Kidney Stones - To retain or go fishing

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WilburRight

Filing Flight Plan
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WilburRight
Im a 43 year old airline pilot who recently had the pleasure of passing a kidney stone 2-3mm. Thought I was dying and went to the ER. An enhanced CT showed the culprit struggling to enter my bladder. I haven't been back to work in the month since, for obvious reasons.

I had a follow-up non enhanced CT that revealed the stone in motion has passed but also a 2mm Parenchymal Stone in my one kidney. So I can either convince a urologist to do a "not medically necessary" extraction OR go down the SI retained stone path.

Trying to weigh risk and reward.

The surgical route carries risks of anesthesia, infection, and UT/kidney damage. Going the SI route would necessitate a low dose CT or KUB x-Ray annually... and Im 43 so the radiation exposure over the next 22 years will not be insignificant.

Im leaning towards surgical intervention to avoid 22 years of annual radiation exposure, thoughts?

disclosure: I am working with a well known HIMS AME, but the path forward is ultimately my choice.

Brothers... how bad was the Ureteroscopy? The stent removal is nauseating to say the least, but when weighed against 22 KUB X-rays...

Respectfully,
A pilot who advises against high doses of Vitamin C, daily dark chocolate, and Japanese green tea.
 
I can't help but I am scared.
So what are some good habits to avoid ever getting one of these things?
I haven't had one but either I am not predisposed to them or its dumb luck. Maybe IPA's prevent kidney stones?
 
Is lithotripsy or some other ultrasound therapy not available? A friend just had some big stones blasted.
 
The BEST thing you can do is have the stone combusted, know it's composition and then go to a Medical Nephrologist for the startegy to reduce the formation of stones in the river.

The urinary stream is best described as the "pot in which crystalline Christmas candy precipitates on the thread". What 's needed is to change the chemistry of the stream appropriately so that nothing forms any longer.
 
@bbchien
the Parenchymal Stone is 2mm. Any chance the FAA would allow imaging other than CT for annual certification? I know generally the guideline say CT/KUB Xray/Ultra Sound. I also know that only a CT will really show a stone of this size... thoughts? I've had 2 CT's so far, one with contrast (In the ER) and one low dose without.

Thanks for your time.
 
I've had three, in three different countries, with three different treatments. AMA :lol:

First was in Japan and treatment was mild pain medication and told to drink more water. Passed without intervention a few months later. $200 ER visit.

Second was in US. Lithotripsy was prescribed and executed. Technology was interesting. Is done in patient, so no hospital stay. Multiple civilian visits before, during and after added up to 12k. Two visits with Chien got me flying again. Or maybe a phone consult and a visit. It's been a while.

Third was in Mexico. Ureteroscopy was prescribed and executed. Google tells me this is done outpatient, but the clinic I went to in Mexico wanted to keep me a night, so that's what we did. Went to sleep and woke up without stones. Procedure and hospital was about $2k. Follow up KUB to show FAA I was stone free was $5. FAA accepted a declaration of that from my Mexican doctor.

First one was the most scary because sharp pain from out of nowhere gets your full attention. The other two I immediately recognized.

Second one was the worst. The pain in all three was similar, but the US medical system was the slowest to deal with, so more pain up front. Then the lithotripsy was the worst recovery.

Third one was the easiest recovery (pain from natural passing of the stone on the first one and the recovery after lithotripsy on the second one), by far.

Time between occurrences above was 2-3 years. I got religion on drinking water and am currently 6-7 years since the Mexican event.

So, back to the OPs question. Were it me, I'd be trying to get clean rather than show a stone with no movement. The various treatments aren't notably better or worse from a pain standpoint and the thing that has ever kept me up at night has been the time bomb aspect. We know, for example, that riding roller coasters can help one pass a stone. To me knowing that the next time I fall down playing sports, the next roller coaster ride, the next high G aerobatics move or the next time I drive my RZR around our terrible roads in Mexico might cause a retained stone to start moving again is enough to not want them. Rational or not, the emotional aspect of having them around gets my attention.
 
WilburRight said:
Im a 43 year old airline pilot who recently had the pleasure of passing a kidney stone 2-3mm. Thought I was dying and went to the ER. An enhanced CT showed the culprit struggling to enter my bladder. I haven't been back to work in the month since, for obvious reasons.

