Saturday, August 3, 2013

don't sleep nd type 2.0: cleaned up a bit

In my delirious state, I neglected to capture a pictureof the real thing. Mine was much more impressive, even though this one has been magnified to be just under four times the size of mine. but you can get the essence of the stone from this stock photo.

In retrospect, I don't think I had as much to say as I thought I did in my last post. Rather than edit, it was easier to start over. I could have deleted it, but instead I was at that particular moment in time, and as a reminder to all that lack of sleep can incapacitate a person every bit as much as alcohol or drugs can, and that one should keep that in mind before getting behind the wheel of a car in a tired state.

My main point was, if I can both decipher what I typed and remember what was going through my brain, that I had passed my very first kidney stone, which I didn't even know I had until shortly before I passed it. It was probaby responsible for my illness not long ago. I'd experienced pain,  and it was significant pain, but it wasn't enough that I wanted to endure multiple tests  and I didn't want to be given drugs, so I toughed it out and stayed away from everyone so they wouldn't notice, which they didn't.  No one around here can have a simple sideache. It has to be something serious, or at least we have to treat it as though  it is.

The pain, though not of the magnitude that I had heard many stone patients describe it, had kept me awake for all of two previous nights. That would have been the reason for my incoherence when I typed my last post.

Anyway, had the stone not been so massive, I might not have noticed it, as I'm not in the habit of inspecting the contents of the bowl before I flush after each use, but 13 mm by 8 mm is tough not to notice. I don't know how much background or personal experience most of you have with the lovely phenomena known in the medical community as as urinary calculi but known more commonly by most of us as *#$^$!#!! kidney stones.  There are a variety of  reasons for and components of urinary calculi. My stone is being tested for its composition as I type. My dad, who now is an expert on kidney stones in addition to his myriad of other areas of expertise, says it looks like a classic calcium oxalate urinary calculus.

Anyway, for those of you who do not claim to have the level of expertise my dad claims, the rock-like formations form in the kidneys (hence the vernacular description "kidney stone")  and may remain inside a kidney for as long as they're comfortable there. The real trouble begins when a calculus begins its descent through the urinary tract. A stone leaves the kidney -- left or right, whichever kidney in which it has chosen to form --  through the ureter of the same side. Note that it leaves initially through the ureter, not the urethra. The ureters connect the kidneys to the bladder. The bladder then passes urine out of the body through the urethra. Classic stone issues begin once a stone has entered the ureter. The ureter cramps from time to time sometimes quite severely in the presence of a stone, even if the stone is relatively small. When the stone moves along, pain usually accompanies the movement as well. Sometimes a stone partially or totally blocks a ureter so that urine backs up into or stays in the kidney. This causes the most pain of all. If it continues for any length of time, it will lead to infection and can ultimately lead to kidney failure. Fortunately, by the time a stone has accomplished this much damage, a person is usually very ill. Symptoms, while a pain both figuratively and literally, exist for a reason, which is to let a person know that something is not quite right with his or her body.

For me, amazingly enough for a stone of that size, my ureter was never 100% blocked, or at least not for any significant length of time. I did experience  a couple of UTI's, which I self-diagnosed with over-the -counter tests. I've found that their results match up very well with my doctor's tests. What the tests don't note, however, is trace elements of blood in the urine, which is a classic sign of a urinary calculus.  In this regard, I might have been better off seeing my doctor, I admit.  What I did instead was to use a stockpile of antibiotics I have from when antibiotics have been switched on me mid-illness. This took care of each infection, but the damned infections kept coming back. Then I had an actual illness, though I didn't have a fever, which is idicative that the infection wasn't running rampant and the kidney wasn't blocked.

A few days ago I lost the ability to like to accomplish a vital body function. Sensations in tandem with this inability to pass body fluids made the nature of the problem obvious. I had three options: A) tell my parents;  B) seek medical attention on my own, as I am a legal adult; C) use what I know to solve the problem myself, knowing that if I didn't have almost immediate success, I would have to resort to option A or B.

I like to take care of things myself if I can. I took an anti-nausea tablet because I knew keeping fluid down would be a challenge. By this time I, even with my lack of genius, knew that it was a stone with which I was dealing, and I knew that it had to have passed through the ureter and bladder into the urethra. Usually once a  stone has reached the urethra, you're basically home free. The issue was that very rarely will a stone large enough to get itself stuck in the urethra ever make it that far in the first place. Usually a stone of such magnitude will have been  jammed in the ureter and have to be shockwaved out or otherwise surgically removed. Rare exceptions occur, though, and I was dealing with one.

