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Old 09-19-2012, 03:52 PM   #1
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Need advice (and support) on stone situation

I'm so depressed I could crawl into my shoe.

I'm 41, healthy, don't drink, smoke or do drugs, fairly healthy diet. Nevertheless, woke up Sunday morning with lower back pain, called 911 and yep, found out I've got a kidney stone. Last two days I've drank a small lake, taken Oxycodone as needed and monitored for passage.

The ER doc left it up to me if I wanted a CT scan, said he didn't really think it was necessary as I was a textbook kidney stone case and it would probably pass in a few days. But today I went back to get a CT scan, because I wanted to know how big this thing was, and if passing was even an option. The result: it's 4mm, positioned at the kidney/ureter junction and causing my kidney to swell a bit with backed up urine. Said there's about a 60% chance it will pass on its own.

The urology department (who I will see tomorrow) is wanting new urine tests but is already suggesting placing a stent to open up free flow. And then perhaps "surgery" though I don't know if they're talking about endoscopic or traditional through the back (I got this second-hand through the nurse practitioner I'm going through at the moment - I'm in graduate school).

I'm not scared of surgery - I'd be more than happy for them to knock me out and take the stone and save me the further misery of passing it. It's the stent I'm dreading like grim death. One need only google "kidney stent" to be drowned in story after story of how utterly horrible having one of those evil tubes inside you is - even causing pain long after removal.

Can anyone offer me anything remotely hopeful in this scenario (other than "maybe it'll pass" ...)? I'd sure appreciate it. The real kicker is this is keeping me from traveling home, where I'm needed to help my Dad with chemotherapy for lung cancer. When it rains ...

Thanks folks, sorry so long.

 
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Old 09-19-2012, 04:18 PM   #2
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Re: Need advice (and support) on stone situation

There is approximately a 60% chance this stone will pass on its own, and as long as there are no complications (infection, kidneys shutting down, intractable pain) some Dr's will wait up to 2-4 weeks. Since you have obligations at home, you might want to ask about a "basket retrieval" where they go up the ureter with a tube, retrieve the stone in a little basket and pull the stone out. That isn't pleasant, but will get you out of pain, and not waste time waiting to see if it will pass. If you chose to wait, an xray should be done weekly to map the progress of the stone. If it fails to move down the ureter with forcing fluids, an intervention will be needed. I don't think you need to worry about the back approach for a stone this small. 4mm is borderline size on passage. Obviously the smaller the better. Good luck- I hope it comes out. If it does, be sure to save it for analysis so you can do preventive measures to keep from getting more. There are different kinds of stones as to chemical makeup.

 
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Old 09-19-2012, 04:31 PM   #3
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Re: Need advice (and support) on stone situation

Thanks, my understanding though is that even if they did a basket retrieval (can they do one that high in the ureter?) they'd still place a stent. Isn't that usually the way?

 
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Old 09-19-2012, 06:03 PM   #4
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Re: Need advice (and support) on stone situation

I have had kidney stones 5 times,now to find out i have high levels of uric acid,my best way of passing was to double up on the pain meds,drink some tart lemonade take some flowmax,when you get enough pain medicine in you and get relaxed,you'll pass it,dont forget to strain your urine ( so you can have the stones anilized) to see what kind they are.

 
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Old 09-19-2012, 08:38 PM   #5
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Re: Need advice (and support) on stone situation

One thing I don't understand is how my kidney is being blocked by a 4mm stone, when people pass bigger ones than that. It would seem to me that any decent-sized stone moving through a ureter slowly is going to plug it up ... so how the heck is my stone, which apparently hasn't started into the ureter hardly at all, responsible for such a water-tight seal?

My instinct is that unless the urologist tells me the data shows my kidney is in serious danger, that I might just say no to the stent and ask for lithotripsy (without a stent). Does that seem rational? I've just read too many stent horror stories in the last 48 hours.

 
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Old 09-20-2012, 08:53 AM   #6
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Re: Need advice (and support) on stone situation

Lithotripsy may be a viable option and less invasive. The only hang up may be your insurance company not wanting to pay for it if you haven't given conservative treatment a long enough chance (drinking and waiting). I don't know if your urologist would justify ordering litho for a stone this size, as usually they are bigger. It doesn't hurt to ask and given your family situation with your Dad needing your help, they may do it, especially since you wouldn't be in town for followup with a stent in place, and you don't want that anyway. I think it is a good option if you can get it done.

 
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Old 09-20-2012, 08:58 AM   #7
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Re: Need advice (and support) on stone situation

Yes, Lithotripsy would be great - unfortunately, I'll have to wait until Oct. 28 when the machine is in town (apparently there's not one here permanently). That's fine - I don't mind waiting for Lithotripsy, if I can avoid a stent!

 
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Old 09-20-2012, 09:49 AM   #8
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Re: Need advice (and support) on stone situation

Maybe lithotripsy could be done where your Dad is. If he is in a big city, you could go there, help him, take all your records and perhaps get it done there?

 
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Old 09-20-2012, 09:59 AM   #9
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Re: Need advice (and support) on stone situation

It's something to consider. I am almost sure my insurance would never allow that, but you never know - it's worth looking into.

 
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Old 09-20-2012, 02:28 PM   #10
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Re: Need advice (and support) on stone situation

Well, I'm pleased to report some good news. I met with the urologist today for the first time, and the bottom line is the nurse practitioner at Dartmouth, where I attend grad school, completely screwed the story up. (Beyond this, she had the gall to call me this morning and rip me up and down for calling the urologist and getting in today, as opposed to waiting until next week for the appointment, like she instructed.) Turns out, she has the ego of a doctor, but apparently not the intelligence.

In short, the stone is NOT at the top of the ureter in the kidney, like she told me, it's actually right at the bottom of the ureter, trying to get into the bladder! Beyond this, the "swollen" kidney she spoke of, is only a little swollen and the ureter not at all. The Uro says "90%" chance of passing, not the 60% she told me. And as to the stent issue, he said unless I come in in horrendous pain and/or my kidney is going into major problems, there's no need. He said in two weeks, if it hasn't passed, we could probably go in and grab it with the basket with no need of stent at all.

Whew! I am equally relieved and infuriated. The nurse practitioner all but mocked me for wanting an appt with the Uro "for peace of mind" when what I needed to do was wait to see if it would pass. In fact, I got exactly the "peace of mind" I needed and learned the real story, not her version.

At any rate - knock on wood, I may avoid the dreaded stent yet! Passing a 4mm may not be a walk in the park, but at least it's on the 25 yard line already, not getting sacked for a safety in the other team's endzone (and will thus be much easier to grab with a basket). I couldn't be happier about that.

Thank you guys for the support - I'll let you know how it goes.

Last edited by howerd; 09-20-2012 at 02:31 PM.

 
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Old 09-20-2012, 04:17 PM   #11
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Re: Need advice (and support) on stone situation

Great news! You'll know when it has passed, as the pain will suddenly be GONE. So straining the urine becomes even more important then. Once you find it, put it in a RX bottle or tiny ziplock bag to take to the lab to see if it is calcium or uric acid. Health care people need to understand the angst people go thru over these problems!

 
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