I had a follow-up non enhanced CT that revealed the stone in motion has passed but also a 2mm Parenchymal Stone in my one kidney. So I can either convince a urologist to do a "not medically necessary" extraction OR go down the SI retained stone path.

Trying to weigh risk and reward.

The surgical route carries risks of anesthesia, infection, and UT/kidney damage. Going the SI route would necessitate a low dose CT or KUB x-Ray annually... and Im 43 so the radiation exposure over the next 22 years will not be insignificant.

Im leaning towards surgical intervention to avoid 22 years of annual radiation exposure, thoughts?

disclosure: I am working with a well known HIMS AME, but the path forward is ultimately my choice.

Brothers... how bad was the Ureteroscopy? The stent removal is nauseating to say the least, but when weighed against 22 KUB X-rays...

Respectfully,
A pilot who advises against high doses of Vitamin C, daily dark chocolate, and Japanese green tea.
Click to expand...

You can drive yourself crazy obsessing about radiation and such, but as an airline pilot I'm sure you're aware that risks from radiation (from x-rays and other sources) can be thought of in terms of time spent in an airliner at altitude.
 
At the end of Sept I woke up one morning and peed what looked like root beer. Scared me. Drank a lot of water and it got better throughout the day.

Next morning, same thing. I don’t usually call the doc, but knew something was wrong. Turns out it was a 3x9 mm stone stuck in the kidney, confirmed first by X-ray, then CT. Zero pain.

Shockwave lithotripsy was scheduled a month out. They gave me a Flowmax script and told me to drink lots of fluids. I didn’t do the Flowmax because I didn’t want it to move and start causing pain. I drank close to a gallon of water every day just to prevent it from getting worse.

In addition to the water intake, I looked up foods that contained oxalates and only ate foods with zero to little oxalate content. Drank no soda or sweet drinks. As close to zero salt and sodium as I could get. And I added lime juice to my water.

I have some expertise in geochemistry. I thought not only would I prevent additional precipitation and accretion, but might also be able to dissolve it…I don’t have a medical background, so this was a crazy thought.

I arrived for my procedure a month later. First step was a pre-op xray that morning. X-ray showed no stone. In the OR, before they put me under, doc scanned and confirmed no stone. They kicked me out and I was good to go.

So no way I passed a stone that big, it must have resolubilized.

I found this after I was cleared:

Geobiology reveals how human kidney stones dissolve in vivo - PMC

More than 10% of the global human population is now afflicted with kidney stones, which are commonly associated with other significant health problems including diabetes, hypertension and obesity. Nearly 70% of these stones are primarily composed of ...
pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov

So my advice, if it’s a calcium oxalate stone (80% of em are), do some crazy stuff like I did and hope for the best.
 
Mino-related thread hijack.

How far back does the FAA care about previous retained stones? Situation: Previous Class 2 medical cert, last was issued around 2016. At that time (10 years ago), it had been about 3 years since I had a kidney stone, and had gone through the process to demonstrate that the retained stones were not moving. Class 2 issued. Was (still am) on a medication, a common diuretic, to mitigate new stone formation.

Zero issues with stones since the episode ~13 years ago. Went Basic Med when the last Class 2-->3 expired to keep life simple. Fast-forward to now. Basic Med is about to need renewal, and I might have opportunities coming up to utilize a Class 2 medical. Will I be required to go through the full CACI protocol to prove I don't have issues, or is 13 years of clean-living enough?
 
WilburRight said:
@bbchien
the Parenchymal Stone is 2mm. Any chance the FAA would allow imaging other than CT for annual certification? I know generally the guideline say CT/KUB Xray/Ultra Sound. I also know that only a CT will really show a stone of this size... thoughts? I've had 2 CT's so far, one with contrast (In the ER) and one low dose without.

Thanks for your time.
Click to expand...
Yes. Annual testimony from the urologist. See attached. But you're clearly going to have more if you ignore the composition of what comes down the pipes.

Get 'er done (the stone composiotion drive what/whether you alkalinize, use thiazides, or control phosphate intake.....(as you don't wnat to have twins, now, do you.....)

I would do this b4 going fishing....or there will be just more fish.
 

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In my mind there are two issues.

