Sunday, August 15, 2010

Kidney stones of the future

While I got a referral out of my doctor primarily to find out what I can do to reduce the likelihood of further kidney stones, and whether my calcium supplementation is part of the cause and should be adjusted, I also intended to ask about the third stone that showed up on my CT scan and which my doctor said might pass one day or might never pass. But I wasn't too focused on it.

The urologist I visited was really great at explaining things and talking to me clearly, neither patronizing nor so jargon-laced I was straining to keep up, and telling me just what I needed to know. And while he certainly addressed my question about how to prevent future kidney stone formation (in a properly scientific way -- I'm going to be doing a urine collection test that should tell us what I need to do to reduce the likelihood of their formation) we actually spent most of the appointment talking about the other issue.

While the CT scan was ambiguous and the followup ultrasound is harder to trust, it seems I have a 5mm stone, approximately, lurking in my left kidney. (The pictured one here is 2-3mm, the same size as the two I've already passed.) While people have been known to have 20mm stones and larger (and there's a whole kind of procedure for those), the usual limit on the size of a stone that they can feel sure will pass is 4-6mm, so I'm right on the edge of where it might make sense to let it pass on its own (and endure one more day of excruciating pain when that happens), knowing that it might get stuck and refuse to pass and require a procedure; or just get the procedure preemptively, so that I avoid the pain and get to choose the date.

I'm leaning towards the latter. The odds are that it is not going to stay in my kidney, so if I do anything else, the one thing I'm sure of is a lot of pain. It might be a few days of pain, or it might be a few days of pain followed by a procedure anyway. Either way, it happens when my kidney wants, not necessarily at a time convenient for me. The only "advantage" in waiting is the chance I might not need the procedure, but as the procedure doesn't sound too bad -- it's not a surgery and it's not likely to be terribly painful -- that's likely only a big factor for people who are terrified of such things.

Actually there are two possible procedures. The totally non-invasive one seems unlikely to work though, due to my size and the fact that my stone is the hardest kind that people make, a calcium oxalate monohydrate, so I'd probably go straight towards the scope approach. (A description of what they do in that one might make the males in the audience cringe too much, so if you're curious, go look it up. But it's done with anaesthetic and such, naturally.)

I'm supposed to be thinking through my options (and I guess in writing this post I've been doing that, or at least crystallizing them -- no pun intended) while we wait for me to do the urine collection and the results to be analyzed in the lab. I wonder how long the lead time is from then to the procedure. It'll probably happen in the autumn -- in between the vow renewal and the holidays would be perfect.

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