A kidney stone: don’t tell me it’s not the end of the world.
Sure, I’m better today, but yesterday I was dying. At least it felt like it. I hadn’t had pain like that since my son was born 17 years ago. Very similar.
Scary, too – what if the pain hadn’t gone away????
In the era of modern medicine we have an answer for kidney stones that don’t pass. Lithotripsy, surgery, basket retrieval – there is an option for everyone.
In post-modern medicine, what will we do? Perhaps what I did yesterday: wait it out.
Of course, I, a trained doctor, could diagnose myself. I could monitor the passage of the stone down the ureter and into the bladder. Fortunately (?) I’d just had a root canal and had a few narcotics on hand. Unfortunately, they didn’t help the dental pain nor the kidney stone pain. Either the ibuprofen helped or the stone had already entered the bladder. Either way, after about 6 hours I could finally rest (with the help of a hot bath and some Benadryl).
But at TEOTWAWKI how will people cope? And taking that back a step, how will they know what’s wrong with them? Of course, anyone who’s had one may recognize another, but a large number of kidney stones occur in patients who’ve never had one.
Interestingly, not all kidney stones produce pain. The pain from a kidney stone is related to obstruction of a hollow viscus. In plain English that means that a tube-like structure in the body, one which normally allows passage of a fluid (or feces), is obstructed by a stone (or a baby, or a plug of feces). In an effort to expel the obstruction, the muscular lining of the tube contracts, much like labor contractions. Just as not every woman has severe labor pains, however, not every person with a kidney stone suffers extreme pains. This is partly related to the size of the stone, but probably also related to a person’s internal neurologic wiring. Kidney stone pain is generally one-sided and is little-relieved by change in position. The onset is often sudden, as a stone lodges in the ureter tubing. The pain may come in waves or be fairly constant.
Kidney stones may also produce bleeding as the stone scrapes along the ureter (tube between the kidneys and bladder). Once it reaches the bladder, the pain usually lets up, though both bleeding and pain may recur as the stone passes from the bladder through the urethra, out of the body.
Other symptoms of kidney stones include the urge to urinate, frequent urination of small amounts, inability to urinate, burning on urination, nausea, and vomiting.
In 25+ years of medical experience, I would estimate that over 95% of kidney stones pass on their own, that is, without surgical intervention.
At TEOTWAWKI having a skilled health professional to diagnose the condition would be ideal. Visible blood in the urine supports the diagnosis, though infection may cause this as well. Usually urinary infection has a more gradual onset than symptoms of passing a kidney stone.
Patients with mild to moderate pain require no or minimal medication. Tylenol or ibuprofen may suffice. Drinking extra water helps push the stone through the ureter (which may hurt). Sometimes diuretics (water pills) are used to encourage the kidney to make more urine, and help the stone along. In a person with a history of infection or a significant amount of bleeding, taking an oral antibiotic for at least 1-3 days may be advisable to prevent infection (trimethoprim-sulfa DS twice daily, ciprofloxin 250-500 mg twice daily, macrodantin 50-100 mg twice daily, possibly amoxicillin 250-500 mg. three times daily, although this is less effective).
In a person with severe pain, some sort of pain relief is required. Narcotics usually help most people, but a supply may not be available. Tramadol may be sufficient in many cases (50-100 mg. every 3 to 6 hours), as may ibuprofen (600-800 mg. every 4-6 hours). Either of these may be combined with acetaminophen (Tylenol, 500-1000 mg every 4-8 hours). (If you’re not sure of the diagnosis, don’t use ibuprofen or aspirin, as these may make stomach problems worse.)
A hot bath may relieve the discomfort to some degree. OTC anti-emetic meds (Dramamine, Bonine, meclizine – 25 mg every 6-12 hours) can alleviate nausea and vomiting. If the pain isn’t too bad and you’re hoping to sleep it off, diphenhydramine (Benadryl) 25-50 mg. orally may help you rest. It didn’t occur to me to try a glass of wine. If one is sure of the diagnosis, a little alcohol may allow you to rest. However, alcohol can irritate the stomach as well, and should be used with caution.
Straining the urine through a fine strainer, a coffee filter, or even a T-shirt may help you recover a kidney stone and confirm the diagnosis.
These days, if you think you have a kidney stone or are experiencing similar symptoms, I advise seeking professional help. But in the aftermath of global crisis, you may be on your own. For most people, if the stone doesn’t pass in a day, it will within a few days of taking increased fluids.
For the few percent who don’t obtain relief, let’s hope a surgeon or two is still available.
- Lithotripsy – All Information (umm.edu)