I followed the rules and still got stoned

I got stoned before writing this column — on a medical disorder that has beset humans for centuries.

The effects of the trip still linger, but the experience largely ended the other day when Dr. Avi Weiss, who refuses to recite the Hippocratic oath held sacred by many physicians, did a high-tech battle with my kidney stones at University Medical Center.

The stones hit a couple of weeks ago, a few days before I was to leave for Michigan to visit my ailing mother. Nausea, difficulty urinating, chills, fever and cramping pain in the back, side and groin left me in the fetal position on the bathroom floor. I asked God for help and my wife answered. I ended up in the UMC emergency room.

When kidney stones move into the urinary tract and block the flow of urine, you’re stoned — and you may well hallucinate from the pain. A colleague at the late Houston Post told me that her kidney stone experience was more painful than giving birth to her children.

One of the most common urologic disorders, a kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. If you don’t drink enough water, doctors say, your urine is likely to have higher concentrations of substances that can form stones. The good news is that most kidney stones leave the body without any intervention from a physician.

The bad news is that medical statistics reveal that each year people make about 3 million visits to doctors for kidney stone problems, with more than half a million people going to emergency rooms. Roughly one in 10 people, more men than women, develop difficulties with kidney stones.

Given the prevalence of the problem — people in Sun Belt areas are at higher risk of developing the painful stones because they don’t stay hydrated enough in hot weather — it isn’t surprising that the new Review-Journal health pages would report on the disorder. We want to give you health news you can use. Still, I must confess that I didn’t want to get stoned to produce the most up-to-date account of the subject possible.

I would have been content to share vivid memories from the ’90s of a kidney stone attack in Houston, one that hit so hard I had to stop my car in traffic and crawl to the grassy median. An ambulance took me to an ER and blessed morphine.

War stories aside, scientists have found evidence of stones in a 7,000-year-old Egyptian mummy. Ben Franklin, who invented the lightning rod and bifocals, also created the country’s first flexible urinary catheter for dealing with the problem.

As with so many maladies, medical authorities, including Las Vegas internist Dr. Ivan Goldsmith, say a family history of stones makes it more likely you’ll have them. My late father passed on his propensity for them to his sons.

In most people, urine contains chemicals that inhibit crystals from forming. But for some reason these inhibitors don’t work for everyone. If the crystals remain tiny, they travel through the urinary tract and pass out of the body without being noticed. Stones up to 6 millimeters in diameter, while often resulting in a trip to the doctor for pain medication, generally pass without surgery by drinking two to three quarts of water a day.

Urologists say you can minimize your risk of kidney stones by drinking 12 eight-ounce glasses of water per day and laying off soda. In the UMC emergency room, Dr. Dale Carrison said I was dehydrated, something I chalk up to my inability to drink water from the fetal position.

Once someone has had a kidney stone attack, his or her chance of a recurrence is more than 50 percent. Doctors claim, however, that if they can study your passed stones, they can then reduce the recurrence rate to 10 percent or less by giving you medications and dietary restrictions.

Well, I’ve followed doctors’ orders since the ’80s and I’m still one of the unlucky ones — I now have undergone three operations to remove stones, which urologists say are “rarely” needed. This episode has knocked me down for two weeks and I still feel like I’ve been sucker punched in the kidney.

If you don’t believe medicine is as much art as science, consider this: I remember when doctors told me to avoid dairy products and other foods with high calcium content to avoid growing stones. Yet recent studies have shown that foods high in calcium, including dairy products, help prevent calcium stones.

“Despite all the studies, it’s ill-defined as to what separates the stone formers from the non-stone formers,” Weiss told me after he lasered and shock-waved my two stones — one stuck in the bladder and the other lodged in the left kidney — into small pieces that passed in my urine.

The 35-year-old Weiss, who knows that precision is critical to good surgical outcomes, says he can’t recite the Hippocratic oath, which is considered a rite of passage for practitioners of medicine in many countries, because of its imprecision.

Not the well-known “first do no harm” admonition, which he says he believes “to the core of my being.” What he objects to is that part of the oath that warns physicians untrained in surgery not to make a patient’s excruciatingly painful kidney stone attacks even worse: “I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.”

“How can I recite that when I’m one of the practitioners, one of those doing the surgery?” Weiss said. “I am a physician trained as a urologic surgeon.”

He’s also trained to give advice: If I want to prevent another kidney stone attack, he said the best thing I can do is to regularly fill a half-gallon jug with urine over a 24-hour period. That, he suggests, will prove I’m drinking enough water to keep stones at bay.

Like Weiss, I’m a stickler for precision. I am once again following doctor’s orders to the letter. I have purchased a half-gallon jug for regular use. I am now trying to determine where to keep it in the newsroom.

Paul Harasim is the medical reporter for the Las Vegas Review-Journal. His column appears Mondays. Harasim can be reached at pharasim@reviewjournal.com or 702-387-2908.

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