kidney stones issue

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I posted about this over on the red board but thought to ask here as well, in case anyone has any fresh insights, or can spell out to me why my case is hopeless.

I was recently diagnosed with four small stones (largest 2.5mm) seen on CT after a US detected a small nonobstructing stone. I have no previous history of stones. I had the full metabolic workup that showed slight hypercalciuria, borderline hyperoxaluria, mildly alkaline urine. Nothing my nephrologist or urologist has told me suggests (to me, anyway) that they are likely to be anything but ordinary calcium oxalate stones, preventable by diet (I'd recently become a nighttime chocaholic and drank lots of chai tea -- no more!). Uro thinks they will pass spontaneously, nephro thinks they probably won't pass anytime in the near future (he can't guarantee that they won't though). Both counseled that I should go with "watchful waiting" even though I asked for lithotripsy because I doubted that I could get recertified with retained stones. I don't have any known underlying kidney disease that would make lithotripsy or extraction unusually risky, I think they're just practicing conservative, HMO-style, cost-cutting medicine.

If it would mean that I could get recertified, I'd be willing to doctor shop to find someone willing to treat the stones in the most expeditious way possible. On the red board Dr. Bruce said that my only hope is if the stones are provably unpassable so the FAA would issue me as is with a letter from the doc. I'm trying to understand this, since dozens of pilots have gotten recertified after passing stones. I understand that mine are too small to be seen on KUB and that just getting KUB cleared for now isn't good enough, but why couldn't I qualify after successful treatment? Maybe I'm reading too much into what wasn't said explicitly but I'm getting the impression that I'll always be held to the standard of completely stone free by CT which is hard to achieve due to the high resolution of modern CT. But that doesn't make sense to me since just about everyone today who has stones is screened by CT at some point, and other people have gotten past this hurdle.

I'm posting unreg since I don't like to share medical details out in the open. Thanks for reading.
 
Dr Bruce is the gold standard. Perhaps you didn't understand him fully, and perhaps he or someone else will weigh in here.

From what YOU said, it sounds like Dr Bruce said you can't get certified with the stones still in your kidneys. It doesn't sound like he said you can't get recertified once they're gone. Perhaps your problem is how to get them "gone". Did you explain to your doctors that you cannot fly while you have known stones, and does that change their mind on waiting for them to pass?
 
Tim, it's very possible that I misunderstood Dr. Bruce! I hope that's the case. But I asked twice about the possibility of getting the stones treated. He didn't even address that but got impatient that I hadn't understood his previous reply regarding a route to SI with retained stones and that that was my ONLY way out. I understood the first part, and am pretty sure it doesn't apply. The second part is what confuses me.

Also, it's my nephro who said that if I need to be 100% stone free by CT, then good luck because CT picks up even the tiniest pieces. So I think that's part of the reason he's against lithotripsy. But I did see an archived thread on the red board where pilots had flecks that were deemed insignificant, and they were told that a letter to that effect would get them issued. I know that each case is unique and there might be details about mine that mean I'd still be disqualified. That's what I'm hoping to get clarification on.
 
OK, without seeing the original stuff (and I don't go to the Red Board), then all I can do is reiterate that Dr. Bruce is probably the best resource available.
 
If you have ever passed a stone, you would understand why you can't pass a medical if there is a chance of passing a stone.

When I had my stone I was driving and I really had a tough time getting home and getting help to the ER. My B.P. was way way high, I was vomiting and ready to pass out.
 
Unregistered said:
Tim, it's very possible that I misunderstood Dr. Bruce! I hope that's the case. But I asked twice about the possibility of getting the stones treated. He didn't even address that but got impatient that I hadn't understood his previous reply regarding a route to SI with retained stones and that that was my ONLY way out. I understood the first part, and am pretty sure it doesn't apply. The second part is what confuses me.

Also, it's my nephro who said that if I need to be 100% stone free by CT, then good luck because CT picks up even the tiniest pieces. So I think that's part of the reason he's against lithotripsy. But I did see an archived thread on the red board where pilots had flecks that were deemed insignificant, and they were told that a letter to that effect would get them issued. I know that each case is unique and there might be details about mine that mean I'd still be disqualified. That's what I'm hoping to get clarification on.
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I'm no doctor, but I'd think that there must be some leeway for "tiny" stones below some size, possibly with a requirement for repeated monitoring of the stones as I suspect they will grow if they aren't passed soon. I had one stone (>2mm which is rather large according to Dr Bruce) and grounded myself until it passed about a week after the one and only episode of pain I had. Per Bruce's recommendation I had my doctor write a letter stating that all evidence indicated that I was no more likely to pass another stone than any other healthy human and that was sufficient for my AME to issue a Class II on the spot a month later.

Start drinking lots of water. You'll want to pass those stones before they get any bigger, trust me.
 
I had a stone, once. My experience was that any retained stone is disqualifying, unless a urologist reports that it is unlikely to pass (there are specific words to use in the report that will satisfy FAA). If you were on the red board, then you are an AOPA member and can call the AOPA medical line and talk to the good folks there. If you got the word straight from Doc Bruce, he's the pro.