The plan was to give myself ninety minutes to blast the stone from its temporary quarters in my urethra. I'm aware the dangers  of water intoxication, otherwise known as dilutional hypotranemia. (I became aware of it through a news story regarding a radio promotional contest that awarded a Wii to the person who could consume the most water in a given amount of time. A mother really wanted to win the Wii for her children and, in the process, drank so much water that she died while accepting the prize.)  Had I been able to drink Gatorade, I would have, but it's on my Donner Party List, and the list isn't arbitrary; I don't just put things on the list to irritate my parents or to make a point to corporations. (It's a moot point now that I'm eighteen, anyway. I eat and drink what I want.) Relying on  a human physiology textbook, I determined I could, at my size, safely consume 2.5 quarts of fluid in ninety minutes, if I even got that far,  without risking danger to myself.  I let the anti-nausea tablet dissolve, then gathered my beverages while waiting for the tablet to take effect. My mom noticed me carrying lemonade, 7-up, root beer, and grape soda up to my room. (Something non-alcoholic besides H2O is safer than pure water in terms of water intoxication.) She asked if I was expecting company. I just told her my refrigerator supplies were getting low. I have a mini-fridge in my bedroom.

The plan, as I devised it relying upon Internet knowledge***, was to space the beverages out over the course of ninety minutes.  I needed to consume a 12-ounce can (or glass in the case of lemonade -- I only drink the good stuff) every thirteen minutes.  It wasn't all that hard. I once had a colonoscopy, and compared to the Fluid of Satan that you have to drink for that, a can of soda every thirteen minutes was a trip to the zoo.  The idea is that you will feel the urge to visit the bathroom, but to hold on as long as you reasonably can so that the pressure will be at its maximum. After four cans of soda and one glass of lemonade, it was the "now or never" moment. I knew if the stone could not be blasted out at that point, a trip to the E.R was in the immediate works.

God must've known the ER personnel had better things to do than to deal with kidney stone patients, because that puppy blasted right out of there.  I gave myself a few moments to recover, then left my bathroom in search  of rubber gloves.  I put on the rubber gloves and did the unthinkable, which was to reach into the toilet (yuck even with rubber gloves) and pluck the nasty little bastard out of the bowl and into a jar.

There was no point in postponing the inevitable. I took the stone to show my mom. I was glad my dad wasn't home, because he would've had more incriminating questions to ask, though my mother herself is a kidney stone veteran. I have no clue as to what her stone count is, but I know it's more than twenty.

"YOU PEED THIS OUT?!?" my mom demanded. She may have passed more stones than I , but never one that large without assistance, apparently.

"No, mother, I went outside and found a rock and brought it in here so I could tell you it was a kidney stone and you would feel sorry for me. OF COURSE I PEED IT OUT!  Why would I say I did if I didn't?" I responded

"I'm sorry," she apologized. "I've just never seen one that big that came out on its own. Damn, that must've hurt!"

"It did," I concurred. "I'd never seen one, period," I told her. "I didn't know it was unusual."

"This," my mother told me,  "is  probably the excretory equivalent of having delivered a sixteen-pound baby vaginally."

"This doesn't mean some OBGYN will think I'm capable of doing THAT?" I asked her.

"No," she replied. "The two have nothing to do with each other, thank God. I don't think there would ever be room inside you for a sixteen-pound baby anyway." She paused. "I need to call Daddy." My dad was doing one of his once-or-twice a month stints in the E.R. He needs to spend X number of hours in direct contact with patients in order to maintain his license to practice medicine.

"It's already out, Mom," I pleaded with her.  "Do we have to call him?"  More than anything, I was concerned about the possibility of a pelvic exam of some sort.

"Just because it's out doesn't mean no damage was done," she answered, "and is that why you were taking all those sodas up to your room? Did you know something was wrong?" she demanded.

"Sort of, but I had things under control, and it's neither here nor there now that it's out," I answered.

"Not really, but we'll address that later," she said as she picked up her phone and speed-dialed my dad. It went to his voicemail, so she called the hospital and asked that he be paged. Though I could only clearly hear her end of the conversation, I could tell from the volume of the Charlie Brown's teacher sounds coming from the phone that  he was his usual  [sarcasm font] calm [end sarcasm font]  self.  Fortunately his shift was to be all night. In the morning he would be too tired to be so vitriolic, or at least I hoped such would be the case.  He told my mom he would have her bring me to the ER, but that they were so packed that I would be better off at home. He was sending a doctor friend to take my vitals  and to collect blood and urine, as well as the precious stone, to take to the hospital.

