08 June 2014

The Age of Stone Surgery

kidney stonekidney stonekidney stonekidney stonekidney stonekidney stonekidney stonekidney stonekidney stone
by Leigh Lundin

Kidney stones give whole new meaning to writer’s block.

I recently experienced kidney stone surgery. I say this calmly, rationally, as if kidney stones weren't nature’s way of reducing all of us to the level of bawling babies incapacitated with pain.

Literature on the subject appears to have been written by sociopaths who’ve never experienced kidney stones. Take for example this sentence, “Some flank discomfort can be anticipated.” That’s like Germans telling the British during the London Blitz, “Expect a little noise and dust.”

You may have noticed roughly half the human race features external plumbing. Normally, I’m satisfied with this arrangement, but at times like these, not so much.

Now knowledgeable in three techniques, I recognized a need for a bit more depth of the subject matter. Following is my tutorial on the topic.

Kidney Stone Owner's Manual

A kidney stone forms as a crystal, the small ones the size of basketballs. Stones can have many shapes, all of them jagged. One might look like a claw from hell or another might resemble a spiked iron ball from days of yore. Note the wide variety at right.

This is not accidental. Let us step through the history of stone surgery, beginning with a prehistoric account.

Percutaneous Nephrostolithotomy

Ogg and his common-law wife, Uma, lived in the fruitful plains of nowhere important. Ogg had been a good provider, but recently, he’d experienced horrible, sharp pains in his lower back that felt like he’d been clobbered by a stegosaurus tail.

Sometimes the hurt grew so excruciating, he passed out, once with his chin in a patty of dinosaur dung. These painful episodes made Ogg very cranky, much to Uma’s annoyance.

He figured this was nature’s way of telling him to slow down. Ogg decided to turn his attention to the arts.

Uma was a delicate flower, relatively speaking with curvaceous 136~124~136 proportions. Ogg decided to honor his beloved by carving a life-size statue, which ironically weighed about the same as Uma with comparable warmth.

He took up his stone chisel and began chipping away where Uma said it made her butt look big. Abruptly, pain struck. Ogg writhed, saying “Ook-ah, ook-ah,” which roughly translated means “@$*#%€! Holy crap this hurts.”

Uma, who’d give birth to triplets, Gog, Magog, and Agog, didn’t have patience with Ogg’s whinging and whining. She rolled her eyes and muttered about men acting like babies.

But something inside Ogg shifted. Wracked with blinding pain in the throes of the seizure, he inadvertently chipped off a feature of his wife’s sculpture she much prized. Infuriated, she picked up Ogg’s granite club and bashed him solidly on the brow, which not only removed his mind from the pain, but toppled him backward onto his sharp stone chisel.
morning-star flail

Out popped a jagged, spiked sphere the size of a megalosaurus testicle. Such were often used as balls in caveman soccer, a very challenging game, especially while still attached to the megalosaurus.

“Oof,” said Ogg, with gratitude and relief. He picked up the spiked ball, hefted it, and muttered, “WTF?” which translates to “What the heck?”

Ogg instantly saw the possibilities and attached a chain to the stone ball and that to a heavy stick, creating the morning-star flail and inventing the phrase ‘my ball and chain.’ Now free of pain and armed with a dangerous weapon, he prowled the plains wiping out woolly mammoths and evangelizing the practice of neolithic stone chisel surgery, now part of urology health care plans everywhere.

Cylon jack-hammer
Electro-mechanical Hydraulic/Pneumatic Lithotripsy

The next advance in technology moved from stone chisel surgery to deploying a piston that could physically batter stones into smaller pieces the size of baseballs. In practice, a hairy man in a hardhat and full body armor passes a full-sized jackhammer up the urethra where he chips away while humming Sixteen Tons, entertaining the patient and staff. That’s “patient and staff” as opposed to the “patient’s staff,” which is unlikely to ever work again and forever be a source of agony.

Ultrasonic Shockwave Lithotripsy

Bible school students learn the rousing spiritual ‘Joshua Fit the Battle of Jericho’ and the accompanying story, which is considerably more bloodthirsty in the details. (“Listen, Josh, are you sure He said wipe out every man, woman, child, bunny rabbit, puppy and kitten? And babies? And Achan’s family too? You joshing, man?”)

The Israelites marched seven times around the walls, shouted and sang like Yoko Ono, blew their ram’s horn trumpets, and the walls came tumbling down. In urology terms, this is called extra-corporeal shock wave lithotripsy.

That’s how ultrasonic works: You make lots of noise until its volume and frequency crumbles the hard stuff inside your kidney or the building next door. In theory. Some stones it doesn’t work on and it can sure as hell leave your insides bruised and littered like the arena of a demolition derby.

