DR. DAVE HEPBURN | AUGUST 14, 2013
Which is worse: childbirth or kidney stones
Strolling across the moonlit hospital compound, I was puzzling over how a woman had lost all five of her babies to a mysterious death, each time within days of their birth. Any day now she was about to have number six and so her northern village elders had sent her to my 40-bed hospital in the middle of the jungle island that is Tanna.
Was there some genetic defect? Perhaps a bleeding disorder or was this, as some of the nurses had speculated, the unthinkable. Did I have a mass murderess in my over-crowded hospital?
Suddenly, without warning, I felt a horrific blow to my lower back. I had been shot. I fell to my knees in pain so excruciating that first I was afraid I was going to die, then I was afraid I wasn’t going to. I picked myself up and limped back up the hill to the hospital. On arriving, I was somewhat relieved that the only blood flowing from my body was coming from my urine.
I was the victim of a stoning, a kidney stoning. Pain and misery? You have no idea.
All these years I thought that a man-cold was the worst plague of mankind, but this kidney stone thing was possibly even worse. I grabbed a nurse and explained that I was going to need some pain control.
The next thing I remember I woke up in the maternity ward in the only vacant bed left in my entire hospital. The rest of the wards were jam-packed with victims of TB, malaria and a recent nasty typhoid outbreak, so I was lying prostrate in maternity, not knowing if my prostate was showing or not, but if it was I didn’t care.
With an IV drip in my arm and a Demerol shot in my keyster I was drifting into oblivion. Look at me now I mused, lying in a maternity ward in the middle of a jungle, surrounded by a dozen pregnant women including the woman in the bed right beside me who… OH MOTHER OF… the woman from the northern village!
I fought with all my might to stay alert but my last foggy thought before succumbing to the Demerol was of a machete being hoisted by a rotund lady standing over my bed.
Kidney stones, also known as uroliths, hurt. They really hurt. Unlike appendicitis, where the patient tends to lie quite still wanting no one to touch them, the kidney stoner cannot seem to find a comfortable position, tossing to and fro’ during the colicky attacks.
Depending on the size and location of the stone, hours or even weeks may pass before it does. Pain control and anti-inflammatory suppositories are used until the stone passes. The patient is also given a urine strainer in order to try and catch the stone so it can be analyzed. Please dispose of these strainers carefully, especially when at the office.
“Bloggins, the coffee has a bit of an aftertaste since I used that new filter you brought in. Got any breath mints?”
Should you catch the stone, it will be sent off to a kidney stoneologist who, 80 percent of the time, will report that the stone is composed of calcium oxalate. 10 percent will have the uric acid stones of gout.
Sometimes the stone does not pass at all. Lithotripsy is a process whereby the stone is shattered while still in the urinary tract. Ultrasonic shock waves or even laser blasters can be used to reduce the stone to stubble. It’s a urologists arcade.
Thirty percent of those with one attack will have a subsequent attack within a year. To avoid stone formations they are advised to:
a. Increase fluid intake to more than two liters per day. Dehydration leads to stones, which is why the summer months are the optimal time to form stones and why I had such a beast while in the tropics. Oddly enough, most stone formers have an abhorrence of drinking fluids.
b. Limit protein intake to 1 gram per kg of your weight per day. Too much protein attracts more calcium into your blood and urine and much to your un-satisfaction you will form rolling stones. Speaking of Keith Richards, drug addicts with “high” aspirations like to use the kidney stone ruse. They arrive in the ER with allergies to everything but narcotics, toss a little blood into their urine sample, then writhe about in pain.
c. Avoid salt. Like protein, salt causes more calcium to build up in the kidneys.
d. Do not restrict your calcium intake. As odd as this may sound, decreasing your intake of calcium may actually increase your absorption of oxalates and it is the oxalate intake that tends to be the problem. Oxalates are found in chocolate, peanuts and tea.
By the way, last time I heard, baby number six was doing okay. I’m not sure why.
Listen live or call in to Dr Dave on his fun yet informative radio show, Wisequacks, heard each Sunday at 2 p.m. at www.cknw.com.