A Kidney Stone Chronicle
By Jerry D. Haight
Between 3 and 10 percent of the population has passed or will pass a kidney stone in their lifetime. For those, it is one of their most unforgettable and painful experience, even greater than childbirth. About half of these will experience their second within a decade of the first. Among the group are the very rare individuals who produce calculi on a regular basis. Coming from a family of chronic stone makers, I pass four or five of these onerous and very painful objects each year but still, each is a unique experience and I never get used to them. One memorable account involving one of these objects began sometime mid November 2008.
It began, with the typical, symptoms; vague, achy and sometimes gnawing, chronic discomfort in the right flank. This first phase and can last several weeks and it ranges in intensity from mild discomfort to agonizing misery. For this stone, it seemed this phase was about three weeks in duration. As the stone worked its way down the ureter, the second segment began.
In this phase, gone were the mild discomfort and antagonizing misery. Gone also were the vague achy and sometimes gnawing pain or discomfort. These would have been a welcomed reprieve from the excruciating sharp breath taking waves of pain caused by the jagged primeval object as it cut and clawed its way through the ureter. This one lasted longer than the typical several weeks and it stretched to five weeks.
During this time, there was lots of trips to the medicine chest and lots of bleeding. But, yes there were periods when it seemed the object was inert and the respite from agony was sorely welcomed. However, experience dictated, more difficulty would come before this stone was history.
Finally, it became time to get help. My father, who was also a frequent stone maker stopped passing stones when one grew into a staghorn (a large embedded stone in the kidney) that destroyed the organ and nearly cost him his life. From the fear of his experience and the fact severe serious maladies can mimic the symptoms of a kidney stone, it is not wise to wait too long before seeking professional help. Accordingly, alerting my primary care physician, she ordered a CT (Computed Tomography). The scan was performed at Tucson on January 8, 2009. In his report, the radiologist reported a small (1mm) stone in the lower pole of the left kidney. He denied any other calculi. This stone just did not equate with what I was experiencing. It was in the wrong side, the wrong place in the kidney and much too small.
The report completely baffled me because for a long period, I had been contending with what experience told me was a stone in the right side. If, there were, in fact, no other stone, what could be accounting for the symptoms and blood? With this in mind, I sought the services of Dr. Steinberg of the Tucson Institute of Urology. He performed an ultrasound in his office. It turned up negative and he told me to return in six weeks if the bleeding persisted and he would perform a cystoscopic exam.
Still in pain, still using IM and oral Demerol and still bleeding, my mind reeled from the news and yet by experience, I knew this was a kidney stone, but nevertheless, I was at wits end, still in need of help. I contacted another urologist and had an appointment in yet another week, but ensuing events would make that appointment moot.
On Wednesday January 14, 2009, several days after my visit with Dr. Steinberg , The stone passed and it was a beauty. It was nearly a centimeter long and 1/2 centimeter wide. All the aforementioned symptoms disappeared along with my faith in the technology surrounding kidney stones. But just what had gone wrong? This was a burning question in my mind so I took a picture of the stone and included it in a letter written to Dr. McManimon wherein I requested a reexamination of the scan in light of subsequent events. The radiologist called me the evening after the review and told me, apologetically, he had now seen a stone in the right ureter, thus resolving this question. But other questions would surface surrounding the same CT and ultrasound and would also include a KUB (flat x-
Shortly after passing the stone, I began phase one of still another stone, this time it appeared to be from the left side. Surely it had to be the 1mm stone reported on the CT of January 8, or so I thought. But was it? The mystery would intensify.
As happened, during the same time period, I was undergoing a renal study with a nephrologists. The purpose of the study was to see if something could be done about my kidney stones. He ordered a KUB on March 31, 2009 as a prelude to an appointment. This radiologist read the scan and issued his finding that "the radiograph revealed no evidence of renal or ureteral calculi". I told Dr. Sikder I was passing a stone. He replied, it couldn't be since it takes years to produce a stone. Still thinking it would surely be the stone reported on the January 8, CT, I reasoned it was probably too small to show up on the x-
On April 20, 2009 a 9 x 8mm stone passed taking me totally by surprise in terms of it's size. If it were the 1mm calculi reported in January, it grew 900% in just over 3 months. That seems incredible. Was it another stone that either the technology or technologist missed? That seems unlikely, but experience has shown it possible. Taking all into consideration, I believe the stone was, in fact, the same 1mm stone shown on the CT of January 8 and that it did grow into the behemoth I passed.
While in the final analysis, it probably doesn't matter, I only wish there were some useful purpose for the abundance of these stones. In the meantime, I will just keep on passing them.