Flexible Pyeloscopy Surgery

Sometime during the Middle Ages, Spanish Inquisitors stumbled upon non-invasive (so to speak) techniques where stones could be tackled by traveling up the ureter. The invention is credited to Bernardo Extirpator XXVIII, a hard-of-hearing and none-too-bright torturer, immortalized by the famous words of his cringing boss as Torquemada lost his cookies. “Pie-hole! Sweet Jesus in Heaven, I said pie-hole!”
xistera

One of the conventional techniques has traditionally been ureteroscopy. The procedure is commonly called ‘basketing’ in which doctors playfully insert into the urethra a xistera, similar to the racquet used to serve 180mph pelota balls in the game of jai alai, except the medical device is about the size of an ordinary laundry basket. This doesn’t give the procedure its name, but afterwards the screaming patient is carried out in a basket.

Rigid Ureteroscopic Lasering

BSG © Garry King 2004
Basket extraction fell out of favor with the advent of Star Wars technology. A ureteroscope, a long, thin peeping device the size of a 37-inch television is sent up the ureter to determine where the stones set up camp. Once located, surgeons call in the big gun, a holmium laser-blasting weapon affectionately called Battlestar Galactica. It vaporizes the stone and the rest of a patient’s resolve not to scream like a 3-year-old.

Note ureteroscopic lasering is not the same as ureteroscopic tasering, invented by Bubba Joe Hadcock when he sat on his newly acquired stun gun. It was subsequently discovered, thanks to his invention, Bubba Joe didn’t have nor ever will have kidney stones. Nor kidneys for that matter. A simple solution to a complex problem.

Clonal Lithography

In its simplest form, the patient’s body is amputated to stop the pain and a replacement grown. Medical technicians cryogenically freeze a patient whilst a clone is fabricated. Conversely for advance planners, a clone may be prepared beforehand and itself cryogenically preserved.

In an in-patient, minimally invasive procedure, the encephalon is transferred in toto to the brain-case of the new host. Patients have been known to immediately resume texting, shopping, complaining about The View, and other normal activities.

The Stent

“Out-patient,” I thought they said but it was “Out-of-your-freaking-mind-patient,” talking about the stent removal. See, at the time of stone removal, they put in a piece of tubing like 3-inch industrial wiring conduit. In the wretched days after blasting the kidney stone, a stent allows pieces to pass through. Sometimes medics issue patients strainers in case the spleen or forgotten medical instruments fall out.

So Dr. Steven Brooks and Nurse Wendy corner me in a room where I hold them at bay with an impromptu lion-tamer chair. It's a swivel chair with spastic casters that would make any self-respecting lion roar with laughter, but my crazed appearance gives them pause.

Dr. Steven Brooks and Nurse Wendy tell me 99% of tough, be-all-you-can-be men opt for out-patient removal of the stent and only a wussy 1% choose being knocked out for hospital removal. Psychology is at work here: As the army knows full well, at the root of male bravery is fear, fear of showing fear. Otherwise, 99% would sensibly choose to be knocked out and wake up the following month fully healed.
automotive parts retrieval tool

So I say okay and put down my improvised lion-tamer chair with its twitching casters. I eye a previously laid-out, sadistic device that looks like an automotive parts retrieval tool, a flexible shaft with a spring loaded handle at one end and a three-prong claw at the other. Silly me, I look at this thing and naïvely wonder how it will slide up.

I say naïvely, because I didn’t realize they would insert yet a terrifyingly larger tube sized to accommodate not merely our automotive parts extractor but a full-grown ferret. I look at the diameters and realize someone hasn’t done the math. A shop vac hose can’t possibly fit up an opening the size of a soda straw, and if it could, no one would ever again sip from that straw.

ferret
@$*#%€! Holy mother of …!

Afterwards, I asked them to just let me lie there a couple of weeks to recuperate as I write these last few words and my will and testament. I hope this technical dissertation helps my fellow layman and laywoman. Meanwhile, my bladder’s shrunk to the size of a pea… Whoops! Wrong word. Gotta go!

24 comments:

Anonymous said...

"In its simplest form, the patient’s body is amputated to stop the pain and a replacement grown." I have to say, that's the single best sentence I have read in years. And also that the drops of blood on the page design took on a whole new meaning this time. Man! You've got my vote for the simultaneously funniest and scariest essay on record. Here's to a full recovery and no recurrence!

Steve said...

This is not a funny subject especially when they come out of no where. My back pain gets pretty close to this. A friend of mine, who also did a lot of sitting for a living,always was rushed to the Orange Memorial to have the most potent of pain medication, morphine for kidney stone pain. Yes, it is like giving birth 10lb baby through a staw.

Fran Rizer said...

Leigh, glad you can find the humor in it. Sometimes you inspire me, but I have no intention of writing about anything similar to this until Steve gives birth to a ten-pound baby. It doesn't seem fair that birthing is limited to females while kidney stones have no gender boundaries.

janice Law said...

Hope you are making a good recovery.
I see that you have taken Nora Ephron's mom's comment that "It's all copy" to heart. Bravo on that!

C.S.Poulsen said...

Congratulations, Leigh! I see you wrote your first AMA paper. Please submit it as doctors do enjoy a good laugh. Who knows, it may give surgeons a new perspective. Only kidding. But I do hope you submit this wonderful expose to the medical community.

