How to survive a kidney stone

I used to scoff at posts like this.  Geriatric wimps, reminding everyone of their own mortality!  Spoiling what precious little time we have left on this life, all those embarrassing biological details – have they no shame?  Well, I am now one of those geriatric losers sharing embarrassing biological details.  Get over it.

For those of you with no interest in kidney stones, and don’t care that your time will come, here is the executive summary of what you need to know:

  • The pain will be in your back, on one side.
  • Hot Tub, Ice Pack, and Drugs.
  • Don’t drink until you know you are able to pee.

There you go.  You are now prepared for the worst physical pain in existence.

For the rest of you who bother reading this far, here’s where I’m going to write about my recent experience with kidney stones.  It’s intended to help others, but will probably just end up being long and boring.  Really, you should probably stop reading now.

Still here?   Ok, here goes.

Kidney Stones

The basics: kidney stones are when stones appear in your kidney and block passage of urine, and it really really hurts.  The pain it causes is worse than childbirth.

Why do these stones appear?  No one is quite sure.  The key seems to involve having excess minerals in the blood/urine, minerals being any pure substance that is solid at room temperature with an ordered molecular structure (a crystal).  For some reason these crystals nucleate and become solids and plug up the tube from your kidneys to your bladder.  It seems to happen more in men, and more when they get older (due to higher levels of iron in the blood?).  Dehydration is a factor.  We know when liquid evaporates, any solids dissolved in the liquid will stay behind – if your body becomes dehydrated, the minerals dissolved in your body are more likely to crystallize.  So don’t get dehydrated – that’s the only advice anyone can agree on.  More on that later.

The key point about kidney stones is the pain.  Oh, the pain.  For men, its like getting kicked in the balls, repeatedly.  It’s someone grabbing your groin, or an elephant standing on them, and slowly grinding them back and forth.  Women, substitute whatever extreme pain you’d like.  Crucifixion is not an inappropriate analogy.  You can’t breath.  You want to die.  I had thoughts of using my shaving razor blade on my wrists.  Thoughts of guns, and heroin, and stabbing myself.  I was punching myself.  Taking a dagger and plunging it into my kidneys would be less painful.

If you haven’t experienced this pain, you never want to.

No one is sure why the pain is so intense.  Some say swollen kidneys, others say blocked urine, others have propounded a ‘stretched urethra’ (the tube that connects the kidney to the bladder).  For me, since the pain is so similar, it is obviously linked to being kicked in the balls.  So something, somehow, is triggering the same nerve.  The only explanation that makes sense to me is the kidneys are so swollen they are pinching the nerve as it runs from your groin up your back.  The kidneys sit along the spine, so it’s making direct contact with that ultra-sensitive nerve, squeezing an area that is normally impossible to squeeze.

For me the pain started slowly, as a mild discomfort, growing and growing over the next ten hours until I thought I was going to die.  This fits with the swelling theory, as opposed to ‘something breaking’ inside where the pain would occur more rapidly.

It’s amazing how little literature there is on a subject that will affect more than one in ten Americans (around 1419% of men and 5-9% of women.  That’s a lot.)  What literature there is, is full of ‘may’ and ‘maybes’ and contradicts itself.  For example, this Harvard study says to take citric acid.  But wikipedia says that increasing acidity is what causes stones.

The most common ingredient in kidney stones is Calcium Oxalate.  So don’t take calcium, or oxalate, or whatever that stuff is, right?  This seems obvious, so obvious that someone tried it and documented the results.  Turns out avoiding calcium did not help kidney stones.  The guys who avoided salt did better.  None of the studies mention Oxalate, which is found almost everywhere, mainly in nuts and chocolate.  And no one seems to have tried avoiding beer, which is the main source of Calcium Oxalate!  One study even says drinking a lot of beer every day helps!  Calcium Oxalate is sometimes called the ‘beerstone’, as it forms naturally inside beer breweries.

So there’s really no solid research on this area which, again, I find perplexing.  This seems to be the most definite study on kidney stones.  I plan on reading more of it later.

