The word "calculus", I discovered last month, has two meanings. The first is of course what we learn at school - a branch of mathematics that deals with variable quantities. The second one is common only in the world of pathology - "a stone-like concretion of minerals and salts found in ducts or hollow organs of the body".
It is shards of the second calculus that we see in the picture above, the 'concretion' that caused me much pain and discomfort last month. It was apparently a set of two minerals attached to each other, calcium oxalate and uric acid, one smooth and layered while the other one with its typical radial spikes.
Whatever be its composition and size, one first-hand lesson was that the degree of pain and discomfort depends primarily on where the stone is lodged. Mine was 6.4mm wide, and stuck at a bend on the ureter, just before it empties into the urinary bladder.
This was not a recent development. Call it carelessness or apathy but I had been carrying this one in my system for at least the past 15 years, and it used to show up with clockwork regularity during the annual medical check-ups. The radiologist would stop at a particular point on my belly and say, "There seems to be an obstruction here...do you feel any pain?...No? Well, then, drink lots of water, and maybe it will get flushed out on its own."
Years rolled by. I started every morning with a few glasses of water, I continued with my regular distance-running, trekking and traveling. At some point the annual check-ups ceased, and I all but forgot about the the radiologist's word of caution...until last month.
On a hot, humid July afternoon, I developed a niggling pain under my left ribs. Initially I assumed it was due to a particularly heavy lunch I had that weekend - rajma-rice followed by a double helping of ice-cream. I thought it would clear up on its own but the pain just doubled up, even after a bout of vomiting.
For the next few days, there was no let up on the pain, just the intensity varied during the day. Sometimes dull and deep, then sharp and persistent, there was no posture that eased it - sitting, walking or lying down. Even taking a deep breath seemed to take some effort; the elastic on pyjamas hurt, and a complete loss of appetite meant that that I was consuming only liquids.
At a nearby hospital the GP too read the symptoms wrong - it was misdiagnosed it as acute Gastritis. When three days of medication did not provide any relief from the sharp, persistent pain that kept me awake all night, an ultrasound test gave the first clue that the doctor was trying to solve the wrong problem. The stomach was perfectly fine but there was a significant swelling of the left kidney - "Left distal uretic calculus with moderate hydroureteronephrosis, and mild perinehpritic soft tissue stranding".
Translated from doctor-ese this simply meant that a stone in my left ureter had blocked the plumbing. The old 'obstruction' had travelled down the ureter to a point where it had got completely stuck at a bend. Fluid trapped in my kidney had not only inflamed it but the tissues had also started getting damage. Something had to be done immediately to remove the blockage, before the rot spread into other complications.
I was actually quite relieved to hear this. It is a blessing to have an 'ordinary' problem, one that has a handy acronym, KSD (kidney stone disease), and something that affects 12 percent of the population. This also meant that there were SoPs for dealing with this in almost every hospital with minimum of hassles from the health insurance companies. So the course of action was also quite straightforward - find a suitable hospital, and get the stone out ASAP.
We zeroed in on a hospital recommended by a friend, one that had an unusual name for an institution based in Delhi - Tirupati Stone Centre (TSC). Even though it was located at one of the busiest crossings I have seen in East Delhi (Karkadi Mor, Gagan Vihar), the hospital itself was an island of quiet efficiency, staffed by sensitive folks and a set of supremely competent nurses from Kerala.
At TSC, Dr. Ajay Agarwal took a look at the ultrasound and CT scans and concluded that immediate action was required. The very next day afternoon I was on an operation table for a spinal anaesthesia followed by a procedure that blasted my kidney stones with a laser-beam, and propped up my urethra with a temporary stent. The procedure took about 40 minutes but it took about four hours for the anaesthesia to wear off, and for the gradual return of sensation to my limbs - little toes, ankles, knees, hips, and then the big toes!
I feel perfectly fine now - only the stent needs to be removed later this month. As in the case of high-school mathematics, it is quite a relief to be spared of the pain and discomfort that emerges from an unresolved calculus problem!
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For those who may find themselves among the 12 percent of the population facing the same ailment, here is a checklist of precautions, tests and drugs that you too may encounter -
Precautions:
- Get a second opinion on the initial diagnosis - tests are important. In my case it was the ultrasound that led us to discover that the problem was with the kidney, not the stomach.
- At private hospitals that are run like Yatharth Hospital Noida, doctors can get their diagnosis wrong
- Hospital admin & accounting rules are such that the emergency services the staff is very hesitant about using their own stock of drugs and disposables. Even in a critical situation be prepared to see your 'attendant' being sent off to buy injections and syringes!
- Telemedicine may be the in thing but insurance companies want prescriptions on paper! On a Sunday the doctor sent us a message on WhatsApp recommending a CT scan but this became s sticking point for the mediclaim company (NIAC) and caused considerable delay in approvals.
Tests:
- Blood tests
- Urine tests + culture
- Ultra sound
- Kidney function test (KFT)
- Liver function test (LFT)
- CT - KUB - kidney, ureter and bladder
Medicines:
For Gastritis (mis-diagnosis at Yatharth Hospital)
- Pan 40 (Alkem) - Pantoprazole Gastro-resistant tabs: It's used for heartburn, acid reflux and gastro-oesophageal reflux disease (GORD)...proton pump inhibitor (PPI), reduces acid in stomach ---
https://www.1mg.com/generics/pantoprazole-210457- Lesuride (Sun pharma) - Levosulpiride tabs: atypical antipsychotic. It works by increasing the release of acetylcholine (a chemical messenger). This increases the movement of stomach and intestines, and prevents reflux (acid going up to the food pipe) ---
https://www.1mg.com/generics/levosulpiride-210137
For Kidney inflammation (on WA)
Post-Op:
- Exfaro 300 (Intas) - Faropenem Sodium ER: Anti-bacterial...can cause diarrhea as a side-effect
- Tab A to Z (Alkem) - multi-vitamin capsules
- Drolgan for SOS only (Ipca labs) - Drotaverine (80mg) + Aceclofenac (100mg): to reduce abdominal pain and bloating...relaxing muscles of stomach and gut by blocking certain chemical messengers ---
https://www.1mg.com/drugs/drolgan-tablet-64223
Prior to Removal of Stent:
