Kidney stone - to remove or not and pain med recomendations

Hello,

I am a 50-year-old female with no history of kidney stone disease. My parents nor grandparents have ever had a stone but my older brother had one stone about 20 years ago.
I am in excellent health, eat a well balanced/healthy diet and exercise regularly.

I do recall about 5-8 years ago a former general practioner telling me they saw a very small kidney stone on catscan and that I’d likely pass it one day without even knowing.
I can’t even recall why I had the catscan done in the first place!

Fast forward to present day. Last month I began experience some minor back pain. I have a chronic back spasm condition that acts up about 1-2 times a year so I tend to be hyper alert to any back discomfort. That said, I have had no spasms since November (knock on wood). I got up on a Wednesday morning and felt a back ache that I’d equate to menstrual cramping aches. (I am peri-menopausal and get my period very sporadically). I popped a few Advil and went to work and used my heating pad off and on the remainder of the day which made things feel better.
That evening I ate a regular dinner but felt some stomach discomfort that night but nothing major. Felt like indigestion. (I also have Irritable Bowel Syndrome so my stomach can act up for no apparent reason.) I went to bed that night and slept fine. Woke up Thursday morning and went to the bathroom and began to feel the cramping again but this time it was more intense and seemed to move from my lower left flank area around to my abdomen area – again almost like menstrual cramps. I have to admit I don’t recall the details as now it’s a bit of a blur but the pain was more intense and felt different to me – different then my period. I didn’t know where it was coming from but it was not stopping and I got scared so I drove myself to the ER.

I described my symptoms and they immediately said ‘kidney stone’. The pain became more intense but I was not screaming in excruciating pain the way some people describe when passing a stone.
They did the usual testing – blood/urine and catscan. They got me on fluids and gave me Touridol and said they would give me Dilaudin. I told them I get very nauseated and sometimes throw up from Percoset, always throw up from Codeine and definitely throw up from Vicodin. They gave me Zofran for nausea and half a dose of Dilaudin and the pain continued so they gave me the other half dose of Dilaudin. The catscan showed an UNOBSTRUCTED 7mm stone in the upper pole of my left kidney. The ER doctor came to see me and wasn’t sure of the cause of my pain and wanted to send me home but I wanted to see a urologist. They sent me to an observation floor and it did not take long for the Dialudin to wear off and the pain came back and I can recall crying. Instead of splitting up my dose they gave me the entire dose at once and the pain subsided but not long after I started to get very nauseated. They were pumping me with fluids and sent me for an ultra sound of my abdomen which showed nothing – it was a miracle I did not vomit all over the technician. I returned to my room still feeling like I wanted to vomit and spaced out from the Dilaudin when a Urologist visited me. He asked me where my pain was – and I likely didn’t point to the correct area in my back and he said well that stone is not causing your issue – I don’t know what is! I asked about removing the stone and he said he did not recommend it – that either procedure (laser or ESWL) would cause me MORE pain then I was in at the moment. One nurse practitioner that saw me on the floor said I had renal colic and it was from the stone in my kidney – lol.

When my nausea finally subsided once the dilaudin wore off – my pain continued and all I wanted was the Touradol. I refused more narcotics. They offered to try morphine or tramidol but I said no. I was only allowed Touradol every 6 hours and after 2 hours on it the pain would return in waves – starting in the flank and move around to my abdomen. It was worse when I urinated. They also saw microscopic blood in my urine but no stone was ever seen.

I was discharged the following day (Friday) and pain continued that night 2 hours into another Touradol dose.

Saturday I woke up with a heavy feeling in my chest that I never felt before – I thought I was having an allergic reaction to meds as my eyes were all swollen. I called hospital and they said not allergic but likely side effect – stop Touradol so I did.