I am not alone in my confusion.  Although they won’t admit it, the medical industry doesn’t know what they are doing either.  The first time I went to the hospital for kidney stones (about a year ago) I went to the Emergency Room.  They gave me a drug called Flomax, which I thought helped.  This time I went to the general doctor, Dr. Miso Milosovic at Kenosha Memorial Hospital, who refused to prescribe me Flomax.  He said it ‘wasnt proceedure’, ‘not a good idea’, ‘Im too young for it’, the ER ‘shouldnt have done that’, it was ‘off label’ and insurance companies wont pay for it.

Go to any forum about kidney stones and you will find someone talking about how Flomax helped them.  So why wouldn’t a doctor prescribe it??  It’s got to be the stupid insurance companies telling doctors how to treat people.  Maybe.  This site says that diuretics, which is basically what Flomax is – it increases urine flow – are bad and will increase your risk for kidney stones.  I don’t know why it says this, but the point is that even the ‘authoritative’ sites contradict each other.

As I got up, just now, to go to the bathroom to pee, my urine came out near solid red.  Blood.  My blockage is gone, but now my kidneys, or at least a kidney, is damaged and bleeding.  Great.  Just great.

Time to talk about my kidney stone.

My Kidney Stone

It started Saturday night, after a long evening of drinking.  I had a very strong and nasty Long Island (really, what was up with that, every Long Island is delicious, then out of nowhere comes the worst Long Island I’ve ever had?), and then a strong craft beer, both of which caused the dehydration and excess oxalate and triggered a kidney stone.  I felt a little uncomfortable that night, but it was more of a mild irritation, a sort of itch inside my groin.  It was equivalent to pulling my groin muscle, or food poisoning.  It felt a little funny when I moved or walked, and peeing ‘didn’t feel right’.  Now that I think about it, I was not peeing nearly as much as I should have been for all the liquid I had been consuming.  Anyway, I thought nothing of it.

I went to sleep and then woke with extreme back pain.  It kept getting worse to the point where I was writhing in bed.  Last time I called 911 and an ambulance picked me up in my undies at my door.  This time I knew the ER couldn’t do anything except give me pain medicine and treat me like a drug addict, so I opted to stay home.

First I tried the ice pack.  If you go this route, dispense with the recommended ‘protection’, the covering surrounding the ice pack, and just smack that puppy straight on your back.  Frostbite be damned.  Yeah, it will sting a little but the sting hurts less than the kidney pain, and after about five minutes you won’t feel the ice pack at all.  Move it around a little, up, down a bit, maybe on your spine for a little, maybe on your butt, I even slapped it on my balls once or twice – the end result is a general lessening of pain.  Not a lot – it will go down from a 10 to maybe a 9.5 – but it is enough to let you breathe and think.

I felt the urge to go to the bathroom several times, but each time I tried nothing came out.  This was not normal.  According to the doctors, if there is pain on one side only, therefore kidney stones on one side only, therefore your second kidney should be fully functional.  The only exception is during the very last stage of having a kidney stone, the kidney stone moves into the bladder and then out the final urethra at which point it is blocking both kidneys.  This stage does not last very long, not long enough for both kidneys to be backed-up to the point of pain, and usually is accompanied by a relief of pain as the one blocked kidney is now free to empty into the bladder.

This is not what was happening to me.  I felt no relief.  Only one kidney felt blocked, and yet I still couldn’t pee more than a few drops.  I conclude my left kidney does not work.  But that’s a story for another day.

There was also, in addition to the need to urinate, a need to empty my bowels.  The body, recognizing there is a foreign presence, goes into purge mode.  You feel nauseated, feverish, and have the urge to go.  Standard food poisoning.  The problem is you are in so much pain every muscle in your bowel region is locked up.  You’re just that tense.  Your whole body is straining to relax enough to breathe, and every breath is a new stab of agony – it’s tough to sit on a toilet and relax.

So after a few hours of chills and sweats and fever and straining, I tried a hot shower.  The pain got worse until I tried kneeling.  The sudden change in heat plus the relaxed body position loosened my bowels enough to go.  I recommend it.

