10: Kidney of Fire

Have you ever had a kidney stone?

Renal calculi is another medical term used for this abomination. I'm not using that term loosely, either. If you've ever had a kidney stone, you know abomination doesn't do those little things justice. They are awful!

I think of the line from the film Prometheus. "Big things have small beginnings." Lawrence of Arabia also used this line. The line is tried and true because when you have a small kidney stone that impacts your urinary tract, it's a BIG deal.

I've had two kidney stones in my life. One came in 2016 very unexpectedly. Before that day in October 2016, I had only heard about how bad kidney stones can be. I've had patients with kidney stones who had to work to pass them. I've heard family members express how awful they are when they have experienced them. But none of those observations can prepare you for how bad a kidney stone can be.

Back in 2016, the stone was made more of protein. Protein is not very dense. Therefore, after the initial pain that forced me into the emergency room that night had settled down, the pain was nowhere near as bad. I took Lortab for a few days to help, but the stone was dissolving with the water I was putting into my system. A protein stone is more pliable, so substances like lemon juice being mixed in your water can assist with dissolving it. Eventually, the stone shrunk, so I didn't even feel it pass, but fortunately, it did.

But at the dawn of 2023, that was not the case for that kidney stone. It was January 5, 2023, to be exact, so Happy New Year to me. I had worked out on my new elliptical my wife, and I got each other for Christmas, and completed 55 minutes working out. Remember, I'm always trying to close the rings on my watch, so sometimes you have to do a little extra to get it done. Immediately following the exercise, I used the bathroom. When I did, my urine was amber.

Amber is the color your urine can become for a few reasons. One is dehydration from lack of water. I didn't think I was that dehydrated because I thought I had drunk enough water. But I was convincing myself I needed to step up my water intake. That week had been a little challenging with elimination needs (nice way to say bathroom needs), so I thought maybe I was a bit dehydrated.

The other reason is blood in the urine. My mind did not go to this then because I assumed it was a lack of water. But, the next morning, I quickly discovered the problem with my kidney.

When I used the bathroom upon getting out of bed, my urine was as amber as the night before. It was terrifying to see that urine. I immediately started downing a whole bottle of water in 5 seconds flat. That's when the pain set in.

People have often described kidney stone pain as worse than child labor. Child labor is by far one of the most painful things a person can go through. I had to watch my wife go through it twice with the birth of our children. But despite that, when my wife had a kidney stone herself, years later, she too said the kidney stone was far more painful than delivering either of our children.

So, needless to say, I was brought to my knees right away from this new kidney stone as my wife escorted me to the emergency room to have it treated.

My labs showed gross blood in the urine, which is why it was so dark. The pain made me want to throw up, so I did. I threw up nothing but water because of that whole two bottles of water I drank. I'm not kidding. I downed another one just before the pain set in.

The worst part was the agony of waiting. Because a kidney stone is not emergent, the staff gets to you as quickly as they can in the emergency room. That's just the way it is and part of prioritization. I was in pain, but they got to it as quickly as possible. The problem for me is that, for some reason, this stone hurt worse than the last one. I assumed it must be huge!

The previous stone came in at 5 mm, which put it at almost the full size of the ureter on my left side. But, as I said, it was protein and easily dissolved by water and other agents. So, it passed with very little effort.

This stone in January 2023 came in at a whopping 3 mm. Do huh? It's smaller than the first one? How is that possible? That's impossible! But I searched within my feelings and my medical record later and knew this to be true. This new stone was smaller but much more painful, and there was a reason for that. The stone was made of calcium oxalate. 

Calcium oxalate stones are some of the hardest kidney stones imaginable. They do not break down as easily as protein. What they do, at least in my case, is move around in the ureter as it passes down, scrapping the interior of the ureter along the way. This scrapping was causing the amber urine. Then, because the orifice from the ureter to the bladder narrows, the stone becomes lodged. Once a calcium oxalate stone becomes lodged, no force on earth, in heaven, hell, eternity, or an alternate universe can make that stone move. All you can do is wait for it to pass or have surgery if it won't pass on its own.

Once I had some Morphine and Toradol in my system, the pain subsided, and I could stop rolling around on the floor at the hospital. Yes, you read that right. I was in so much pain at one point in the waiting room that I lay on the floor and did not care. Even once I had a bed, I still had to get up and move in different positions to get some relief until they brought me some medications. It was excruciating!

But finally, I got some meds, and they prescribed pain meds, Lortab and Toradol, along with Flomax, to help get the stone out of my system. After that trip of despair to the emergency room, I went home to suffer through 5 more days of pain trying to pass this stone before my follow-up appointment. 