Monday I went to see a Urologist (different one then I saw in hospital). He ordered an xray of my kidneys and he did a urinalysis in office and looked under microscope and said he saw a lot of blood on the smeer. He said it was not a UTI and he did not know cause. Would order further testing on it to be sure I did not have a kidney disease of any kind. It became apparent that I likely did pass a stone the days before but no one could see it, too small? – but they continued to say my pain was not from 7 mm stone. The xray he ran turned out to show nothing more then was confirmed on ct scan. Urologist wanted to do a cystoscopy which I had done last week – and nothing abnormal was detected. I told him I thought I was retaining fluid as the scale said I gained 8 lbs since my hospital stay. He sent me to my regular doctor who listened to my lungs and heard fluid and sent me BACK to the ER but this time, different hospital where HE made rounds. So I got out on a Friday and was back in that Monday.
Sure enough I had plural effusion on lungs and was admitted and given Lasix. They were very puzzled as to why this happened to me and ran a bunch of tests on my heart, ran blood tests a few times a day and all came back normal. They attribute it to last hospital just giving me too much IV fluid to try to flush a stone – even though docs all said they never saw this. I also saw a Pulmonologist and he was not overly alarmed. And I consulted with a Nephrologist (my general practitioner sent him) in hospital who had no idea why he was seeing me. Said my kidney function was great. Said the stone in kidney my kidney was causing me NO pain and he said it could stay there forever. They all said the catscan that day in ER showed NO inflammation of kidney, ureters etc.

I just completed a 24-hour urine collection that was sent off to Litholab in Chicago. I consult with my urologist in a few weeks about the analysis. I recorded my volume after the 24 hours and I had urinated exactly 2.5 liters of urine.

I have spoken to my urologist about the 7mm stone. He said he could blast it with ESWL. If I wanted laser he’d send me elsewhere to someone who does more of those. He said there was no urgency though. But I’m scared. I know I will never be able to pass the stone. And I just wait around until one day I find myself in excruciating pain and head to the ER? Or I be proactive and get it out and deal with the aftermath and recovery of the ESWL which does not sound fun either! (by the way he could not even get the cystoscope up my urethra – he had to dilate me, glad I was sedated! And he used a flexible scope.)

One of my concerns also is I can’t seem to tolerate opioids – they make me so sick. They also gave me Reglan along with Zofran in hospital to combat nausea of Dilaudin but I did not help. Anyone try ANY other pain meds that don’t make them sick to their stomach? What about any other successful anti-nausea? I’ve heard Phenergan might be worth a try? As I said I’ve never tried morphine before or tramadol. But I find I want to be prepared in case that 7mm stone starts to move OR if I have the lithotripsy and am in pain afterwards.

I might opt for another opinion just for someone to give me better idea if the lithotripsy will be successful and if I should try it. I thought I read that location of stone and proximity to surface can also indicate success rate? I just want a doctor to guide me in my decision but it seems like no one may know the best answer! Baffles me that in this day and age kidney stones are such a big problem for so many people!

Thanks for any feedback!

Thanks very much Reggs - I appreciate your response. So all 3 of your lithos were pretty straightforward and didn't cause a lot of pain after? Did you need a stent? I'm scared of those - I believe my doc said he would not use one but what if all the 'gravel' or pieces get clogged up? is that a possibility? I've read it can be painful for some people to pass that stuff.

I've had a few docs say no way will i be able to pass a 7mm stone. Even if it made it through my ureter into the bladder I don't think it would get through my urethra. I had cystoscopy last week and doc could not get instrument in - he had to dilate me. Thankfully I had asked for anesthesia even though he and his nurses said I didn't need it. My insurance covered it so I went to sleep for the procedure. After he said you know yourself better! Good thing you were asleep. I did have some spasms and cramping for a day or two after but now I feel fine.

I've also had two Urologists and one Nephrologist tell me to leave the stone alone that it might never pass. I guess that is easier said than done as I'm a big worrier! :)

I will check out your blog - thanks!!!

Lithotripsy is much better than waiting for the stone to float around periodically blocking the ureter. Spent 6 months with a 10mm stone ultimately did lithotripsy. Painful, peeing blood for a day, stent for a week was hell...but after the stent removed got better asap. Went to vegas against Dr's. Orders and passed fragments all weekend in hotel. You don't want to get caught out of town when the hydronephrosis hits.

I consulted my father, who is a Urological surgeon. The surgery is a fast recovery. If you don't want surgery, he said you can dissolve the stone with Urocit k. He also said take Calcium/Mag with every meal to absorb excess oxalates and stay away from foods high in oxalates such as soy, sweet potato, celery.