From there I discovered that a stream hot water directed at my lower back reduced the pain from a 10 to a 9.  I spent several hours in that position until the hot water ran out.  When the hot water ran out I was in bit of a pickle and spent a lot of time solving the problem.

First, I just used cold water.  Vibration should be all one needs, right?  Nope.  Still hurt.  Sitting in water?  No effect.  I tried a heater in the room with cold water.  Bad idea, because when the hot water comes back, you get overheated.  I contemplated a hair dryer but worried about electrocution problems.  I had a silly mental image of hanging the room heater in front of the shower nozzle and running the water over it to heat it up.  Maybe a mild electrocution would help?  But nothing worked – it had to be hot, and it had to be a stream.

So I went back to bed with a hot pack and beat my back, expecting to achieve the same results as the hot shower.  Strangely it did not help.  I hit harder.  I rubbed.  I vibrated.  I rocked.  I writhed.  It only seemed to make things worse.  Was I imagining the benefits of the hot shower?  I went back to the shower which now had hot water.  Sure enough, it helped reduce the pain.

Here is how to make the hot water last longer:

First, if you have a hot water heater in the basement, go turn up the heat to max.  Plug the shower (so you will get a layer of hot water in the bottom).  Run the shower on you until you feel the reduction in pain.  Turn off the water to give it time to get hot again.  Just kneel in hot water for a while, five to ten minutes.  When your back starts getting cold, roll over and put your back in the hot water.  The fetal position on your side also works.  Do this until the pain starts returning.  Then turn the water back on.  In this way you can make the hot water last indefinitely.

I founding that kneeling with a straight back worked best (doggy position), but it was hardest on the knees.  Putting head down (Muslim position) didn’t matter.  Leaning back on my haunches and arching my head backwards (uh.. howling wolf position?) helped only briefly.  Head touching my knees (fetal position) worked well.  It provided decent pain relief with not much energy needed to maintain the position.  Fetal position on the side was not quite as effective.  It did not seem to matter which side I laid on.  Same for laying on back – not as effective.  My theory for why this is so is you need to use gravity to help the stone along.  If the stone has to fight gravity, it will hurt more.

At this point my mother got sick of my groaning and suggested I use her tub which has a whirlpool-like feature.  This was a lifesaver.  Thoughts of razor blades and suicide went away.  I highly suggest a hot-tub with directed-jets-of-water to everyone with a kidney stone.  If you’re in Europe you can use one of those sweet detatchable-nozzle thingys every shower has.  If you don’t have one, get out to the local sports club or pool and just force your way in.  Get someone to drive you if you must.  Call all your friends to find out if anyone has a tub that shoots jets of water.  It’s worth it.  I know you won’t because you’re in too much pain, but I still recommend trying.

I spent the next three days in the tub.  Here’s a few silly things you can do to pass the time:

  • Waterproof your phone.  Ok, so this requires planning ahead, but it would let you use your phone in the shower, which is perfect for kidney stone sufferers.  Also great for the guy whose got everything.
  • Ice pack on head.  Now turn up the heat in the tub.  How hot can you go?
  • Practice staying very very still.
  • Scrub the tub.  Mr. Clean magic erasers work miracles.
  • Rearrange towels under you.  Your knees and butt will get sore.  Putting a towel under you helps, but you need to rearrange it every now and then – even the fluffiest towel gets creases that will dig into you.  You can try folding them into triangles, or hexagons, whatever.
  • Stick your thumb in your ear and listen to your heartbeat.
  • Put your ear against the side of the tub and listen to the vibrations.  You can eventually distinguish which vibrations are coming from which pipes!
  • Try to figure out how the water is draining from the tub.  Newer tubs seem to have a metal cap thingy implanted in the side of the tub that leaks around its edges.  What happened to the good ol spider-hole style of drains?

My mother also filled me full of tea, since every piece of advice about kidney stones says to drink lots of water to ‘flush it out’.  A piece of advice – if you are going to sip from tea someone hands you in a thermos, do not do it while lying back.  You won’t be able to spit it out in time and will burn your entire mouth.

But back to drinking lots of fluids.

On Drinking Lots of Fluids

Here I disagree with the doctors.

