It was 2 a.m. on Mother’s Day when the pain awakened me.
The searing pain started on my right side but over the next couple of hours moved about. Sometimes it seemed to emanate from my lower abdomen; other times it circled around to my lower back.
Was my appendix blowing up? Had my stomach turned inside out? It was when the pain turned into what felt like a series of electric shocks and jolted me out of bed that I knew: kidney stones. I had last felt that pain a dozen years ago, when I had a tussle with a stone or stones that eventually made it out without medical intervention — other than the pain medicine I got at the ER.
So we celebrated that Mother’s Day by me asking my wife to drive me to the emergency room at 4 a.m. By the time we got to the hospital, the pain had subsided. But a scan showed I did indeed have a kidney stone lodged in the ureter, the narrow passageway between the kidney and the bladder; the pain, I was told, likely resulted from the stone pushing its way out of the kidney.
Kidney stones, as the Pikes Peak Urology website explains, are formed when salts and other minerals in urine stick together. They typically vary in size from a sugar crystal to a golf ball. The intense pain usually results from a stone being stuck in a certain position in the ureter and the resulting pressure in the kidney due to urine backup.
“All of my women patients who‘ve had stones and babies, they’re like, ‘Give me another baby, it hurts less,’” said Dr. Jeffrey Moody, a kidney stone specialist with Pikes Peak Urology.
Kidney stones affect about 10% of people in the U.S. and dehydration is a key risk factor. Studies have shown people in hot, humid Southern states are more likely to develop kidney stones, but the risk of dehydration — and thus stones — is increased in “high and dry” Colorado as well, Moody said.
At the ER, I got meds in case the pain came back (it did) and was urged to arrange a follow-up visit to a urologist. An appointment with Moody, and another scan, revealed that a stone was still lodged in my ureter on my right side — while two other stones, at a size that made it unlikely they would make it out on their own, lurked in my left kidney.
“In general, people only make one stone at a time,” Moody would tell me later, but I was what he called “an overachiever.”
Moody performs about 250 ureteroscopic procedures a year to demolish and/or remove kidney stones, and I was about to be one of those cases. Such procedures involve the insertion of a small tube — the ureteroscope — into the urethra and up through the ureter to the kidney. (The good news: You’re under anesthesia.) My procedure was a bilateral one — meaning Moody had to go through both ureters, because I had stones on both sides. (“Lucky you,” one nurse told me.)
Moody, my surgical report states, used a “Bagley semi-rigid ureteroscope.” That was used to deliver a “20-micron holmium laser fiber” that zapped the stones with laser energy.
Basically, Moody says, “we made dust” that later would be flushed out through my urinary system.
There are other treatments available. The size and position of the stone, a person’s anatomy and other factors determine which treatment is used, Moody said. On the less invasive side is ESWL, or extracorporeal shockwave lithotripsy, in which shock waves from outside the body are targeted at a kidney stone, causing the stone to fragment, similar to the laser. On the more invasive side is percutaneous stone removal, in which a scope is inserted through a small incision in the back to remove the stones.
Any of those options sound preferable to the old days, which involved open stone surgery when the surgeon makes an incision in the patient’s abdomen or side to reach the kidney and remove the stones.
“When I first started, my oldest partner had done hundreds of open stone surgeries.” Moody recalled. “I have done probably three in my career.”
Open stone surgery requires a week or so in the hospital to recover. In my case, I left the outpatient surgery center an hour or so after waking up. I had a souvenir, though: Moody had inserted a ureteral stent on my left side — a thin tube placed in the ureter to help drain urine from the kidney.
My left ureter was “somewhat snug,” the surgery report notes, and Moody wanted to make sure the flow of urine wasn’t cut off by swelling in the ureter. The stent was removed a week and a half later in an outpatient procedure that was not pleasant but was quick.
So my key question for Moody was: How do I keep this from happening again?
No. 1, he said: Drink lots of water.
So how much water?
“What I tell people is drink typically another 16 to 32 ounces a day of what you drink now,” Moody said. “So a half liter to a liter more. However much you were drinking before, you made a stone, so let’s boost that.”
Also monitor calcium intake. Calcium oxalate stones are the most common type of kidney stone. In the old days, patients might have been told to avoid calcium completely, but oddly, either too low a level or too high a level of calcium can increase the risk of kidney stones, Moody said. There’s “kind of a Goldilocks amount that’s just right,” he noted.
Oxalates are a compound found in many foods, from healthful ones such as spinach to not so healthy foods like potato chips. Eliminating high-oxalate foods can help reduce the risk of kidney stones, as can reduction of sodium in the diet, Moody said.
If I don’t make changes, there’s a 50% chance of developing another troublesome stone in the next five years, he explained. With changes, that risk is reduced to 5%.
For further motivation, I asked Moody what was the largest stone he ever had to remove. He recalled one 4 inches or so across — “imagine the palm of your hand.”
Double ouch.
This content was originally published here.
