Post-lithotripsy pain in the legs, several days after procedure?
March 6, 2014 6:31 AM   Subscribe

Have you ever had a lithotripsy? I got one (torso) on Monday for kidney stones, and while things seemed fine for the 48 hours following the procedure, starting yesterday afternoon I've been experiencing intense, radiating pain in my upper legs and hips. Enough that I can't sleep, even with hydromorphone painkillers. I've left a detailed message at the urologist's, but while I wait to hear back, I'm wondering if this is something in the realm of "normal" or "super weird" or even "Emergency room stat". This is Quebec, so I'm not incredibly optimistic about the doctor getting back to me promptly, either.

Pain does seem to respond to the painkillers, which reduce it from "holy shit" down to "ouch, this is an annoying throb". I'm not good at knowing when to worry or not about medical stuff, but this seems really... odd, given that the procedure was performed on a part of my body about eight inches north of where the pain actually is.
posted by Shepherd to Health & Fitness (11 answers total) 1 user marked this as a favorite
Yes, any weird, extreme, post-operative pain is an emergency.

So go. Now.
posted by Ruthless Bunny at 6:32 AM on March 6, 2014 [2 favorites]

IANAD/IANYD, and I don't have any specific knowledge of this procedure, but I agree that this warrants a trip to the emergency room, now.

I would say in general with medical problems, when things get worse rather than better, that is usually a sign that you should see your doctor. If you add on to that severe pain (and anything that prevents you from sleeping would certainly count as severe in my book), not to mention a recent procedure involving a vital organ, then that's enough to raise this to the level of seek medical attention right away.

Better safe than sorry.
posted by litera scripta manet at 7:36 AM on March 6, 2014

I'd suggest calling 8-1-1 and asking a nurse about it. They're available 24/7 and can tell you whether you need to visit the ER immediately.
posted by randomnity at 7:51 AM on March 6, 2014 [2 favorites]

Go to the hospital, now. You shouldn't be having extreme pain post-procedure. I'm guessing they gave you aftercare instructions or talked about them, and I'd be willing to bet 'extreme pain' is one of the 'dial 911' signs.

It's Quebec. You're covered. Go to the nearest emerg (or, better, the emerg of the hospital where you had the procedure; continuity of care is a good thing) right now.
posted by feckless fecal fear mongering at 8:28 AM on March 6, 2014 [1 favorite]

I'm going to head into Emerg, I guess... dragging my feet because where I live, at least, there's a six- to eight-hour wait to see a doc if you aren't literally bleeding all over the place. Maybe I'll get lucky, but English people in French towns who aren't in a state of obvious physical distress (as is, there is a knife visibly sticking out of you or some sort of limb at an obviously wrong angle) usually get to watch the queue cycle three or four times before you get called in. I'll bring several books and a pillow and prepare for a long camp-out.
posted by Shepherd at 9:59 AM on March 6, 2014

It can be normal - you'll be passing the stone fragments for a few days. The reason the pain is lower than your kidneys is that the ureters (tube the stones have to pass down to get out) pass from the kidneys down your flanks to your bladder which is in your pelvis. That said, if it's severe, or has been going on a few days and isn't improving, it's worth getting checked out in case a fragment has got stuck somewhere on its way out.

Doesn't need to be emergency room stat, but it does need assessing by a doctor within the next 24hrs or so. You may need an ultrasound, so go to wherever in Quebec you would go for one of those if you can't get hold of your urologist or anyone on their team (in the UK one of your urologist's juniors would usually arrange to see you in A&E or on the ward or you could just turn up in A&E and A&E would ring them to come down and see you, not sure how it works in Canada).

This might be helpful/informative too.
posted by tinkletown at 10:15 AM on March 6, 2014

Just noticed your update - go to the ER in the hospital where your urologist works if that is an option. Most post-op complications go straight to the team responsible in the UK, bypassing A&E. Hopefully Canada is the same.
posted by tinkletown at 10:17 AM on March 6, 2014

There now; unfortunately the admitting nurse confidently declared that it has nothing to do with my lithotripsy so I assume the urologist will not be contacted.
posted by Shepherd at 12:51 PM on March 6, 2014

things seemed fine for the 48 hours following the procedure, starting yesterday afternoon I've been experiencing intense, radiating pain in my upper legs and hips.

Radiating pain in leg and hip sounds like nerve pain, and in both legs and both hips, it sounds like nerve pain originating at the level of the spinal cord.

There is a considerable possibility that lithotripsy from outside the body can have an impact on the spinal cord:
The terminal part of the spinal cord and/or roots of the spinal cord in the upper lumbar spinal region can be deleteriously affected by shock wave energy during the ESWL procedure owing to their relationship with the kidneys. ESWL treatment is common but data are limited regarding the complications of this procedure, especially in neural tissue. As we are not aware of any prior studies about the possible effects of ESWL with regard to adjacent neural tissue, we sought to investigate the clinical and histopathological effects of ESWL on the spinal cord.
Extracorporeal shock wave lithotripsy caused not only haemorrhage but also damage to neuronal structures except the nucleus. Our findings showed that higher-energy ESWL caused more myelin degeneration in the spinal cord. [from experiments carried out on rats]
Pain after 48 hours could be due to inflammation setting in after some disruption of nerves in the spinal cord by the lithotripsy.

MRIs are good at detecting the myelin-related problems in the spinal cord caused by MS, and if I were you, I would ask my doctor about the possibility of an MRI of my spinal cord.
posted by jamjam at 11:18 PM on March 6, 2014

13+ straight hours in emergency and still no doctor. This is why "you should go to Emergency!" type solutions really aren't super great for Quebec.
posted by Shepherd at 11:35 PM on March 6, 2014

Can you call the urologist's office during business hours so you get a live human being?
posted by leslies at 5:29 AM on March 7, 2014

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