I do not ‘need flushing’.  Do I look like a toilet to you?  If I am in excruciating pain due to kidneys with too much fluid, does it make sense to push more fluids into me?  If you have constipation, do they tell you to eat more?  No.  Obviously not.  I say let vibrations and the fluid that’s already there do the work, and leave the poor kidneys alone.

If you are going to drink, make sure you can pee first!  I could not, hence I made the pain worse.  By worse I mean it spread to my stomach, since the pain in my kidneys could not get any more severe.  I drank so much liquids, about eight tall glasses, four or five liters, I could feel my stomach distending and the liquid pushing its way up my esophagus into the gorge of my throat.  I think I permanently damaged something with all that liquid.  I mean, five liters going into the body, and nothing coming out (except through sweat)?!  Not good.

After a day or two of this stomach pain I couldn’t take it and tried to force myself to throw up.  I was not successful, but the attempt helped, and I think the change in pressure helped move the stone because shortly after that I let out a massive fart, was able to pee, and the pain subsided.

The night of the third day, after trying to throw up, the stone passed, and the pain lessened from a 10 to about an 8, meaning I now felt like I had been kicked by a horse.  My stomach slowly stopped hurting as well.

However the pain was still there, and still fairly strong, and the whirlpool and ice packs and drugs did not help as much, and so after a day of this, this now being the fourth day, I decided to go to the hospital.

The Hospital

I didn’t want to go to the emergency room (see above note about being treated like a drug addict) so I called my doctor, Dr. Milosovic and told them to take me now or I am going to the emergency room.  They said they would call me back.  I told myself I would give them ten minutes then I’d leave.

They called right as I was about to head out the door.   The nurse said they scheduled some tests – an x-ray and a urine sample – and it was up to me if I wanted to take them.  I don’t really know what that means.  I wish they had just told me what to do, not left it up to me.  But I felt obligated that since they had ordered tests for me I should take them.

So I went to the X-Ray department instead of the emergency room.  I had x-rays, I gave some urine samples, then I went back to the doctor’s office.  They told me to wait.  So I waited.  And waited.  A receptionist came out and I explained my story again, she said she would talk to the doctor.  I waited some more and then a nurse came out and asked my story again and again said someone would talk to the doctor, and I should continue to wait.  No definite ‘he will see me’ or ‘he wont see me’, not one way or another.  Just wait.

Waiting, waiting, waiting.  While waiting my mom called around and pulled some strings (She works at the laboratory) and got the tests processed extra-fast, else I might have been waiting a day or more.

They finally called me in.  Not sure how long it took.  Next time I will insist on a time limit, say, one hour, and if I’m not called in by then I will go to the Emergency Room downstairs.

The doc looked over the tests (X-rays showed nothing, there was blood in the urine, no sign of an infection) and then ordered a CT scan for me, which is what he should have done in the first place.  The CT scan was done very fast, within ten minutes, and the doctor got the results over his lunch break.  An upset patient (“You Lied To Me!”) walked out while I was waiting, leaving his appointment time available.

The CT said I had two more kidney stones, one entering the urethra, the other still in the kidney.

Here the doctor told me I was not about to die, there was nothing to do except take pain killers, drink lots of water, and go home.  He did not prescribe me Flomax even though I asked.  So I went home, I took pain killers, drank lots of tea, and sat in the hot tub.

Later that night the level-10 pain started up again, the pain that makes you want to die, the ‘renal colic’.  That was the second kidney stone the CT scan told me about.  By now I was an expert at pain management.  More on that later.  I also had a new prescription of Vicoden and anti-nausea pills from the doctor, and taking them along with some old Oxycodone I had from my knee surgery, I was floating on the clouds and able to eat for the first time in four days.

