Sunday, August 3, 2008

Kidney Stones (part 3)

The first time I had trouble with a kidney stone, I went to the emergency room around 2 in the morning, was released to go home around 5am, and the stone passed around midday. The second time, however, the lithotripsy did not break up the stone but just knocked it out. It took a week to pass. The kidney stone had to work its way into the ureter, a very small bio-tube that connects the kidney to the bladder. The stones often obstruct and stretch ureter which causes the severe episodic pain which is felt, as previously mentioned, in the lower abdomen and groin. It is the worst pain I have ever experienced. On top of the pain and discomfort, there is a embryological link with the kidney and the intestines and the vomiting center is stimulated and nausea and vomiting make a very bad situation worse.

My hope is that the stone passes after the treatment because if it doesn’t, the urologist will have to take a more invasive approach. The thought of a laser being threaded up to the kidney is not a pleasant one.

Last Sunday, a week ago today, I woke up and felt pretty good. The family was getting ready to go to church and I went downstairs and sat in front of my computer. When I stood up I felt a twinge of pain and although my first thought was for the worse, I convinced myself it was nothing. By the time I went upstairs I told my wife I would not be going to church. Three hours later, we were back at the emergency room.

I have been to the emergency room several times for this now, that even in my pain, I know what is going to happen. I fill out a form and show proof of insurance. I am brought back to see a nurse and a physician. The nurse takes vital signs and the doctor gets briefed on my medical history by asking dozens of questions . . .the first one is, “how are you doing?”. My pre-programmed response of “I am doing ok” is challenged with “you cannot be doing okay or you would not be here”. After my self diagnosis is confirmed the doctor gives me a brief overview of what they are going to do for me.

I am walked over to another room and a male nurse comes in to chat. He starts an IV and then says he will be right back with some relief. I have no idea what he comes back with . . several vials that are injected direct into my IV. He tells me that he is going to give me a pain killer that will go right to work. I am warned that I may feel a slight burning sensation but it will pass and I am going to feel a heavy weight on my chest. I have no idea what he put into me but it works. It was a rocket ride of sorts and I can fully understand why there are drug addicts now. To go from intense pain to euphoric pleasure and then sudden peace with my situation is a remarkable experience. I am wheeled for an MRI and also for X-rays where it is later confirmed that I do have a 4mm stone working its way from my kidney to my bladder.

I am released from the hospital that afternoon. It will take three days for the stone to be caught in the strainer. There are several more but the fragments are small and it is my hope they can all just pass without incident. My long term hope of relief is temporal, at best. I have read that the recurrence rates are estimated to be around 10% per year, totaling 50% over a 5–10 year period and 75% over 20 years. I am also told that men are affected approximately 4 times more often than women. As my father in law is fond of reminding me, growing old is not for sissies.

Saturday, August 2, 2008

Kidney Stones (part 2)

My urologist uses a lithotripter to attempt to break up the stone with minimal collateral damage by using an externally-applied, focused, high-intensity acoustic pulse. I am glad I am heavily sedated during this process. I am positioned on the apparatus' bed and my back is supported by a water-filled coupling device placed at the level of kidneys. I am not aware of it, but they have also placed a tube down my throat so that I can continue to breathe. Somehow the doctor is able to locate the stone using some type of remote imaging system so he can focus the shock wave on the stone. He will deliver 120 shocks per minute for the next hour or so. I am also very glad that I am under a general anesthetic.

I wake up in a different room. There is a strange awakening that takes place as one regains consciousness. Somehow, the body knows it has been traumatized and the brain is trying to figure out when and where. My eyes slowly clear as I look around the post op area. There are nurses talking and walking about. I spot the clock and it takes extra effort to focus in on the time. It is a few minutes after 5pm . . . my brain starts working the math . . . what time did this start . . .1pm? 4 hours ago? When will I be home? Three hours from now? The nurse comes by and sees how I am doing. I am very thirsty and ask for something to drink. I get a little ice cold can of Sierra Mist. Other than getting the sedative, the cold soda is the highlight of my day. I have not eaten anything since 4pm the previous day and have not had anything to drink for the previous 16 hours.

I lay there for an hour or so. My wife has been talking to me off and on for the past hour but I do not hear much of what she has to say. Things are getting back to normal rather fast with the exception of the feeling that I just did a few rounds with a professional kick boxer.

After laying there for an hour, the nurse tells me I can go home as soon as I can stand up and go to the bathroom on my own. I gather my strength that has been returning ever so slowly the past hour and stand up and slowly walk across the post op area to a bathroom with my plastic bag of clothes. The nurse walks with me and opens the door and unties the gown for me. She also gives me emergency instructions before I lock myself inside the privacy of the oversized toilet area in case I get sick or fall down.