The way the FAA seems to deal with very small stones is by allowing a KUB as proof there are no retained stones. The KUB is not very detailed and small stones simply won't show. The CT is the hi-res system and will show nearly everything. I think if the stones showed on CT and not on KUB there should be some way around this. (I'm NOT an AME).

Try calling the AOPA medical guys and see what they say.

edit: I just read your posts on the red board. My reading from what Doc Bruce said was that if they are staghorn, you're probably OK because they don't pass. I understand your problems now - I hope you can get that clean KUB accepted or find some other way around this.
 
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OP here. Thanks Lance, yeah I've been drinking lots of water. Enough that my nephro says I don't need to drink any more. :) And Matthew, I don't actually have a clean KUB, just what my docs told me, that they probably wouldn't have seen a stone that small on KUB. I gather KUB is not an option for me FAA-wise since everyone knows the stones are there from the CT. Though there was a thread on the red board where someone got issued with a 2mm stone seen on CT but a clean KUB later on with no treatment, so I'm a little befuddled on that point too. Maybe that extra 0.5mm makes a big difference to the FAA.

I'd really prefer to get rid of the stones, period. I only asked (on the other board) about getting issued with the stones still there because my docs aren't exactly gung ho to do anything about them.
 
Unregistered said:
... I don't actually have a clean KUB, just what my docs told me, that they probably wouldn't have seen a stone that small on KUB. I gather KUB is not an option for me FAA-wise since everyone knows the stones are there from the CT....
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OK - I'm getting a better understanding, now, of the dilemma. You've probably explained the problem to your docs? Once my urologist understood my issues with FAA, he was very willing to help out any way he could. I didn't really end up needing any special treatment, though. I went to a guy recommended by my AME. I figured that would help matters in case there were any borderline calls. I still think you might get some help from AOPA Medical, if you haven't tried them yet. I'm pretty sure they keep everything confidential, and you can talk to a real person, rather than via forum posts.
 
I've got a great pilot pal who is also a urologist who specializes in ultrasonically removing kidney stones. He flys his own Aerostar all over the place as well as gliders. I could put you in touch if you are interested. He's the guy I'd want working on ME.
 
wby0nder said:
I've got a great pilot pal who is also a urologist who specializes in ultrasonically removing kidney stones. He flys his own Aerostar all over the place as well as gliders. I could put you in touch if you are interested. He's the guy I'd want working on ME.
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My doc told me that using ultrasound to "remove" (actually break into multiple pieces) stones was fairly unpleasant and not terribly effective, kinda a last resort thing. Perhaps his information was outdated?

OP, unless you already did I'd ask Dr Chien very specifically whether it would help your case to get a KUB showing no stones. Even if you have to pay for it, this might help a lot.
 
lancefisher said:
My doc told me that using ultrasound to "remove" (actually break into multiple pieces) stones was fairly unpleasant and not terribly effective, kinda a last resort thing. Perhaps his information was outdated?
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I didn't think it was that bad. They doped me up for the procedure so I was real happy for that part. Afterwards I don't recall any problems. The bits passed with no problems (at least I assume all the little bits passed...)
 
Thanks everyone, I really appreciate the support and encouragement. Feels a lot better than being told to resign myself to LSA anyway! BTW I think the best choice of intervention depends on the specifics of each individual case. I know there are a number of ways to treat stones including ureteroscopically with a laser. From what I've gleaned with a quick search, ultrasonic lithotripsy seems to be used mainly for large stones. But I gather that the exact location of the stones makes a difference too, and I don't have that information.

I'm going to try to get back together with both my docs this week and discuss my options, and hopefully get a copy of the CT report. What I told them is that I *think* I can't be issued with retained stones. I didn't have the impression that they really cared, but at least now I can plead and beg with conviction. I do have an appointment set up with a second nephro in January in case I can't get anywhere with my present docs.

And yes, Lance, I didn't have to ask Dr. Bruce. I wrote in my OP on the red board that I suspected it was true, and he confirmed it.
 
As you are unregistered on BOTH boards, why don't you send me a real e-mail, it works from either board, then I'll send you a fax # and I'll look at what you've got.

Dr. Bruce
 
OP here with a status report... my urologist decided lithotripsy was my best option. It was scheduled for today. I went in, was prepped, IV and all, on the table but they could not find any stones on ultrasound. The doctor griped that the US machine had poor resolution, but he also doubted most ultrasounds would even see a stone that small. So lithotripsy is a no-go.

So now I'm up against the $64,000 question: if I can get a "stone free by KUB" report without extraction or lithotripsy, will that be enough for the FAA? My urologist thinks my stones are too small to show up on KUB, but I need a thorough bowel prep first -- they did a KUB today too, but couldn't even see the right kidney at all. Do I have a chance here? Or do I need to go for ureteroscopic extraction?
 
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