Drugs

By the way, the maximum recommended dose for the Oxycodone was 2 pills every 6 hours, and I was pushing that to the max.  For kidney stone pain, don’t hesitate (like I did) to take the drugs.  Don’t try to find ‘the right dose’ or be afraid of overdosing.  Just immediately take the maximum dosage.  Don’t be afraid to mix the Vicoden with the Ibuprophen with the Oxycodone and Acetemetophin and Aspirin.  Just do it.  It will stop the pain.  So what if it causes liver damage?  You already have kidney damage, and the longer you wait the worse its going to get.  Livers can heal from almost any kind of damage.  Don’t be afraid.  Overdosing on pain meds is not that bad.  You feel a sort of pressure on your chest, maybe like a hand is squeezing your heart, but its not painful, you’re already struggling to breathe, and its nothing compared to what you’re going through with the kidney stones.  Don’t tell me you like pain!?  Take.  The.  Drugs.

At the most extreme moments of pain, if someone had offered me a shot of heroin, I would have accepted.  Well, maybe not a shot.  Maybe a pill.  Fun fact:  did you know Heroin was originally and legally sold in pill form?  It was invented by Bayer and marketed as a “non-addictive Morphine alternative”.

Levels of Pain

At some point the pain dropped to a level-8 style pain which lasted a few hours before dropping to a level 3.  I conclude that the level-10 style pain is when the kidney stone is in the upper part of the urethra and only blocking the one kidney, and the level-8 style pain is when the stone has passed through the bladder and is in the lower urethra.

For the level 8 pain, the bladder is taking the swelling now, not the kidneys, which is something the bladder is designed to do.  So the pain is less, and lasts less as the lower part of the urethra is shorter, more flexible, and can take more pressure.  And then the stone passes, the pain subsides, and you merely feel like you got kicked by a goat.

The pain doesn’t instantly vanish.  We are talking about draining fluids here so it happens gradually and it is almost a surprise as you realize you haven’t groaned or it didn’t hurt to breathe that time and you check your pain and suddenly its not there.  You had been avoiding deep breaths, avoiding thinking about the pain, pretending it wasn’t there, that it is now difficult to cast your thoughts in its direction.

When do you know the stone passed?

The only sign to say ‘now is the moment of the passing of the stone’ is that you had to pee.  It won’t be a huge pee.  Maybe just a trickle.  And there won’t be a stone, nothing you can see anyways.   The size of the stone is just a few millimeters, and it slowly wears away as it grinds its way through your tubes, and when it actually comes out its maybe the size of a grain of sand.  It dissolves in your urine too.  At best you will probably see little ‘flakes’, which might be the pieces of the kidney stone or it might just congealed blood from your kidneys.

But the important thing is, the pain is gone.  All that’s left is a low level pain, the residual aftereffects of a distended kidney which needs time to heal.

That brings my story to today, late Thursday / early Friday night.  I am able to pee profusely, not just in little trickles, but great streams of it.  It’s coming out bloody.  This alarms me greatly, and is nauseating to see, but its normal to have a damaged kidney, and blood is normal when something is damaged, and I am assuming it will heal.  There are little flakes of red that I assume is dried blood, meaning the damage is old.  Some are disturbingly large.  I think that must be skin.  Or kidney pieces?  I have one stone left in my kidney.  It doesn’t block anything, and doesn’t cause much pain, but it’s still slowly damaging the kidney.  Maybe that’s what’s happening here.  If I see fresh blood or it doesn’t seem to be improving I will go to the Emergency Room.

 

What I learned about pain management:

There’s several different types of pain management.  They can be combined, or separate.

