Nephrolithiasis

I just like the way that diagnosis is spelled. And it's easy to see what it means: "nephro" refers to kidneys, and "lith" means stone. Tada.

I saw a nephrologist today who reversed two of the changes made to my supplements recently as the first round in trying to deal with my propensity to form kidney stones. My MGB surgeon's office, trying what we think is a scattergun approach to bringing my Vitamin D numbers up (we don't know what'll work, so let's try everything simultaneously!) have put me on 2000 units per day plus 50,000 units twice a week. (A typical dose for someone with chronically low vitamin D is either 1,000 units a day, or 50,000 units once a week.) I'm being switched to 1,000 units a day (though still waiting on a clarification on the details there). And my calcium dosage has been changed from 1500mg a day (the typical post-surgical dosage) to 6000mg a day (what my urologist put me on) to 9000mg a day (what the urologist changed it to) to 3000mg a day (are you dizzy yet?). But now I have to take it after meals on an empty stomach, not before them.

I also, annoyingly, have to start counting salt intake. I think my salt intake is probably average-ish for an American, but I realize that that's also, by a doctor's standards, "high." Fair enough. But while it's entirely possible that it's a contributing factor in the kidney stone formation, I felt like the "diagnosis" was awfully pat and cookie-cutter. The doctor pretty much took for granted that I eat way too much salt, the same way he took it for granted I had high blood pressure and cholesterol problems because I was fat, and then "corroborated" this by asking for one random meal and concluding that we must have vastly too much salt all the time. Even if he is right (and I think he's overstating it), it irks me that he didn't really find out, just assumed.

I'm going back to the urologist right after writing this post, so by time you see it, I'll probably have another post where everything gets changed again. The real purpose of this appointment is to try to set up getting my 5mm kidney stone removed before it decides to remove itself the hard way. I'd rather do it on my own schedule, and under some anaesthetic if possible. However, even if I get it out this way, I could be forming another; and if I go through this to get it out, it might not have ever come out on its own, so it might be a waste. My nephrologist is not keen on the preventative removal approach, and I'll mention this to my urologist. But the day before Thanksgiving, when it seemed like it was getting stuck (and I still think something was) has me eager to settle the question.

The real upshot of my nephrologist's visit, though, was that I am doing two more 24-hour urine capture tests to be analyzed more thoroughly, along with some bloodwork, so they can figure things out all over again. So I have two months more to wait and then another follow-up appointment in February. That'll make it more than half a year I've been trying to get to the bottom of this, so I hope by that time they've got something more to say than nephrolithiasis.

Because really, while passing a stone is profound agony (and that's with the 2-3mm ones I've passed so far, which is a far sight easier than a 5mm one), this is something I can live with. Kidney stones are very unlikely to result in life-threatening problems, and they are also unlikely to be more than once every few years. And some people just have them, period. How many doctor's visits and blood tests and diet changes before it's not worth it to avoid them?