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drwexSo, the plan is still, mostly to shoot lazors up my peehole but I have an awesome new doc to work with and a much better set of information to work from. tl;dr if you have any problem that a urologist could be helpful with I will cheerfully recommend you to this lady. And I think I'm still set for surgery in a couple weeks.
The previous urologist was OK, if brief. However, he didn't have any openings for several weeks and only does surgery on Tuesdays. He didn't see a problem with this.
The new doctor does her surgeries on Friday and immediately understood why I'd want that as it would give me a weekend at home to recuperate. This doc also gave me much more information and options to go on. Some things I learned:
1. It's not the size of the stone that matters (hurts). Although it's true that smaller stones are easier to pass, she's worked with a patient who needed intervention for a 2mm stone and one who actually passed a 10 mm stone (because they do dissolve, see below).
1a. The pain actually comes from the kidney, when the ureter is blocked and urine backs up in it. So if a small stone actually blocks the ureter that can hurt as much or more than a big stone.
1b. The other source of pain comes from the stone moving from the bladder out. She stated that she's had female patients who would prefer to birth a 20-lb baby than have/pass another stone. This matters because if I do decide to pass it (see below) I need to be prepared to feel like (and I quote) "someone kicked [me] really hard in the balls". Men apparently have non-trivial amounts of testicular pain from passing stones. Good to know. She also made sure I had the anti-nausea med available (I do).
1c. This is the real reason they put in a stent after the procedure. She noted that having the device inserted tends to inflame the walls of the ureter and the stent holds it open while the inflammation goes away. If the inflamed ureter swells up and closes, you're right back where you were when the stone was blocking it. This is way more useful info than I got from the first doc.
1d. I did ask about the use of ultrasound to pulverize the stone. The first doc simply said "we don't do that" - she elaborated that procedure is not used for stones that have already left the kidney. It's a simple risk/reward tradeoff: stones that don't naturally leave the kidney are both very painful and highly risky so it's better to undergo the ultrasound procedure, even though that itself has some risks. Stones like mine that have already made it out of the kidney are best dealt with directly, not exposing the kidney to the risks of ultrasound. No procedure is entirely risk-free, of course, but outcomes for people who avoid the ultrasound are considerably better than for those who have that procedure.
2. Passing the stone is not an unreasonable option to consider. She left the decision up to me but pointed out that I'm so far mostly pain-free, and that even though the stone is 7mm, it's basically football-shaped and is "head down" (she used a lot of birthing language, which cracked me up) making it more likely to move down the ureter on its own.
2a. As a result, we've agreed I should go back on the drug that relaxes the walls of the ureter to encourage it to move.
2c. Like the dude with the 10mm stone it's never going to pass in its current state; however, people who pass large stones do so because the stone naturally breaks up or dissolves. To encourage this, I'm adding concentrated lemon and lime juice to my water. The more acidic I can make my urine, the more likely it is to dissolve on its own. Even if doesn't fully dissolve, a smaller stone is easier to remove.
I really like that she was direct and honest about this option and offered me support for whichever course I'd take. Passing the stone without intervention is the best possible outcome, but people who have a lot of pain (see above about the intensity) often want earlier surgery to get it over with. That's how I felt before, but being relatively pain-free and having a doc who'll support this option makes it more interesting.
We're going to continue down the surgery road but as I said, taking meds and trying to get the stone to pass on its own. I have a surgical prep appointment this Friday and the op is scheduled for a week after that so my body has two weeks to get its shit together. If I pass even a part of the stone we'll cancel surgery for sure.
3. Stone risk is much more extended than I was told before. She said 7-10 years is the horizon she's comfortable with. That doesn't likely mean long-term medication, especially if there are no recurrences, but it does mean diet modification.
3a. Her preferred anti-stone diet is "lots of water, low salt, low protein" with a varied menu of foods. Variety is key, she says
3b. In discussing protein she says that red meat protein is the big problem. People who have bacon with breakfast, a ham sandwich for lunch and then steak-and-potatoes for dinner are at the highest risk. Most of my protein comes from white meats, secondarily vegetable (soy, rice/beans) and third from dairy (milk, cheese). Red meat is way down the list. Still, care is important and I'll keep choosing the turkey burger over beef as I do now. Just don't try to take my bison burgers away ;)
I got all the above, a new X-ray, and a sense that this is a doctor I really want to work with. She snarked at me! If you know me at all you know that's a good sign for me. Combine that with a great bedside manner, the sense that I'll be supported no matter what, and lots of relevant info delivered in comprehensible fashion and you've got a winner.