  1. Stay very very still. The body can adapt to anything.  Even constant pain, as long as it is consistent.  Eventually the body will tune it out.  The problem here is, you have to breathe.  You are so sensitive, even the smallest breath agony.  I was never able to fully just ‘ignore’ the pain, but it did help to take small breaths and breathe in and out through the nose.  And of course, not move.
  2. Distraction.  This is what it says – you distract yourself with as much stimuli as possible.  This was pretty tough with such severe pain.  Watching TV just gave me a headache.  Texting and the like took too much concentration.  The only thing that worked was extreme changes in heat and cold.  I would turn the water to max hot, then after a while to maximum cold.  Repeat.  During those moments of ‘brr thats cold!’ I wasn’t thinking about the pain.  In bed, writhing was the best distraction.  You try to limit it to your arms or head, not the whole body.  There’s a lot to be said for good writhing technique.
  3. Displacement.  This is moving the pain somewhere else.  It is the old joke where someone says they can cure your headache then punches you in the stomach and says ‘I bet you’re not thinking about your head any more!’  As sadistic as it sounds, it is a valid form of pain management.  You just punch yourself in other parts of the body.  When Jim Carrey was filming The Grinch, the suit he was in was so painful they brought in a Marine trainer and taught him to punch himself in the thigh.  I also had to use this technique while watching The Grinch.
  4. Pressure.  When you get a cramp, you naturally stick a fist into that part of the body and push.  This cuts off the blood flow to the pain cells.  Acupuncture attempts to cut off signals from nerves to reduce pain.  It may be just distraction but it seems to help.
    When I was laying in bed, I found that putting the ice pack into a hard little ball and pushing my back into it helped if I did it in a very specific spot.  It was almost right on the spine, between the spot of the pain and the spine, right where I imagine the kidney to touch the spine.  There’s no actual pain in that spot, but applying sharp pressure there seemed to cut off much of the pain.
  5. Ice Packs.  The simplest and most effective means to reduce the pain of a kidney stone is to slap an ice pack on that kidney.  Why no one else seems to mention this, I don’t know.  Maybe it works for only me.  Ice is a tried-and-true pain reliever, so maybe its so obvious no one feels the need to mention it?  ‘Duh of course I used an ice pack while I had my kidney stone’?  I don’t know.  Doctors don’t mention it, the internet doesn’t mention it…. anyways, use an ice pack.
  6. Drugs.  Oxycodone and Ibuprofen all the way.  Any sort of pain killer.  Start taking them right away and don’t be afraid to take the max dosage.  You’re not going anywhere, you don’t need to drive, you’re just going to be lying in bed anyway, and nothing could be worse than how you already feel.  It can only make things better.  Vicoden made my hairs stand on its edge and ultra-sensitive to light and sound and my own body odor (Or maybe it actually made me smellier?), so I prefer Oxycodone.  Caffeine also is great.  It’s not a pain reducer per se, but it makes you feel better.  So while the pain will be the same, you just won’t mind as much.
  7. Mental focus.  This is a little trick of long-distance runners where they mentally focus on the pain and try to think of it as an external phenomena, something to be analyzed and categorized outside and separate from the rest of the body.  It takes a while, but it does work.  You become extra sensitive to each little spasm and eventually you will find yourself thinking things like ‘oh, that was a super strong wave of pain there!’  Sounds corny but it works.  Just it doesn’t work very well for kidney stones.  It takes a lot of concentration and the pain is just too much.  I found it more effective to lie very very still (#1) and take drugs (#6).
  8. Placebo effect.  Meaning anything you read on some website or advice from your friends how they ‘know someone’ who had a kidney stone and they say ‘such and such’ works great.  Do it.  Eat it.  Whatever.  It will help.  Even if it contradicts common sense or something else, the power of belief can work wonders.  In clinically controlled trials of painkillers vs. placebo, the placebo worked to reduce approximately 3% of pain.

For my kidney stone, I used every one of these techniques together.  Combined with the hot tub, there were rare moments where I didn’t feel any pain at all.  It was almost pleasant.  I’m sure the drugs had a lot to do with it, but lying very very still as a hot jet of water pummeled my back, pushing the pressure point at my spine, an ice pack on my neck while I massaged my temple, all while focusing on the pain and trying to analyze it, worked wonders.  As I write this, I still have a fourth kidney stone that has not blocked anything inside my body.  Its floating around in my kidney and will start moving down the urethra any time now, but I’m not dreading it.  I think I can control the pain.

 

Follow up:

Doctor said I needed to see a specialist, an urologist.  The urologist wouldn’t see me since I didn’t have the right insurance.  Everyone I called said they didn’t take my insurance either.  Apparently it’s straight Medicaid, the poorest persons insurance, and those hoity-toity specialists don’t usually take it.  I just went on my insurance’s website, just now, and searched for Urologists within a 100 mile radius of my zip code.  None was found.  So now I don’t know what to do.  I guess I will just wing it.  If the blood doesn’t stop in a day, I go to the Emergency Room.  Again.

 

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