013 [8 favorites]

Thanks to MeghanC for providing the perfect illustration of my point. Stone plus infection is an emergency, and not a minor one. It can turn into sepsis (a bloodstream infection) fast. Only thing to add is I'm sure she meant to type "This is not the typical course of things for people with kidney stones". Just to be clear.
posted by treehorn+bunny at 8:36 PM on May 8, 2013

[Edited MeghanC's comment by request to add the missing "not"]
posted by jessamyn (staff) at 9:44 PM on May 8, 2013 [1 favorite]

I've had ~ a dozen kidney stones. Most would pass, some wouldn't. I've had ESWL and stents three times. The first few times I went to the ER, they usually just gave me some morphine and waited it out.

One key trick that I've found is that VERY aggressive walking and VERY hot showers both relieved the pain a fair bit. Try to avoid taking a bunch of liver-damaging painkillers if you can avoid it (I did this, I think.)

Often, the stone is pulverized by the time it gets to the bladder. The pain presents differently as it goes down the ureter so I can tell how long I have left by how it hurts.

Consider getting a KUB x-ray if you can't get a CAT scan. You'll at least see the size of the stone.
posted by joshu at 1:04 AM on May 9, 2013 [1 favorite]

If you need to go to the ER and simply can't pay, just go. You will probably get this thing dealt with, and your credit rating will take a major hit for a few years while the hospital sends you letters with increasingly bold fonts. (This is assuming that even a payment plan is beyond your means, which it may well be.)

Then a few years pass, and the debt gets taken off your credit rating. I know. I've never had a kidney stone (knock wood!) but I had terrible health years ago and I was totally broke. I did the ER thing, didn't pay, and it didn't ruin my life. Homeless and very poor people have to do it all the time. Welcome to the nightmare that is the American healthcare system!

Having bad credit can really complicate your life, but it won't ruin it. It doesn't last forever, and there are steps you can take to help build it back up. (That's another post.)

I am so sorry you're dealing with this. There are way, way too many stories like this happening every day in the US. It makes me wanna spit.

Watch for the danger signs, and if you feel 'em, get your poor butt to the ER!
posted by Ursula Hitler at 4:17 AM on May 9, 2013

Thank you so much everyone! I was so afraid, and my poor partner was at a total loss as far as what to do (except to tell me DRINK ALL THE WATER). I was too zonked out to consistently strain my urine last night, but I don't hurt any longer. I felt a weird twitchy sensation in my bladder at some point that I think was the stone moving along, and this seems in line with what a lot of ya'll were saying. I don't think I wanted to see it anyhow, and couldn't have afforded to have any tests run on it once the emergency "passed".

Bookmarked the links for non-insured people anyway, because now I'm paranoid.
posted by zinful at 11:11 AM on May 9, 2013 [1 favorite]

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