A few minutes later DR. Jeff, AKA Chairman Mao, came to our door with his bag.  He lives three houses down and around the corner.  He took blood, asked for a urine sample, checked my pressure, and felt for my pulse. "You're not dead," he told me.

"You must have graduated Number One  in your medical school class, " I told him.

He smiled and and said, "You're rubbing salt in a wound." My dad graduated Number One in their med school class. Dr. Jeff graduated Number Two. Dr. Jeff  knew very well that I was aware of that.  The topic comes up frequently.

 He gave me an antibiotic shot. He told me that he wasn't giving me a painkiller until we had evidence from the blood test that nothing was seriously wrong with the kidneys. In absence of lab evidence that everything was essentially OK, pain would be the best indication that anything was wrong. He made me pinkie promise to have my mom call him if pain got worse at all. He said he'd come over with a painkiller -- something good -- once the lab reults came back clear.

Then he asked for the stone. It pained me more than the stone itself had pained me to give up my prized possession. This was a relic.  "Will it be destroyed in testing?" I asked him.

"Probably," he answered, "but you've got to give it up."

I handed over the jar. He looked inside and exclaimed, "YOU PEED THIS OUT!?!"

My mom laughed hysterically because those were her exact words.

"No, " I answered, "I went outside and found a rock and brought it in here and told you that I peed it out so you would feel sorry for me," I said again. "OF COURSE I PEED IT OUT."

"Sorry," he said. "I know I'm not a urologist, but even though I'm just a shrink,  I went to medical school just like everyone else, and I've never seen one close to this that wasn't removed surgically.  Your dad is going to be proud."

"Good, " I answered. "Maybe it will partially cancel out how mad he's going to be."

"I wouldn't count on it," Dr. Jeff said as he headed out the door with the precious 13mm stone that I would never see again.

I won't go into all the gritty details, but we are all again on speaking terms.  No real harm was done.In terms of the ureter through which the stone passed, the stone accomplished one of two things: either it roto-rootered it so that I can easily pass large stones, or it scarred it to the point that a much smaller stone will have difficulty passing. Time will tell if the problem comes up again. If it doesn't, there's no reason to conduct expensive and invasive testing to determine the status of my right ureter.

I will say by way of disclaimer that I wouldn't recommend that people medically treat themselves in this manner. I'm just the curious sort, and in the interest of science, I wanted to see if I could solve the problem myself. I had my cellphone nearby to call 9-1-1 if necessary at any point, and I also had the home intercom system turned so that my mother could hear from anywhere in the house if I as much as groaned.

I'm now going out on the deck to practice my violin. My mother needs a break from hearing me. My room is relatively thick-walled, but a violin can be piercing with its highest notes. My mom said the neighbors will go crazy if I practice out here for more than an hour, but an hour of culture is probably good for them if I play through real pieces without stopping and repeating, and if I don't play scales.

I promise that this has not become Alexis' New Hypochondriac Journal. If  I have another medical problem, no matter how minor or major, in the next six months, you will not know about it.   If, God forbid, I have a heart transplant in three months, I'll blog about the birds I see from my window without ever mentioning where that window is. This I solemnly promise.

*** I know about that lemon juice and olive oil trick, with or without honey, but trying it would be pointless for me. I would only have tossed my cookies,  even with ondansetron. I'm picky. I could never stomach olive oil, with or without lemon juice or honey.


  1. Wow! That is a hell of a story, Alexis.

    I bet my Christian friend would say it's TMI, but I enjoyed reading it. Especially since I just woke up with a mother of a cramp in my calf. I like your medical dramas.

  2. i hATE leg cramos. Some peope just say, "Eat a banana," but bananas can be cinstipating (TMI) to some people.Watermelon is good as well. The bottom line, thugh, is that you canno prevent them entirely.

    If I have one, I scream until someone comes in to massage it. I won't be abe to do that in the dorm next year, where I will spend at least half of my nights. Or if I do that in the dorms, I'll mak emyself unpopular very fast. Not as fast as the idiot who keeps burning popcorn in the microwave in the midde of the night, but unpopuar nenetheless.

  3. I don't get leg cramps very often, but when I do, they hurt like hell. I usually get them in my thighs. Not this time. OUCH!