The previous urologist was OK, if brief. However, he didn't have any openings for several weeks and only does surgery on Tuesdays. He didn't see a problem with this.
The new doctor does her surgeries on Friday and immediately understood why I'd want that as it would give me a weekend at home to recuperate. This doc also gave me much more information and options to go on. Some things I learned:
1. It's not the size of the stone that matters (hurts). Although it's true that smaller stones are easier to pass, she's worked with a patient who needed intervention for a 2mm stone and one who actually passed a 10 mm stone (because they do dissolve, see below).
1a. The pain actually comes from the kidney, when the ureter is blocked and urine backs up in it. So if a small stone actually blocks the ureter that can hurt as much or more than a big stone.
1b. The other source of pain comes from the stone moving from the bladder out. She stated that she's had female patients who would prefer to birth a 20-lb baby than have/pass another stone. This matters because if I do decide to pass it (see below) I need to be prepared to feel like (and I quote) "someone kicked [me] really hard in the balls". Men apparently have non-trivial amounts of testicular pain from passing stones. Good to know. She also made sure I had the anti-nausea med available (I do).
1c. This is the real reason they put in a stent after the procedure. She noted that having the device inserted tends to inflame the walls of the ureter and the stent holds it open while the inflammation goes away. If the inflamed ureter swells up and closes, you're right back where you were when the stone was blocking it. This is way more useful info than I got from the first doc.
1d. I did ask about the use of ultrasound to pulverize the stone. The first doc simply said "we don't do that" - she elaborated that procedure is not used for stones that have already left the kidney. It's a simple risk/reward tradeoff: stones that don't naturally leave the kidney are both very painful and highly risky so it's better to undergo the ultrasound procedure, even though that itself has some risks. Stones like mine that have already made it out of the kidney are best dealt with directly, not exposing the kidney to the risks of ultrasound. No procedure is entirely risk-free, of course, but outcomes for people who avoid the ultrasound are considerably better than for those who have that procedure.
2. Passing the stone is not an unreasonable option to consider. She left the decision up to me but pointed out that I'm so far mostly pain-free, and that even though the stone is 7mm, it's basically football-shaped and is "head down" (she used a lot of birthing language, which cracked me up) making it more likely to move down the ureter on its own.
2a. As a result, we've agreed I should go back on the drug that relaxes the walls of the ureter to encourage it to move.
2c. Like the dude with the 10mm stone it's never going to pass in its current state; however, people who pass large stones do so because the stone naturally breaks up or dissolves. To encourage this, I'm adding concentrated lemon and lime juice to my water. The more acidic I can make my urine, the more likely it is to dissolve on its own. Even if doesn't fully dissolve, a smaller stone is easier to remove.
I really like that she was direct and honest about this option and offered me support for whichever course I'd take. Passing the stone without intervention is the best possible outcome, but people who have a lot of pain (see above about the intensity) often want earlier surgery to get it over with. That's how I felt before, but being relatively pain-free and having a doc who'll support this option makes it more interesting.
We're going to continue down the surgery road but as I said, taking meds and trying to get the stone to pass on its own. I have a surgical prep appointment this Friday and the op is scheduled for a week after that so my body has two weeks to get its shit together. If I pass even a part of the stone we'll cancel surgery for sure.
3. Stone risk is much more extended than I was told before. She said 7-10 years is the horizon she's comfortable with. That doesn't likely mean long-term medication, especially if there are no recurrences, but it does mean diet modification.
3a. Her preferred anti-stone diet is "lots of water, low salt, low protein" with a varied menu of foods. Variety is key, she says
3b. In discussing protein she says that red meat protein is the big problem. People who have bacon with breakfast, a ham sandwich for lunch and then steak-and-potatoes for dinner are at the highest risk. Most of my protein comes from white meats, secondarily vegetable (soy, rice/beans) and third from dairy (milk, cheese). Red meat is way down the list. Still, care is important and I'll keep choosing the turkey burger over beef as I do now. Just don't try to take my bison burgers away ;)
I got all the above, a new X-ray, and a sense that this is a doctor I really want to work with. She snarked at me! If you know me at all you know that's a good sign for me. Combine that with a great bedside manner, the sense that I'll be supported no matter what, and lots of relevant info delivered in comprehensible fashion and you've got a winner.
