Personal Health Update

I wasn’t exactly handed a winning ticket at the Genetic Lottery. As a kid, it would have taken less time to list the parts that did work as they should have. But things got under control and I am generally fine these days¹beside that violent twitching on the left side of my face and the regular furball coughing, that is.

However, God personally hates me and wants to make sure I know it. Which is why I belong to the statistically improbable demographic of young people with recurring kidney stone problems despite relatively healthy dietary habits²people in their twenties who barely drink a can of coke a month aren’t supposed to get kidney stones, let alone chronic ones.

On a nearly regular basis, about once every two years, I get to enjoy the pain of childbirth, minus naming process and postpartum hormones rush.

On the plus side, with the years, the routine has started to take the edge off (or I am developing a much higher tolerance to pain): when a stone episode strikes, nowadays, I just casually recoil in a fetal position for a couple hours at a time while waiting for it to pass after a week or so; years ago: I would longingly stare at a kitchen knife while considering my options for self-surgery on the spot.

The other good thing is that I have learned to recognise early symptoms (as well as the time they are likely to occur: mine always happen in Winter, for no reason any specialist has ever been able to explain satisfyingly), which helps preventing me from making bad decisions… such as embarking on a 15 hour trip home to San Francisco from Paris via London (aka: the Story of my First Stone). Testament to the good old pre-911 days: when some security guy at Heathrow noticed the sweaty, grimacing guy waiting for his plane, went and asked “Sir, I must ask you: have you been consuming any drugs?” and got a near-hysterical answer of “No, but if you have any, I’ll take them!” through gritted teeth… he just walked away as he came.

These days, once the chest pain shows up, I would know better than trying to lob it with, for sole comfort, 2 aspirins and a cup of boiling hot tea purchased on the Eurostar.

Three days into the current episode, I finally went for a consultation at my nearby hospital: a CT scan confirmed the obvious and I was sent on my way with the usual advices and a couple prescription drugs.

Incidentally: I paid ¥5,000 (less than $50) for a full consultation and a CT scan, both of which took a grand total of 40 minutes, from the moment I stepped into my neighbourhood clinic. The actual cost, pre-universal-coverage, was ¥19,000, or about $200 (for that money, a US CT technician won’t even spit on you): dear US readers, aren’t you glad you live in a country gloriously free of such pesky Universal Healthcare and reasonable health costs.

Anyway, all that to say that I am slightly incapacitated at the moment, and lagging on communication (although oddly productive on whatever I manage to put my mind to, in between two bouts of holding my abdomen, wondering if downing a bottle of Draino might help). It will get better and I’ll catch up on email and everything, soon (i.e. anywhere from next week to next year).

That’s it for the immediate personal health update. Everybody with a normally working pair of kidneys and zero interest in the practice of hobbyist medicine at home can (and should) stop reading right now. Trust me, there’s nothing interesting under the fold.

Kidney Stones remedies

Like anybody confronted to their 4th or 5th stone in a decade, I have collected a good deal of empirical knowledge on the issue. It also helped that the first two episodes happened outside of the realm of modern medical medicine: the magic of timing, transatlantic flights and insurrance-less lulls between [proper] jobs in the land of proudly unaffordable healthcare³needless to say: in between years of fully covered, perfect health… try to tell me God doesn’t have it in for me, after that.

Googling and webbing of all stone-related issues tends to yield a mix of obvious, factual and completely moronic/batshit insane advices. With a recurring theme being the product-pushing agenda of the websites giving said advice. In light of this, I figured I would compile a few of my anecdotal findings on the matter, for the sake of the odd Google seeker who may end up here.

Note that:

1. I am not a doctor (unless you count that honorary degree in Love Potion and Curse Healing from Kinshasa’s University of Black Magic). I shouldn’t even have to tell you to consult with a professional, before anything else⁴frankly, if you hadn’t figured that for yourself, you shouldn’t have the IQ required to operate a computer. Once you have seen a physician, received a diagnostic, commiserating pat on the head, painkiller prescription (and little useful else): feel free to come back here.

2. These aren’t tips to prevent reoccurrence of stones. I’ll let you google/consult for these. Although, they may not always do the trick (take it from somebody who’s been drinking liters of water a day and depriving himself of chocolate for the past few years, and yet is currently contemplating removing the coating from his painkillers to try and snort them for faster absorption).

3. The focus here is on things that will help you deal with pain (and, possibly, but with absolutely no guarantee, help pass the stone faster… on the assumption that not wriggling in pain and spams, helps smooth the descent).

4. Any [already questionable] advice contained here applies only to calcium oxalate crystals (you know, the cool spiky-looking ones that seem designed to tear your insides while clawing their way out). Some might work for other types of stones, but no guarantee here.

