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with Rod Moser, PA, PhD

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Wednesday, March 16, 2011

Kidney Stones are a Major Pain

The first one really caught me off guard. It hit me in the middle of examining a baby in my office and felt like someone stabbed me in the side with a spear and then twisted it for maximum pain. I ended up getting the stone(s) pulverized by lithotripsy — a medical technique that breaks up the kidney stones using a several thousand blasts of sound waves. Waking up from this procedure feels like someone beat me with a baseball bat until they tired and quit. Kidney stones are painful, and the procedure to treat them is no picnic either. This was well over five years ago, but the memory is still fresh.

Well, they’re back! About a month ago, these stealth pieces of gravel decided to move south — from the kidney down the tiny ureter. I ended up in the ER. Medical providers do not like being patients, especially patients in the ER where everyone is equal, and the fact that you are a medical provider who works for the same group, means absolutely nothing. Patients are triaged — the most critical cases seen first — and apparently, kidney stones, though painful, are rarely life-threatening. I won’t say that I moved to the bottom of this list with the wino who fell and sprained his ankle, but I suspect I was no where near the top. I waited about an hour before I received the care that I needed.

Perhaps because I am a medical provider, the ER doc did not feel that it was necessary to examine me. He ordered the tests that I expected and treated me appropriately. It would have been nice if he at least shook my hand, for God’s sake.  At that moment, I feel like I was not a person, but a “kidney stone”. I know that many people have this same experience of depersonalization.  It seems that the most technically-experienced medical providers seem to have missed the class on professional behavior. Oh, well. I wasn’t in any position to make new friends anyway.

Being told that you have three stones still left in your kidneys, is like telling a soldier that there are still three snipers hiding out there…somewhere. You don’t know when they are going to rear their ugly heads and take a shot at you.

I have felt like crap since last week. “Feeling like crap” is a very acceptable medical term, and universally understood by anyone who has ever felt like crap before. When you get influenza, you feel like crap and everyone knows how you must feel. A moving kidney stone makes a person feel super-crappy – a few steps above just plain ‘ol crappy. I often feel sorry for Thomas Crapper, the inventor of the flush toilet. Little did he know that some day, people would be using his name in this context. I extend my apologies to the Crapper family and their descendants.

Since 2 AM (why do these things happen in the middle of the night), I have been in excruciating pain in my left flank. Not finding a spear, I knew something was amiss. Not wanting to go back to the ER and experience those indignities again, I treated myself (more or less; my wife is a PA).  Medical providers can do this at a higher level since we are often well-supplied with an armada of therapeutics at our disposal. I really don’t like taking pain medication, but I dislike pain much more. The stuff I have at home is not nearly as good as what goes in the IV at the ER, but it is better than Tylenol.

You are supposed to drink tons of water to “flush out the stone”, but because you are so nauseated and uncomfortable, the thought of drinking something is not high on your list. At least with an IV, you can bypass the stomach. I have to get me an IV set-up for home.

In the morning, I called my own medical provider. I don’t like waking up hard-working doctors in the middle of the night. He ordered some x-rays that confirmed that the largest of my sniper-stones is on the move. It’s more than half way down the ureter — a journey that can take a few more days, or one that may end up at the lithotripsy table again.

I had a full schedule of patients, so I called our front office supervisor early in the morning (I don’t mind waking her up) to cancel them. Guess what? She apparently forgot, or didn’t do it. By 9 AM, I got a call from my medical assistant that I had three patients in rooms, waiting for me. My colleagues will have to step up and see them, because I cannot. I take pride that I don’t keep patients waiting, so I hope that they remember my prompt care in the past, and forgive me for this unforeseen inconvenience. I feel badly for people that had to take off work, or pull the kids out of school for their appointment and that I couldn’t make it.

I even had the wild idea that I might even make it tomorrow, but I know that isn’t going to happen either, so I have to cancel about a hundred patients this week. I can’t even dump them on my wife, who works in the same office, since she and her friend were going on a trip. The kidney stones screwed up her plans, too. She will stay home and take care of me and honor the pact that we both agreed to when we got married.  Her trip will need to be postponed. I feel badly about that, too, but mostly I just feel bad (crappy).

Writing a blog post when you are in pain adds a certain amount of emotional flair to your words. I am sure glad that I am not dictating, otherwise there could be a smattering of expletives throughout this piece. I would rather sit and type than writhe around in pain while watching Andy Griffith reruns.  I find that one of the best ways to deal with pain is by distraction. Stay busy and you won’t feel sorry for yourself.

The type of pain medication that I use at home is not a mind-altering narcotic like they use in the ER. It is not as strong (obviously) and it does have an annoying side-effect of making my tinnitus (ringing in the ears) worse. We call this an iatrogenic effect — an undesirable symptom caused by your treatment. Medicine is like Newton’s Laws — for each desirable effect, there may be equal and undesirable side-effects. Treat one problem; get another. Treat that problem and you get two more. And, so forth.

Dogs are highly intuitive; at least, my three seem to be. They worry when I am sick and stick to me like Velcro. I have had all three on the bed, lying with me. I had my foot sticking out from the blankets and my dog Zach, took the opportunity to lick my toes. When you are in and out of a pain stupor, this can really play tricks with your mind. In my mind, I thought it was my nemesis — the chicken-eating coyote. I was this close to kicking my best friend, but thankfully, I did not.

They say that all things will pass in time. I can think of just one that I would like to pass right now.

Posted by: Rod Moser, PA, PhD at 7:42 am

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