Everybody Must Get Stoned…NOT!!!
Kidney Stones in the E.R.
By C.Soul R.N.
Hi all…the E.R. has been busy again; the flu season hit us hard and I have been lucky (if you want to know about the flu, please refer to my previous column “One Flu over the Cuckoo’s Nest”). Today’s column comes from a recent encounter with a relative in my E.R. He was rubbing his right groin region and then his right flank (the right side of his lower back). He said that he became nauseous when trying to urinate but he could not urinate. Without one test, I looked him in the face and said “welcome to the club, you are now officially a stoner…kidney stoner that is.
Patient#1
This is a 12yo boy who came in complaining of bilateral low back pain for four hours. According to mom, he has already passed 2 kidney stones in the last year and this seems like another.
Patient #2
This 52yo male works as a machinist and said that he has had this odd right flank pain for days, that seems to get worse just before he tries to urinate. His only health history is high blood pressure.
Patient #3
A 42yo female walked into my E.R. with a smile complaining of left flank pain for 2 hours. When she gave her address, we noticed that she traveled 60 miles and bypassed 4 hospitals to get to us. This was her first visit to our facility…ever!
In this edition of my words to the unwise, I will discuss education. We, as nurses, are trained to talk with and educate our patients. We read, go to seminars, get certifications, etc… in order that as we talk to; “WE KNOW WHAT WE ARE TALKING ABOUT.” We know that you are in pain even if we have a stoic look to our faces…and we care. We also know that if you refuse to listen to us, to “GET YOUR DRUGS AND RUN,” then our sympathy level drops into the negatives and you…you social retard…deserve and own all of your pain and discomfort.
Patient #1 did have more kidney stones. When I asked mom what his diet was like, she said that he consumed at least 2 liters of Mountain Dew (the worst soda ever made for human consumption), multiple “power drinks,” and milk. She also stated that he drank no regular water what-so-ever. I explained to the mother and patient that between the carbonation and caffeine, the patient was dehydrating himself constantly and his kidneys were unable to expel the mineral salts that make kidney stones. I further mentioned that the phosphorus in the soda, replaced the calcium in the bones, making his bones weaker. Most of all, the spare calcium has to leave via the kidneys…and if there is nothing to push it out, then it settles and creates a stone.
After hearing this, the patient said he sis not care and would not change his diet. I then said that the more stones you get, the more frequently you will get them. Again, he said he did not care. Mom said “well I guess I can not stop him.” When asked who purchased the drinks, she said that she did, so I told her… JUST DON’T BUY THEM. After this conversation I said in my mind like most nurses, when you destroy your kidney with a jagged stone and you are on dialysis at an early age, I will laugh for you…or was that at you?
Patient #2 was diagnosed as having his 1st kidney stone. He tried to make light of his condition and even tried to laugh, but could not. After talking more with this patient, he admitted to no coffee, but 2 bottles of cola per day. He also said that he barely consumed any extra water and sweated a lot at work. The doctor released him with discharge orders to increase water consumption, eliminate soda completely, and use pain pills sparingly.
Patient #3 was interesting for our E.R. doctor. This patient came in smiling. This smile only disappeared when the doctor came in; then she would writhe in agony until he left. Her urine showed large amounts of blood. She said she was claustrophobic so she could not go into the CAT scan. She also said that she was allergic to the medications in the Valium/Ativan family, thus she could not have anything to detour her phobia. Within the next hour we had given her Toradol (a wonderful non-narcotic made for kidney stone patients), which did nothing, then a grand total of 20 milligrams of Morphine I.V. push later only touched her pain.
I told our doctor of an old incident when a patient poked their finger and placed blood in the urine to fake results to get narcotics. The doctor admitted her for pain control, but said that she could only get more pain medication if, for her next urination, she had to do it in the presence of a nurse. Her next urine was negative and she confessed to poking her finger to produce positive results.
Well, she wasted our time, taxpayer money, and our sympathy. We knew something was wrong when she bypassed all of those other hospitals, but it is us to a fault, that dictate that we must take people at their word. Even when every red flag is waving.
Let me impart some knowledge and experience e to help you prevent or slow kidney stone production. The area where the stone is made is about the size of a walnut. If you kidneys are not constantly dropping fluid here, then the heavier minerals have time to accumulate and over time, form a “stone.” These are mainly formed by people who consume a lot of soda, caffeine, and milk…and not enough water.
A doctor explained to me that if you have a bucket full of sand and one small hole in the bottom of it, some of the sand will get out, but over time if nothing is added, the sand will harden. Also if you start putting water into this sand-filled bucket, the sand will come out with it. If the water is added at a semi-regular rate, no matter how much sand you add, it will not fill the bucket or have a chance t6o harden.
If you have been reading this article then you know the preventative measures: Drink less to no Soda, Caffeine, and Milk. Do drink more water (about 1 gallon per day) and something not yet said; drink 1-2 tablespoons of lemon juice in 1 cup of water per day. Most stones are made of Calcium Carbonate which is dissolved by Acetic Acid (Lemon juice)…so theoretically this works. Cranberry juice is great but does ZERO to stop a stone.
My final story is very close to home…my mom. When I was 11yo, my mother got a kidney stone in the shape of a jagged rock; it was about ½ inch long and 3/8 inches at the peaks of the 2 tooth-like structures. This tone tore at my mother’s kidney and caused micro-perforations (holes) in the Ureter. This caused her to get an infection that progressed to septicemia. Since in 1973, blood infections were hard to cure, we were told my mom’s days were numbered. My mother pulled through, but the infection ruined both kidneys to 15% function for both. Her pancreas was harmed and this would cause early diabetes. And she could not walk without help for 6 months. I know that this is an unlikely incident, but it “DID” happen. My mother passed small kidney stones almost everyday until she died in 2005 at the age of 67yo. For those of you reading who say, “That’s pretty old”…my mother was the youngest in her family tree to ever pass so early.
Even if it’s genetic, kidney stone production can be slowed or even halted. Since you now know you have the power to do this, I believe that people who come in multiple times for kidney stones should have a psychiatric consult along with treatment, because you must be crazy to keep doing this kind of harm to your body…Good Luck!
Stay Well, C.Soul R.N.
Mr. Soul has been in the medical profession for over 20 years. He has worked the streets of Detroit as a paramedic. As a nurse, he has worked in trauma centers and community hospitals on various units, but loves the Emergency Center.