That being said, and before going into things that work, let’s start with:

Things that don’t work

Cranberry juice and all other bullshit herbal grandma remedies. Not because they are bullshit herbal grandma remedies with usually zero evidence-based medical results, but because they all apply to a completely unrelated issue. Kidney stones (calcium oxalate ones, that is) aren’t UTI, nor even caused by UTI and rarely have anything to do with UTI. Whatever anecdotal health benefit cranberry juice (and dozens other Flower Power remedies) may have, are entirely geared at UTIs. Drinking cranberry juice while passing a stone has been proved to help, only insofar as drinking any fluid helps. So feel free to replace cranberry juice by gallons of gin&tonic and call it a family remedy: your chances are the same.

Things that work

Water goes without saying. Gallons and gallons of it. All the time, all day long. That stone isn’t gonna carry itself down (that being said, if/when your kidney shows sign of excessive straining on echo or CT scans, lots of water might no longer be a good idea: that’s what your doctor’s advices are for).

Painkillers obviously work. Although if you have tried, you already know that even the strongest painkillers have a very limited effect, in time and in strength. Dosage increases will barely help. And unless you fancy a life of addiction to opiates, they are rarely a good idea. NSAID are the standard fare (also: they are easier to keep on the stomach than opiates, which helps if you aren’t hooked to an IV feed). I have found antispasmodics to be more helpful in the long term (less direct pain relief, but less cramping, which is precisely the point).
Anyway, no real point discussing pharmaceuticals here: you will need a prescription (or a very good dealer), that, again, is what your family doctor is for.

Cannabis. Yep, herbal remedies aren’t completely useless after all. Surprisingly enough, medical cannabis isn’t just a hoax pulled by aging Californian hippies trying to ensure good-quality supplies at cheap price: there’s a reason cancer patients are told to smoke some reefer.
In addition to being a powerful analgesic, cannabinoids have antispasmodic and muscle-relaxant properties, which is precisely what your strained tubes need (less spasm/constriction = less friction = less pain). Trust me⁵err, I mean: trust my good friend who tried once, officer, it works well. And if it doesn’t, you can always just put on some Bob Marley records and bob your head to it until you forget all your troubles (just kidding).

Of course, were you to choose the weedy path of natural remedies, you should probably avoid living in a country where possession of any drugs (that are not tobacco or alcohol) is a crime on par with killing kittens or having sex with underage schoolgirls⁶just kidding, of course: the latter is perfectly OK and barely frowned upon by Japanese society, provided you are a well-off middle-aged businessman who doesn’t mind buying them Hello Kitty toys in return.

Which leaves you with:

Heating pads. No joke.
Heating pads (preferably the strong, chemical kind, universally available in Japan, where they are known as ‘kairo’) are a real life-saver. Staying warm is key: keeping one or two strong heating pads over your lower abdomen at all time, greatly helps with the background pain and seems to lower the recurrence of acute pain episodes. During last year’s episode, I was able to be nearly functional for three weeks, including a (very sober) New Year’s Eve party, patiently waiting for my two stones to go down their merry way⁷or, more exactly: until a very nasty surgical device was inserted to bring them out once it was realised they wouldn’t come out on their own, but that’s beside the point.
If you live in Japan (or another country where these awesome little pads are easily available), go to your nearest pharmacy and buy a few hundreds. If you don’t:

Hot baths are an obvious piece of advice. But just in case you had not noticed yet: dipping into near-boiling water at regular intervals will do miracles to subdue the pain. Just make sure not to get cold chills when you get out.

Things that Might Work

For pain management, the doctor at my local Japanese clinic only prescribed antispasmodics and told me to come back if I needed stronger (which didn’t bother me much, considering how little effect stronger meds usually have anyway).

Along with the antispasmodics, was a prescription for a slightly stranger medication called Urocalun, which turned out to be a rather Japan-specific drug, based on some plant extract (yes: another herbal remedy, but this one comes with somewhat scientific studies attached, rather than your crazy grandmother’s aunt recommendation). Most salient research papers I could find on the topic are in Japanese and only appeared in domestic publications (as is unfortunately typical of a vast amount of Japanese research) where methodologies are, ahem, not always of the highest scientific grade, or sometimes feature downright bizarre ideas (rope jumping as a way to pass stones, anybody?). More importantly, it is not always clear whether Urocalun is only effective as a preventive treatment or can also help during acute episodes.

But at least, there seems to be some scientific basis going for it (which is more than lots of pseudoscientific remedies like homeopathy ever had) and is the first I ever hear of a widely distributed drug treatment for kidney stones (other than palliative, that is). I have the tablets and will be taking them religiously for the next few weeks, we’ll see if it helps.