I was hospitalized recently for a kidney stone. Kidney stones are small deposits of minerals that form inside the kidney when there is an unusually high concentration of certain chemicals that crystallize and then stick together. Smaller stones migrate into the ureters, then into the bladder, then are expelled when you urinate. Larger stones, however, don’t fit; they get lodged in the ureters, and prevent urine from draining out of a kidney. This is obviously very bad for the kidney. It is also very painful.
I’ve been asked by many of my like-aged friends what the procedures were like, what caused it, how I knew I had one, and how to prevent it. Here are my thoughts on what happened.
The Basic Timeline
(For the purposes of this section, “The Event” is when I decided I needed medical treatment.)
Four days prior to the event, I’d had odd feelings in my pelvic region. (I recognize this is particularly funny phrasing — go ahead and laugh; I did.) It is hard to describe what I felt; all I can say is that it felt like I had a stomach located there, and that “stomach” was “rumbling” as if it were empty and I were hungry. I wasn’t sure to make of these feelings, but they weren’t painful, so I just went on with my day.
Five hours before the event, I developed mild lower left back pain. I’ve had back pain before, and it was 10pm, so I thought I’d take some ibuprofin and go to bed once it kicked in. I also had what I thought was bad gas, so I voided both solid and liquid in an effort to fix that problem.
Three hours before the event, it still hurt, but I thought I could lie in bed, relax, and sleep it off. For the next three hours, I tried unsuccessfully to go to sleep while the pain slowly grew from mild to acute pain, which I still wrote off as having wrenched my back or something. Still unable to sleep, I decided to try voiding again, and when that didn’t fix anything, I woke Melissa and told her I probably needed to go to the hospital.
After driving to the emergency room, I was immediately given a hospital gown to change into and a bed to lie in. Anticipating I would need fluids and pain medication, an IV was inserted:
I was also hooked up to various monitors:
(My blood pressure was elevated likely because I was in a hospital for the first time since being born, worried about my condition, and in some pain.) I was then examined by a doctor, who ordered a CT of my midsection, and the results showed a 7mm stone lodged just inside the beginning of my ureter, close to my kidney.
The size and placement of the stone dictated my treatment. There are various ways to remove lodged stones:
- Smaller stones can eventually migrate down and out. These are managed with pain medication until they pass, which can take a day or more.
- Larger stones must be removed, and are typically broken up so that they can be passed or extracted. There are two ways to break them up: Sound waves, or a tiny medical laser.
- If the stones can’t be broken up, or are in a completely inaccessible location (which is rare but happens 5% of the time), then the final recourse is to cut open your back, then further surgery to remove them.
Luckily I didn’t fall into the rare category. But because my stone was so close to the kidney, they couldn’t use sound waves, so I was scheduled for the frickin’ laser.
The actual procedure goes something like this:
- A stent is inserted into the affected ureter, with one end in the kidney and the other end in the bladder. It is a thin hose with perforated holes near both ends so that urine can drain into the bladder around the lodged stone, which brings the kidney out of immediate danger. You want this, because it isn’t always possible to get the stone out during the procedure, and you want to be able to pee semi-normally while waiting for the second attempt, which could be few days.
- The stone is located with a scope, then a medical laser blasts it into pieces. Thank the gods of fiber-optics for that bit of medical technology.
- The pieces are then extracted, and sent off for analysis. The analysis usually returns a few weeks later, to be discussed with you and your urologist; the mineral makeup of the stone can be used to determine what caused it and possibly how to prevent it.
- The stent is left in 2-3 days to facilitate healing, then removed either at home or at the doctor’s office.
You are, thankfully, knocked out for this. Knowing the procedure — the stent is inserted exactly as you think it would be inserted — I would have insisted on it.
After I recovered (which didn’t go well; more on this later), I was sent home, where I rested for an additional day. Two days after the procedure, my wife helped remove the stent, which, again, is done exactly how you think it is done. It wasn’t painful, but it sure was unsettling!
Expect the unexpected
The above sounds very routine, which it mostly was. The surprises for me came after the procedure itself. Here is a list of things that surprised me:
- I did not come out of anesthesia very well. Some people wake up slowly and act drunk, crack jokes, act silly, etc. Others wake up normally as if nothing had happened. I fell into the relatively uncommon category of people who wake up atypical; in my case, I was panicking. I felt very anxious, like my brain was racing without a limiter, and my heartrate was elevated. Melissa described my actions as if my body were trying to process trauma signals, but the actual pain itself was being blocked by medication, so my body wasn’t sure how to process everything else. I tried to sit up and walk it off, but I was on a lot of pain medication that made me very dizzy and nauseous, so I couldn’t get up. For at least 8 hours afterwards, I oscillated between this state and sleep.
- Pain medication has enough goofy side effects that I will consider going on much less of it if this ever happens again. For example, my urine was discolored a bright orange color for days. The pain meds also gave me constipation; I had my first normal movement four days after being admitted to the hospital. Then, the constipation turned into diarrhea for a day after that. What fun!
- I was extremely tired for up to a week afterwards, despite getting plenty of sleep every night, and never actually having been cut open. It felt similar to recovering from a bout of the flu, where you are tired all the time and slightly short of breath. I took this as evidence that my body had some healing to do even though I was never cut open, which goes to show you that any invasive procedure usually incurs some trauma that the body has to spend time and energy healing.
- The IV insertion point stays with you for a while. Over a week later, I still had a bruise and marks from the surgical tape. Nearly two weeks later, I still have the marks from the tape, and scrubbing doesn’t seem to remove them:
Statistics show that people who get one stone have a 50% chance of developing another in the next 5 years. (That is why this article is somewhat negatively titled “1.0”.) Lifestyle changes (mostly dietary) can help reduce this. While I haven’t yet gone over analysis results with the urologist that performed my procedure, he told me after the procedure that he had quickly examined a piece and was fairly certain it was the most common type of stone (calcium). To reduce the changes of another occurrence, I was advised to:
- Drink more water to dilute the amount of uric acid produced
- Eat less salt
- Avoid “dark” sodas (coke, pepsi, dr. pepper, etc.) as these contain phosphoric acid as a flavor additive. (Phosphoric acid has been shown in some studies to assist stone production.)
As I only enjoy dark soda, I’ve essentially given it up completely, and replaced it with water, sports drinks, and tea. I have to be careful about the tea, as some processed teas also adds phosphoric acid. Read your food labels, kids. Also: I’m not fond of tea.
I was sad to give up pop. It was my only vice; I don’t drink alcohol or coffee, smoke, or do pharmaceuticals. I drank it every day, and I am really going to miss it. I may still have once a month or so; perhaps as a treat at a restaurant.
I still think it’s really cool that a medical laser was fired inside my body