I drop the gown and go to the bathroom and to my horror, what I see going in the urinal resembles tomato juice . . . I get dressed and cleaned up and go back out. My face must have shown my dismay because the nurse sees me and says “are you ok?” My response is not unlike Ving Rhames character ‘Marsellus’ from Pulp Fiction . . “naw, I’m pretty {exp} far from okay” . . . I think it . .but bite my tongue and say “no, I just pee’d blood”. The nurse does not even flinch and responds “that’s normal” . . now, I am no medical doctor but I know that what I just did is not normal but I am dressed and all I have to do is wait for my wife to pull the care around up front and the nurse will have someone push me in a wheelchair and let me go home. Home is close now and I see light at the end of the tunnel so I stay quiet.

We stop on the way home and I get my prescription filled. I also added a couple of 2 liter bottles of 7-Up to the cart. All I needed now was for my wife to take my hurting body home, allow me to take some pain medication and go to bed (which is what I did) and sleep for the next 12 hours.

Friday, August 1, 2008

Kidney Stones (part 1)

The Good Book says we are “fearfully and wonderfully made” but sadly, we live in a fallen and broken world where there is something wrong with everything, my kidneys not excluded. The kidneys, when healthy, filter out waste products from the blood and secrete the nasty’s on to the bladder and then out of the body as . . . well, you know . . . number one . . . pee . . .

For some unknown reason, I am in that 10-15% of adults in the United States that have been diagnosed with a kidney stone. The way I understand it, some of the chemicals found in my urine are able to crystallize, concentrate, and precipitate into solid deposits on the kidney walls to form the ‘stone’. These crystals can grow through a process of accretion to form a kidney stone. My particular stone composed of calcium oxalate crystals.

I have been dealing with kidney stones for the past couple of years. The first time was the result of my stupidity for going on a ‘grapefruit diet’. While I did lose weight, I woke up in the middle of the night about two weeks after I started and felt like somebody kicked me in the groin. I was certain that I had somehow ruptured my appendix while I was sleeping and was soon to be departing this world. The pain was so severe that I rolled out of the bed and fell to the floor, crawled to the bathroom and vomited. I cannot say how long I agonized as time cannot be measured when each second is as painful as the one before it. It was all I could do to get dressed so my wife could take me to the emergency room at a local area hospital.

Having been through this routine in the past, I now realize the situation is not fatal; however, that does not lessen the severity of the symptoms. Last year, right before the holidays, I went to the emergency room in the middle of the night for another kidney stone that had developed. While I passed that particular stone the next day, the x-rays showed that each kidney had a 5-6 mm stone growing. I was referred to a urologist that recommended a lithotripsy which is a non invasive surgical procedure that uses high power sound waves to break the stones up into little bitsy pieces.

My first experience with the lithotripsy was a scary one. I was checked in to the surgical unit and just walking into the pre-op area was a surreal experience. It was kind of like going to the doctor’s office only they made me get undressed so I could wear a light green hospital gown that only covers the front leaving most of my posterior exposed to the draft. The nurse that helped me was very kind and made a world of difference in my experience. She even offered to tie the gown up in the back to provide me some semblance of dignity. She proceeded to take all vital sign measurements and started an IV and answered all the questions that I asked.

My urologist came in and spoke with me and physically marked the side he was working on with a marker.

The anesthesiologist also came and also spoke with me. Anesthesiologists, I have learned, are physicians that have completed four years of graduate doctoral training after gaining a general degree and doing at least four more years of residency. My anesthesiologist had the primary responsibility of protecting me while I was unconscious. I was told all surgery involves some risks and general anesthetics can affect critical life functions like breathing, heart rate, and blood pressure. Little did I know, the one that I only thought of as “the gas man” was actually the one that was there to immediately diagnose and treat any medical problem that arose during my treatment.

When it was time to go, I was visited by a certified registered nurse anesthetist who gave me a couple of shots, a chemical cocktail of sorts, which would sedate me. Things kind of get hazy and surreal after that and I can barely remember being moved from the gurney to the table. I did notice a huge hot water bottle like feature but my brain was to fuzzy to understand what it is or what it is for. I try to see what is happening around me but the chemicals in my blood are making me indifferent to what is going on. I watch an oxygen mask come down over my face and I am told to take some deep breaths and then . . . nothing. No dreams, no visions, no pain or awareness. No sense of time or space. I wondered if this is what it is like to be dead.