*Coping with Kidney Stones*
By: Spitfire
24 October 2005

First let me say that I sincerely hope that neither you nor anyone you know ever needs this information. I tolerate pain well, having been cut, stabbed, bruised, crushed, burned and even stitched up without anesthesia, but *nothing* hurts as much as kidney stone pain. If you develop a kidney stone and medical help is not available, youíll want to know this.

For some background, the common types of kidney stones are crystals that grow inside the kidneys. The most common form of stone is formed from calcium in combination with either oxalate or phosphate. There are also stones formed from uric acid. Iíve had both calcium oxalate and uric acid stones. The stones Iíve had range from the size of a grain of sand to the size of a large cooked grain of rice. This doesnít sound very big but because of the crystalline structure there are dozens of extremely sharp points and edges sticking out of the stones. Imagine taking a grain of rice, sticking razor blades and needles in it and sending it through your Ureter (the tube that connects your kidney to your bladder)

The pain is caused by three main mechanisms. First, the sharp edges of the stones cut and slice as the stone moves through the Ureter. Second, the pain causes tiny muscles around the Ureter to contract until they cramp, causing more pain. Over time that pain can cause major skeletal muscles to cramp up and even sprain. If the stone completely blocks the Ureter, urine backs up and causes pain that way. The good news is that kidney stones will usually pass by themselves over time. If yours doesnít, itís beyond the scope of this article and you better hope you have a doctor on your team.

Indicators of a kidney stone attack may include a dull aching pain in your side or lower back. You may feel bloated, gassy or constipated, but no amount of peeing, farting or pooping relieves the feeling. Your pee may or may not have blood in it, displaying as red or orange in color. The first kidney stone I ever had started with a gassy cramping that progressed to a dull aching pain and then to the real pain. All the rest of them have skipped the gassy cramping stage and started with a dull ache, and then the real pain has started. You wonít mistake the "real pain". Imagine someone punching you in the stomach, kicking you in your private parts and then stabbing your side with an ice pick multiple times - itís worse than that! The first time you get one of these things youíre going down and youíre going to be curled up in a ball on the ground gasping for breath. It feels like something important has broken inside. If youíre really lucky the pain will be intense enough to make you projection vomit. After the first time you may not go down but anything within arms reach is in serious trouble and you may still need something to hurl in!

OK bro, *that* sounded like fun, now what about treatment? If the hospitals are functioning I highly recommend the ER. Theyíll hook you up to a large bore saline IV and as soon as theyíre sure itís a kidney stone theyíll squirt some Demerol in it which will take the pain down in less than a minute. Unfortunately theyíre also using the IV to try and push the stone out (never worked for me) and this causes more pain as the urine backs up. They may also inject a couple of tubes of radioactive liquid in you and then do X-Rays so they can find the stone and see how big it is. This is handy, especially the first time, but after several of the things I learned that my stones didnít need surgery and would pass when they were good and ready to pass. (Mine usually get stuck where the Ureter narrows and then again at the opening to the bladder) By the way, if they do need to intervene because the stone is too big they can sometimes blast it with sound waves and if not they can put a probe in through your bladder into the Ureter and try to remove or crush the stone. My urologist strongly recommended against this as long as I could manage the pain and I took his suggestion.

No hospital? I suggest that part of your medical preps include some moderately strong pain killers, and I donít mean aspirin, Advil or Tylenol. Weíre talking Percocet or Morphine here. After youíve had one kidney stone, any urologist worth seeing will give you a script for at least 30 tablets of either. Percocet served me fine for years but recently they have made me vomit so my doctor switched me to instant release Morphine tablets. The key to effective pain pill use is to take them at the first sign of pain. If you wait until youíre a puddle on the floor they just donít work as well. If you manage to capture a stone and get it analyzed your doctor may be able to prescribe a pill that helps keep them from forming. Urocit worked fairly well for me but ended up causing horrible acid reflux so I had to stop taking it. And no, they donít have anything to dissolve an existing stone, at least nothing theyíre telling me about.

No meds? The pain can still be managed. WARNING - be careful here folks you could drown or burn yourself. I once had a urologist from an unspecified Middle Eastern country who was supposed to be on call in my AO the weekend I had my 4th kidney stone attack. The POS called back six hours after I phoned his emergency service (repeatedly). He was three states away at a golf resort and couldnít prescribe any meds strong enough to help with the pain over the phone. He did however clue me in on a technique that has worked for me every time (thanks for waiting until the 4th time Iíve had this to tell me ya lousy, oh never mind I fired him anyway).

Run the hottest bathtub of water you can stand and get in. Make sure your abdomen (tummy through crotch) is covered. If the pain subsides, great, if not add more hot water until it does. If you run out of hot water or if you have your water heater set to a low "safe" temperature you may need to boil water on the stove. One gallon should be enough to add to the water already in the tub. This works best if youíre already in the tub and someone else pours the boiling water in, being very careful to not pour it on you. I usually draw my legs up to my chest and my wife pours the boiling water in at the other end of the bathtub. At any rate, when the water is hot enough the pain should subside within a few seconds. Be very careful now, itís easy to get too hot and pass out. I keep a *plastic* water bottle on the edge of the tub and drink every few minutes. If you get dizzy, sleepy or notice your skin turning bright red, you need to get out right away, pain or not. Depending on the severity of the attack, this technique stops the pain for between 20 minutes and several hours after I get out of the tub. If water is an issue, leave it in until youíre sure you wonít need it, that way you can just add more hot water.

If youíre prone to kidney stone attacks you need to drink lots of plain water, especially during an attack. A minimum of Ĺ gallon per day is recommended and more wonít hurt anything. With any luck at all the stone will pass within a few days, although Iíve had three now that took over two months - those got stuck at the bladder opening which doesnít hurt so much. For you men especially, put your mind at ease, once it gets in the bladder you can stop worrying, itíll pass through your penis without much trouble at all, in fact unless youíre paying attention you probably wonít even notice it passing.

Well, not a fun subject but hopefully useful if you ever need the information.
Spitfire



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