High and arid Colorado ripe for kidney stone development | lifestyle


It was 2 a.m. on Mother’s Day when the pain woke me up.

The burning pain started on my right side, but over the next few hours it moved. Sometimes it seemed to come from my lower abdomen; another time it circled my lower back.

Did my appendix explode? Had my stomach turned? It wasn’t until the pain turned into a series of electric shocks and pulled me out of bed that I knew: kidney stones. The last time I felt this pain was a dozen years ago, when I’d struggled with a stone or stones that had eventually made it without medical intervention – other than the pain medication I was given in the emergency room.

So we celebrated Mother’s Day by asking my wife to drive me to the emergency room at 4 a.m. When we got to the hospital, the pain had subsided. But a scan showed that I actually had a kidney stone in the ureter, the narrow passage between the kidney and the bladder; the pain, I was told, was likely due to the stone pushing out of the kidney.

Kidney stones, as the Pikes Peak Urology website explains, occur when salts and other minerals stick together in the urine. They typically vary in size from a sugar crystal to a golf ball. The severe pain usually results from a stuck stone in the ureter and the resulting pressure in the kidney from urine congestion.

“All of my female patients who have had stones and babies say, ‘Give me another baby, it hurts less,'” said Dr. Jeffrey Moody, a kidney stone specialist at Pikes Peak Urology.

Kidney stones affect around 10% of people in the US, and dehydration is a major risk factor. Studies have shown that people in hot, humid southern states are more likely to develop kidney stones, but the risk of dehydration – and stones – is also increased in “high and dry” Colorado, Moody said.

In the emergency room, I was given medication in case the pain came back (they did) and was pressured to schedule a follow-up visit with a urologist. An appointment with Moody and another scan revealed that there was still a stone in my ureter on my right side – while two other stones lurked in my left kidney, the size of which made it unlikely they would make it on their own.

“Generally people just make one brick at a time,” Moody later told me, but I was what he called a “high-flyer.”

Moody performs about 250 ureteroscopic procedures annually to destroy and / or remove kidney stones, and I was close to being one of those cases. In such procedures, a small tube – the ureteroscope – is inserted into the urethra and through the ureter to the kidney. (The good news: You are under anesthesia.) My procedure was bilateral – that is, Moody had to go through both ureters because I had stones on both sides. (“Lucky me,” a nurse told me.)

Moody, according to my surgical report, used a “Bagley semi-rigid ureteroscope”. This was used to deliver a “20 micron holmium laser fiber” that tapped the stones with laser energy.

Basically, Moody says, “we made dust” that was later washed out through my urinary system.

There are other treatments. The size and location of the stone, a person’s anatomy, and other factors determine which treatment is used, Moody said. On the less invasive side, there is ESWL or extracorporeal shock wave lithotripsy, in which shock waves from outside the body are directed onto a kidney stone, causing the stone to shatter, similar to a laser. On the more invasive side is percutaneous stone removal, which involves inserting an endoscope through a small incision in the back to remove the stones.

Either of these options sounds preferable to the old days that required open stone surgery where the surgeon would make an incision in the patient’s abdomen or side to reach the kidney and remove the stones.

“When I first started my oldest partner had done hundreds of open stone surgeries,” Moody recalled. “I’ve probably done three in my career.”

Open stone surgery takes about a week in the hospital to recover. In my case, I left the outpatient surgery center about an hour after waking up. However, I had a souvenir with me: Moody had inserted a ureteral stent on my left side – a thin tube that was placed in the ureter to drain urine from the kidney.

My left ureter was “a little tight,” according to the surgery report, and Moody wanted to make sure that urinary flow wasn’t interrupted by swelling in the ureter. The stent was removed a week and a half later in an uncomfortable but quick outpatient procedure.

So my key question to Moody was: How can I prevent something like this from happening again?

No. 1, he said, drink plenty of water.

So how much water?

“What I tell people is that they usually drink another 16 to 32 ounces a day of what you drink now,” Moody said. “So half a liter to a liter more. No matter how much you drank before, you made a stone, so let’s increase that. “

Also, monitor calcium intake. Calcium oxalate stones are the most common type of kidney stone. In the past, patients may have been told to avoid calcium entirely, but oddly enough, either too low or too high calcium levels can increase the risk of kidney stones, Moody said. There’s “some kind of Goldilocks amount that’s just right,” he noted.

Oxalates are a compound found in many foods, from healthy foods like spinach to not-as-healthy foods like potato chips. Eliminating foods high in oxalates can help reduce your risk of kidney stones, as can reducing sodium in your diet, Moody said.

If I don’t make changes, there is a 50 percent chance of developing another disruptive stone in the next five years, he explained. In the event of changes, this risk is reduced to 5%.

For further motivation, I asked Moody what was the biggest stone he had ever had to remove. He remembered it was about 4 inches in diameter – “Imagine the palm of your hand.”

Double ouch.