• 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:


    • Calcium oxylate. My second one was L-shaped and about .7 long. That was in 1997 and the imaging was via IVP and after it passed and I picked it out of the toilet, it looked just like the shadow on the radiograph. I’ll bet my IVP was a lot less expensive than your new-fangled imaging, too. The most amazing thing was learning that Demerol does not make it hurt less, it just make it so you don’t care which gave me a small insight into heroin addiction.

      • My perception was that it hurt less specifically because I didn’t care and relaxed. I was very tense until I got to the ED bed. I even told the nurse that I thought the placebo effect would be strong enough that I could do it w/o drugs. He gave me drugs anyway. I enjoyed them. 🙂

    • I had that great fortune to have learned nephrology from Dr. Goldfarb during medical school. I will never forget his descriptions of THE PAIN that he and other stone-makers go through, nor the 1-liter water bottle that he would usually have finished by the end of the lecture.

    • I have had more kidney stones than I could possible count. I probably have 5 right now. The largest was a stag horn that filled half my kidney. I have the ultra orphan condition primary hyperoxaluria. I have been to the Mayo Clinic Hyperoxaluria Center (bless Dr. Milliner).

      Working with Big Data, and mashups, I am curious if different retrospective studies might shed light on when these things are likely to occur – why does that Ca+2 combine with C2O4-2 sometimes, but not always. Analyzing social media data (i.e., observational data) – patient self reports with geo & time stamps – could be kinda fun 🙂

      Two last thoughts, a 7-mm stone could def be picked up in an ultrasound. Dr Gary Curhan at BWH specializes in stones. He’s great.

    • I’ve regularly gotten stones on a five year schedule since my 40th. Just had my 5th episode. Yes, as a professional roadie, you try carrying that strainer in your briefcase and pulling it our while on a plane and see what inquisitive looks you get.

      When offered, I had thought the lithotripsy was they way to go. However, it failed to break up MY stone, and I was left with a giant brused back and kidney. Yes, more pain on top of extreme pain if you can imagine that.

      The saving grace is that the pain comes only when the stone chooses to move causing an exteme pain from the ureter spasm. Guzzeling water is recommended because moves the stone, which results in more spasm which results in more pain.

      Go for the “basket catch” procedure. Shorten the time lapse but not necessarily the pain. They go in and get it. Then all you have to do is pass the small clots a week later with almost as much pain.

      Oh the humanity!

    • When I worked emergency 1983-1993, I would use variably-effective IV narcotics and order the time-consuming IVP. By the time I started urgent care in 1993, IM Toradol was known to offer prompt relief of the pain of kidney (or gall) stones and their passage soon after. I never ordered an IVP at urgent care. Why did Dr. Goldfarb and Dr. Frakt not receive Toradol. Is this a manifestation of the phenomenon where medical advances are slow to be accepted?