1-you have a renal parenchymal stone. OK, so this is a little weird. Stones are typically in a renal calyx, pelvis, ureter or bladder and those are the ones likely to move. A calcification wholly within the the substance of the kidney, i.e. the parenchyma, is not typically going to move. (because it's "trapped" in the parenchyma of the kidney tissue, so to speak.) So this is not likely to move and cause problems. It is a marker, as is your other stone that passed, of an increased likelihood of your getting another stone in the future. This does tend to be a recurrent issue.

But it's really important to note that removing this 2mm ditzel won't appreciably decrease your risk for having another kidney stone. Did you see a urologist yet and have them review the scans? Some stones are easy to go after with various procedures. But a lot of small stones/calcifications within the parenchyma of the kidney are challenging and risky to get out. Combine this with the fact that it's not likely to cause you a problem-- and, more to restate the point, your risk for a recurrent stone is still notable and won't change much after removal. So why remove it?

2- Prevention of further stones. This is not related to whether you fish out any current stones or not... Ideally we'd like to know the composition of your stones. That's why we give folks a strainer to strain their urine while they are passing a stone. Nothing beats lab analysis of a stone. Statistically most are calcium containing (oxalate and phosphate). There are things to do to reduce your likelihood of a recurrent stone. See below.

NIDDK stone prevention guidelines

As far as monitoring, I'm not an AME, but in the non AME world, if you have calcium stone on an initial CT, we typically follow this up with serial KUB's, since you can use the initial CT as a reference to where the calcium spot is on the kub. Is there some risk in getting serial KUB's, yeah, but smaller than the surgical risk...

So 1-prevention is the key. 2-have an honest discussion with the urologist about the risks of going after a small, asymptomatic stone in the substance of the kidney. I haven't seen your scans, but the way you've described it, I'd be hesitant to have any procedural intervention. Kidneystones often dissolve or pass on their own. Lifestyle change and monitoring may be the best option.
 
Mark K said:
In my mind there are two issues.

1-you have a renal parenchymal stone. OK, so this is a little weird. Stones are typically in a renal calyx, pelvis, ureter or bladder and those are the ones likely to move. A calcification wholly within the the substance of the kidney, i.e. the parenchyma, is not typically going to move. (because it's "trapped" in the parenchyma of the kidney tissue, so to speak.) So this is not likely to move and cause problems. It is a marker, as is your other stone that passed, of an increased likelihood of your getting another stone in the future. This does tend to be a recurrent issue.

But it's really important to note that removing this 2mm ditzel won't appreciably decrease your risk for having another kidney stone. Did you see a urologist yet and have them review the scans? Some stones are easy to go after with various procedures. But a lot of small stones/calcifications within the parenchyma of the kidney are challenging and risky to get out. Combine this with the fact that it's not likely to cause you a problem-- and, more to restate the point, your risk for a recurrent stone is still notable and won't change much after removal. So why remove it?

2- Prevention of further stones. This is not related to whether you fish out any current stones or not... Ideally we'd like to know the composition of your stones. That's why we give folks a strainer to strain their urine while they are passing a stone. Nothing beats lab analysis of a stone. Statistically most are calcium containing (oxalate and phosphate). There are things to do to reduce your likelihood of a recurrent stone. See below.

NIDDK stone prevention guidelines

As far as monitoring, I'm not an AME, but in the non AME world, if you have calcium stone on an initial CT, we typically follow this up with serial KUB's, since you can use the initial CT as a reference to where the calcium spot is on the kub. Is there some risk in getting serial KUB's, yeah, but smaller than the surgical risk...

So 1-prevention is the key. 2-have an honest discussion with the urologist about the risks of going after a small, asymptomatic stone in the substance of the kidney. I haven't seen your scans, but the way you've described it, I'd be hesitant to have any procedural intervention. Kidneystones often dissolve or pass on their own. Lifestyle change and monitoring may be the best option.
Click to expand...

I have a 1cm renal cyst right where the stone is located. It may be in the cyst or more likely in the kidney.. it is not a classic case indeed.
I am have seen a Urologist. I was unfortunately unable to screen the stone that passed already. He does not want to get this stone, as you said it's risky and not medically necessary in the least.
 
Then all you have left is to stay hydrated, wait and capture the next one. And have him do the CACI sheet annualy prior to your medical.
 
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