Each day, unfortunately, the pain never improved. This lack of pain relief was vastly different from the previous stone. Eventually, with the stone in 2016, I had no pain at all. This stone was evil! The stone kept lodging in my ureter, right at the passageway that would send it out of my body for good. A couple of times, while straining urine, I saw a speck of dark pieces in the strainer. I thought This is just the tip of the iceberg. I'm ready to sink the Titanic. Heck, let's blow up the Titanic at this point!

Finally, the last of those 5 days came, and out came the full stone. I held that stone at my fingertips, looking at it like David in the picture. It felt rock solid between my fingers. No crumbling or anything, and protrusions were visible on one side. It looked almost like an insect. It was ghastly and awful, and I couldn't wait to trash that thing. Immediately the pain ceased, and all was well again. I was so relieved the pain was over from that awful stone. Then the blood clots came.

I never had blood clots from my first stone. Like I said, it wasn't as dense. This one scrapped the interior lining of my ureter all the way down and plowed through the orifice from my ureter to my bladder. It caused damage that led to blood pooling up in those areas. The result was a bunch of clots on the lining of my ureter that had to come out with the urine. At one point, the bottom of the toilet was filled with leftover clots. That was intense too. The clots didn't hurt, but just passing them was insane. All I could think was What has this tiny stone done to my kidney? 

A few weeks later, I returned for my follow-up scan to see if my kidney had returned to normal size because the build-up of fluid made it swell, and everything was back as it should have been. It was such a relief. I actually cried when I was alone in the patient room waiting.

So, what does this have to do with my sugar concerns and dieting?

Well, do you know what can cause calcium oxalate stones? This link will tell you more, but dehydration and chocolate and nuts are a big culprit.

You see, coming out of the Christmas holidays, I had been eating a few things that were not good for me. After getting my last A1c of 5.8, which wasn't horrible, I decided to enjoy some things through the holidays and pick back up on dieting with the new year. That's not uncommon for anyone, so I was no different in this case. But I was indulging in some really delicious stuff.

For one, my mom makes the best roasted pecans. They are to die for. Now, pecans are lower in oxalate, but not in the amounts I was eating. I was eating roasted pecans like they were going out of style. On top of that, I had started just munching on peanuts as a whole, buying a big box of peanuts at the store whenever it suited me. Indulging in peanut butter sandwiches. I was going nuts for nuts.

Then I added in chocolate! I was eating a ton of Milk Duds and other chocolates, from leftover Halloween candy to Christmas candies. Don't forget chocolate chip cookies! But the last part was the dehydration. By this point, I had slipped back into drinking more diet soft drinks than water. I love the taste of Diet Wild Cherry Pepsi or Pepsi Cherry Zero. I love the taste of those so much. But they contain more carbonation, which can be dehydrating. Combine that with 3-4 days of irregular stools, bingo, and kidney stone from Hades!

The dehydration caused by the loose stools and lack of water was probably the single biggest factor for the stone, but the overabundance of chocolate and peanuts didn't help. What had happened was after receiving my A1c result, I just wanted to have some fun through the holidays. It cost me pretty well by January 5, 2023.

So, over the last 8 months since, I've drank almost nothing but water the whole year. I had a few times of diet drinks coming back into the mold, but I've just adopted the habit of drinking water now. I've also cut way back on chocolate, and nuts have been cut out almost completely except on rare occasions. I don't want another kidney stone, but those food items are also fattening. Chocolate and nuts contain a lot of calories, especially if you eat them in bulk, like I was doing during Christmas. You can't do that when you're trying to maintain a balance in your diet. You especially can't do it when you have sugar control issues.

Now, it is not to say you can't indulge occasionally. Anything in moderation is not bad, but I was not moderating it. I opened my mouth wide and poured a whole bag of pecans into it in one sitting. Put it in perspective, my mom, during the holidays, made my dad and I the same size tin of roasted pecans, with the same amount of pecans for each. My tin of pecans was gone in 2 hours. My dad's tin of pecans was gone in 2 weeks. Yeah, that's a little bit overindulging, to say the least.

I had said in the last post that I needed to make changes to my diet, and the kidney stone made me do just that. Following the kidney stone debacle, I was back in action, trying to get my diet in a place that would lower my A1c again. My goal was to be at least at 5.6 or lower by May. The new year had begun, 2023 was one I was looking forward to, and my goal was to get things under complete control if possible. I was now heading that way.

So tune in next time for 10: Swamp Rabbits, Grants, and Graduations, OH MY!