What kind of stone maker are you?

Related, I recommend “Cocktail Party Nephrology,” by David Goldfarb. It’s worth a read even if you’re not a stone maker. H/t Karan Chhabra

I make stones. Do you make stones? What kind?

I’m talking about kidney stones (of course). I formally joined the club of stone makers Sunday night. It began with the customary hazing ritual that delivered THE WORST PAIN I’VE EVER FELT IN MY LIFE. Only, it was more painful than that.

Fortunately, the very worst of it only lasted about an hour, which is how long it took for us to wake a dear friend, wait for her to arrive and crash at our house where and while our children slept, whisk me to the Mt. Auburn Hospital emergency department, complete triage/intake, and get me pumped full of drugs. Thank goodness I didn’t have to wait long at the ED, though every minute felt like a minute feels like when a too big stone is scraping its way down too narrow internal plumbing. (I’m talking the ureter here, not the urethra, which is much bigger. [The things you learn in the ED.])

About those drugs: Oh those blissful, narcotic drugs. Can we take a moment to praise the products of the poppy and their synthetic imitations? I know, opioids are associated with all manner of social ills. Those are important limitations. But the strength is that when you feel like your insides are being shredded, they take you to a happy place. The drugs almost make the pain worth it. (Notice, I wrote “almost.”)

The whole episode wrapped up in a few hours, though there may be more to come. I missed one day of work, but that was more precautionary than necessary. The ED experience was about as good as I could imagine. I didn’t even mind the beeping machines, frequent interruptions by the nurse, or the automatically, periodically inflating pressure cuff. Yeah, I was tired and wanted to rest. But I was also on drugs, remember?

The most frequent question of stone makers seems to be, “Did it pass?” There’s only a couple of ways to know. One is to catch it, you know, like a baby. (Aside: The other thing I learned in the ED is that women who have both delivered babies and stones say the pain is comparable. I’m just sharing what they told me!) If you think straining your bloody urine is fun, well, you’re wrong. The drugs, taken as directed, are of no use here. It’s just a pain. To cut to the chase: No, I have not caught mine yet.

Another way would be imaging. Stones show up nicely on CAT scans, which is, by the way, how they know mine is/was 0.7 mm. That is, apparently, kind of large for a kidney stone, though larger is possible. It’s large enough that it may not pass without some help. I have to admit, this kind of help is rather cool. (Follow the link.) At the moment, I have no plans for such help.

My mind has turned to prevention. As great as those drugs are, I really don’t want to do this again. I’ve been collecting and reading kidney stone formation and prevention literature. The first rule is to drink a lot of water. I know there’s been some backlash against the “eight glasses per day” rule. But, you know what, if it’s going to keep you out of the stone maker guild, I recommend it. Just shut-up and drink the damn water. It won’t do you any harm.

Then there are dietary changes. But what those should be depends on what kind of stone maker you are. Eighty percent of stones are calcium based. And 80% of those are calcium oxalate, the rest calcium phosphate. Ten percent of stones are uric acid based. And there are other unlikely stones and rare gems our amazing bodies can make. Ideally, I’ll catch my stone, find out what kind I make, and figure out how to alter my diet accordingly.

Failing that, playing the odds, I’d assume a calcium oxalate type. That would bum me out because it would mean I’d have to cut back on nuts, specifically peanuts (and peanut butter) and almonds. A huge portion of my calories come from these nuts. Sigh. Reducing salt is another recommendation, but I don’t consume that much salt. So I wouldn’t consider this a hardship.

Then there are supplements and drugs. I won’t go there yet.

There are a few studies (but only a few) on these matters. I may blog on them another time, after I know what kind of stone maker I am. Here’s a start:

@afrakt

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