A Kidney stone Experience

It all started on a typical Maui fall day, with beautiful trade winds and sunny skies over the Kapalua Golf Course. Me(Tom) and my wife Teresa were about to start the ninth hole when i had to go to the bathroom.

I was standing over the urinal and noticed blood in my urine. Confused as to what i should do, i decided to just finish playing golf without mentioning anything to my wife. Needless to say, I didn't have a good score from that point on, anyways.

Back at the hotel i was still urinating blood, but decided it could wait until i returned home to California the following day. There were no other symptoms, no pain, no other indications. Upon returning to California, i went to see a urologist who asked me to have a kidney ureter bladder (KUB) x-ray done, which documented that i had a kidney stone.

My stone were so big it couldn't pass from the kidney to the ureter (the tube from the kidney to the bladder). The stone was approximately 8 mm, while the average inner diameter of the ureter is 4 mm. My doctor scheduled a lithotripsy, a treatment where shock waves are used to break up the large stone into smaller pieces that can then pass through the urinary system. It's about an hour of pounding, so when i woke up, i was sore, It feels like someone has been punching me in the kidney a couple times.

Upon waking up, i was told the procedure was successful. I was given a prescription for Vicodin, which i decided was unnecessary, since i have been through surgical procedures before without pain medication. I was told that this situation was different, but i left the hospital at 4 p.m. anyway without filling the prescription.

Yes i did  later regretted my decision. At 10:30 p.m., I was in the emergency room on my knees begging to be given anything at all, the only way to describe the pain is to have a little man with a razor blade, hacking at the ureter. I was given drugs and told to stay in the hospital, where i stayed for a day and a half. After being sent home this time, i started taking the Vicodin every four hours.

By the time Sunday evening came around, 24 hours later, I had not slept, I walked the whole time, back and forth through my house. I couldn't sit down, and I was taking the Vicodin every hour. I was completely overdoing it. I was also taking medication to help take the tension off the ureter, but used in combination with the Vicodin, i soon had a drug conflict, which i describes as an "LSD trip."

I was hallucinating, people were talking that weren't there. The next morning i had to call my doctor, unable to stand the pain and unable to continue the medication. He had another KUB x-ray done to me and while looking at the results, i began to feel relief from the pain.

My doctor determined i had passed the stones, although they hadn't actually come out yet. He determined the stones had moved to the bladder, and when i returned home, they did came out. I figured it was over, but as months went by, i started having an urge to urinate that wasn't there before.

Whenever there was urine present, I immediately had to pee, then over time it got worse and worse. Then my bowels got messed up, tightening from the tension, always having to go to the bathroom. After a number of x-rays were done, i figured it was a kidney stone. He was put on several medications to control his bladder and bowel. The doctors thought it was trauma, but it kept getting worse. Then one day i was having lunch with a friend, who was also a urologist. He said, 'Boy you don't look good,' and I told him I'm having problems with the trauma that occurred from the kidney stone last year.

After hearing my symptoms, he told me he thought i might have a kidney stone lodged right on the nerve, right at the base where the ureter comes to the bladder, a place that wouldn't be visible in an x-ray. The next day i had my urologist order a CAT scan. When the nurse came back in she said, 'You must be in a lot of pain.' She explained they found a 4 mm kidney stone right where my friend thought it would be—lodged on the nerve at the base where the ureter comes to the bladder.

I next underwent a procedure to go through the penis, in through the bladder, then up to the ureter. The stone would be lasered into pieces and removed. However, upon undergoing the procedure, my doctor discovered my ureter was not in a good condition. It had been beat up by the stone, It had been festered.

He left a stent in my ureter to make sure it would heal properly, but for me, the pain of having the stent was just as bad as having the stone, and i wondered if the problem had really been solved. For two weeks, I had to look forward to going back to the doctor's office and have something go up through the penis and through the bladder to pull the stent out.

After two weeks of anticipation, the day finally arrived. The doctor used a device that resembled a plunger for anesthetic. The device was put through the canal, through the urethra, then through the bladder. The nurse held my feet to keep me calm while the doctor inserted a small, firm tube into my penis to the urethra to give an opening for the device used to pull the stent out. The experience as uncomfortable, but not painful. After about two minutes, my doctor was able to pull the stent out. I anticipated more pain and discomfort than there really was, coming out was nothing. It didn't hurt at all.

After being sent home, i was told to take it easy for a couple days. Within a 24-hour period, all the problems i had been experiencing for the last year completely went away. When the stone was analyzed to help determine the cause, my doctor found it was a soft stone, made up mostly of calcium, and i found out later that my body naturally produces a high amount of calcium. This put me at risk for developing kidney stones.

Another factor with my stones was that i wasn't drinking enough water. Today i make a point to drink lemon water every morning because the lemon will have an effect on any stones that have begun to develop during the night. It's never how much water you drink, but it's how and when you urinate, at night when you go to bed, you have an eight-hour period, so there's an opportunity for the calcification to occur at night.

Although my problems went on for over a year, i have been fine since my last procedure. It was just like a miracle, when they lifted that thing out of there, it was life-changing.

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Kidney Stones

Kidney stones (renal lithiasis) are small, hard deposits that form inside your kidneys. The stones are made of mineral and acid salts. Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

Passing kidney stones can be quite painful, but the stones usually cause no permanent damage. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances, surgery may be needed. Your doctor may recommend preventive treatment to reduce your risk of recurrent kidney stones if you're at increased risk of developing them again.

Symptoms

A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur:

• Severe pain in the side and back, below the ribs
• Pain that spreads to the lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Pain on urination
• Pink, red or brown urine
• Cloudy or foul-smelling urine
• Nausea and vomiting
• Persistent urge to urinate
• Urinating more often than usual
• Fever and chills if an infection is present

Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.

When to see a doctor

Make an appointment with your doctor if you have any signs and symptoms that worry you.

Seek immediate medical attention if you experience:

• Pain so severe that you can't sit still or find a comfortable position
• Pain accompanied by nausea and vomiting
• Pain accompanied by fever and chills
• Blood in your urine
• Difficulty passing urine

Causes

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that keep crystals from sticking together, creating an ideal environment for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:

Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Your liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate.

Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.

Uric acid stones. Uric acid stones can form in people who don't drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.

Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).

Other stones. Other, rarer types of kidney stones can occur.

Treatments and drugs

Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptoms

Most kidney stones won't require invasive treatment. You may be able to pass a small stone by:

• Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
• Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
• Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms

Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more invasive treatment. Procedures may include:

1. Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (SWL). SWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable. SWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.
2. Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. You'll receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if SWL was unsuccessful or if your stone is very large.
3. Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
4. Parathyroid gland surgery. Some calcium stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result. Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that's causing your parathyroid gland to overproduce the hormone.

Prevention

Prevention of kidney stones may include a combination of lifestyle changes and medications.

Lifestyle changes

You may reduce your risk of kidney stones if you:

• Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water. If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.
• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes.
• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn't have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals.
• Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

Medications

Medications can control the amount of minerals and acid in your urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:

• Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
• Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalinizing agent may dissolve the uric acid stones.
• Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
• Cystine stones. Cystine stones can be difficult to treat. Your doctor may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn't help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine.

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