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“Most intensive pain I ever felt”: Kidney stones more common in men and could be sign of more serious health problems to come, docs say

Tony Monko has never given birth, but he says he’s experienced the closest thing to it – passing a kidney stone.

“It was the most intense pain I’ve ever felt,” said the 50-year-old Carroll Township man, who has also weathered multiple broken bones, shingles and recurrent Lyme disease. “The first one I had is really just a blur because I was in such pain that I was really out of it.”

Monko has passed two kidney stones – one when he was age 22 and one last August. An MRI showed he has another stone in his right kidney, but it hasn’t caused him any pain or problems yet.

Just knowing it’s there, however, is an unpleasant thought. “I’m just waiting for the pain,” he said with a half smile, half grimace on his face.

“The pain is excruciating. It puts people on their knees,” agreed Dr. R. Scott Owens, of Urology of Central Pennsylvania, Inc. in Camp Hill. “It’s the one thing that will make people cancel vacations. It’s hard because they come on so suddenly, you can literally be doing something one minute and be down with pain the next.”

Good hydration – two liters of water daily – is the first line of defense against kidney stones, doctors say.
Monko, a landscaper, knows that only too well. Last summer, he was out on a job when his second kidney stone attack struck. He was mowing a lawn one moment and sweating profusely and fighting off severe pain and nausea the next. He had to have his teenage son drive the truck and trailer home because he couldn’t.

“This time my pain was all abdominal; the first time was all in my back. So when my wife said it was probably a kidney stone, I didn’t think so. I thought it was my appendix,” said Monko, who went to the emergency room, where an MRI confirmed it was a kidney stone about two millimeters in size.

Result of excess minerals

A kidney stone is a solid substance that forms in the kidney when high levels of things like minerals are in the urine.

“Whatever you eat or drink in a given day, your body will suck up what it needs and a good portion you will urinate out. The excess minerals your body doesn’t need aggregate together and form a stone,” said Dr. Jay Raman, urologist at Penn State Milton S. Hershey Medical Center.

Kidney stones are fairly common, occurring in about 12 percent of men and six percent of women in a given year, he said. The rate is about double in men, probably because their diet contains more stone-forming foods, Raman said.

It may surprise people to know that if they have kidney stones, they have a higher risk of developing high blood pressure and diabetes in the future, Raman said.

Current research is looking into ways to detect whether someone’s kidney stones are causing enough injury to the kidneys to result in long-term health problems in years to come, he said.

Five common types

The most common types of kidney stones contain calcium, which binds to other excess minerals to form calcium oxalate or calcium phosphate stones. Uric acid stones form when people eat too much acid, found in red meat and fish. People with gout and people who are taking chemotherapy sometimes also produce too much uric acid and can end up with a stone, Owens said.

Other less common types of stones are struvite stones, which arise from infections when bacteria produce a certain enzyme that leads to stone formation, and cystine stones which arise from a genetic disorder that prevents people from breaking down sulfur bonds in their urine, Raman said.

Pain in the abdomen or back or while urinating, nausea, vomiting and blood in the urine are common symptoms of kidney stones. When the stone moves down to the ureter, the thin tube that connects the kidney to the bladder, pain can be searing. If an infection is involved, symptoms may include fever and chills.

Treatment is often based on the size of the stone, doctors said. If imaging shows it is less than three millimeters in size, there’s a 90 percent chance of passing it so the person is usually sent home to wait with an anti-inflammatory drug or painkillers like Percocet or Vicodin.

“For patients with a stone in their ureter, we can give a drug called Flomax, which is also used for enlarged prostate. It dilates the ureter and allows the stone to pass,” Owens said. “It can take 24 to 36 hours to pass or it can take four to six weeks.”

For larger stones with much less chance of passing – or if the pain becomes too unbearable before a smaller stone passes naturally – doctors can intervene with two different surgical techniques, both done under general anesthesia.

If it’s not an urgent situation, lithotripsy is done, which involves sending shock waves externally through a machine focused right on the location of the stone, which is first identified with imaging. The shock waves cause the stone to break up so it can pass.

In acute situations, urologists use a long tubular tool called a ureteroscope, which is fed through the bladder up to the ureter, and then laser energy is used to chip the stone into smaller pieces.

Prevention depends on type

Doctors give patients a strainer to take home in order to catch their stones so that they can be examined to find out what type they are so that prevention counseling can be given.

After the stone passes, Owens asks patients to collect their urine over a 24-hour period so it can be analyzed for calcium, sodium, oxalate, uric acid and citrate, which is a natural inhibitor of stones. He also checks the blood level of the parathyroid hormone, which controls calcium absorption and mobilization in the body.

High calcium in the urine can be addressed with a prescription for hydrochloric dioxide and low citrate can be replenished with a prescription for potassium citrate.

For patients with the common calcium oxalate stone, Owens provides a copy of a low-oxalate diet and advises them to monitor calcium and sodium intake, avoid a lot of Vitamin C and D and reduce animal protein intake.

Even if people don’t have the hereditary disorder that predisposes them to cystine stones, a familial history of any kind of kidney stone predisposes people to have them, Owens said. People who have had gastric bypass surgery and who have inflammatory bowel disease such as Crohn’s disease have higher incidences of kidney stones because they tend to get dehydrated more easily, he said.

Good hydration – two liters of water daily – is the first line of defense against kidney stones, doctors say.

“I recommend water with lemon, which has citrate that can actually get in between the calcium and oxalate and prevent them from binding together,” Raman said. “But juice, tea, coffee, Gatorade – all not good because they contain higher levels of oxalate.”

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