A Broad Abroad said...

Wincing and laughing - you have my sympathies.

Steve, mine felt like giving birth to a porcupine holding a pineapple with nothing to show for it.

Leigh Lundin said...

Anon, thanks for your kind comment, which makes the writing– if not the surgery– worthwhile.

Steve, it’s hard to argue with that. Back pain can be bloody painful as well.

Fran, there’s nothing fair about kidney stones at all. Things you might not expect can contribute to kidney stones, in my case ice tea and almond milk.

Janice, I hadn’t heard Nora Ephron's mom's advice, but I concur. A writer has to get something out of all that misery!

C.S, I did send a link to the surgeon, Dr. Brooks, and my school friend Lela. They both have a good sense of humor.

ABA, I feel for you, poor thing. A pineapple… yes, that sounds about right. Add in a porcupine or hedgehog, and that about sums it up.

Vicki Kennedy said...

Leigh, so sorry you had to go through that hellish nightmare of pain. Years ago I had a friend who had a kidney stone removed and he described how awful it was to me. At least you have a sense of humor to get you through it.

CarolynJenkins said...

OH MY GOD!!!! You didn't deliver a baby, you delivered a meteor. I'm sooooo sorry to have read you went through so much pain. I've heard stress can cause kidney stones. Hope editing my book didn't contribute to it.

Dale Andrews said...

We who are about to undergo the knife salute you!

(Seriously, feel better!)

Herschel Cozine said...

Leigh, thanks for providing a good laugh, or more correctly, laughs. They were sorely needed and appreciated. I have never had kidney stones (fingers crossed) and after reading this will opt for removal of the kidney before it happens. Your ability to laugh about it is admirable. There is nothing like a good sense of humor to get through rough times.

Leigh Lundin said...

Vicki, it's a laugh or cry situation. Comedians say we laugh at what makes us uncomfortable.

Carolyn… a meteor! (laughing) Yes, I think you nailed it in one, complete with burning flames.

Dale, good luck with your shoulder surgery. That's a whole 'nother writer's block.

Leigh Lundin said...

Herschel, thank you. I confess that I still shudder at words like 'sorely' and you're wise to consider kidney removal.

Dixon Hill said...

Leigh, I commiserate. I’ve had it done twice. The first time, the surgeon arranged for me to get my pain medication afterwards, but unfortunately marked the prescription so I couldn’t get it until after leaving the hospital (where he had me remain for 24-hour observation after the surgery LOL). Not the most pleasant 24 hours in my life. To add insult to injury, I wound up contracting Pseudomonas. LOL

R.T. Lawton said...

Leigh, thanks for the humorous write-up. A rodeo cowboy once told me his doctor said passing a kidney stone would be like passing a bowling ball, but what the doc didn't tell him was that same bowling ball would be wrapped in barbed wire.

Some stones pass on their own, others don't. You have my empathy. The doc that took out my stone went in with a garden hose to which was attached a fruit basket, a shovel and an first generation Polaroid camera. When he installed the stent, he left a white string attached for removal due to take place several days later. The other end of the string hung out a couple of inches. You can imagine my consternation one morning when I could no longer see that end of the string.

Leigh Lundin said...

Dixon, that's awful! And thanks to pharmaceutical abuse, it's damn hard to get truly effective pain-killers.

RT! I shudder to ask what happened. A bowling ball wrapped in barbed wire just about covers it.

Eve Fisher said...

Oooh! Ouch! The only thing comparable I've got begins like this: My husband was getting some outpatient surgery (details available for a small fee) and the first thing the doctor did was knock into the instrument tray which went flying, smashing everything made of glass, desterilizing everything in the room, and sending out a tsunami of various liquids. Obviously this increased his confidence in his surgeon by at least 100%. I am still trying to figure out why he stayed for the procedure, because I would have RUN.

Meanwhile, all my sympathy, and hope that you have decent medication.

Leigh Lundin said...

Thanks, Eve. I suspect the answer is that when faced with doctors wielding knives and needles, big men become petrified little boys.

Jan Grape said...

Oh my, ouchy just doesn't seem to cover it at all. Funny, funny words you managed to write. Never had a kidney stone and never hope to have one. However, when my shingles pain first started, I thought it was a kidney stone. Would have been nice in a way because then I wouldn't have the daily nerve pain that I do.
You did make me laugh all through your write-up and I'm sending healing thoughts and energy that you recover quickly and completely.

Leigh Lundin said...

Thanks, Jan. My very big and very strong father was laid low by shingles, so I feel for you. Why do some of the most painful afflictions like shingles and gout have such innocuous sounding names?

Elizabeth Zelvin said...

ROFL, Leigh! I'd say those proverbial monkeys who type ('scuse me, keyboard) are even less likely to come up with this post than with Shakespeare's collected works. A+ for originality and humor

Leigh Lundin said...

Thanks, Liz. Next time, it's clonal Lithotripsy for me!

Jeff Baker said...

Glad you were able to get all that off your, uh, chest!

Leigh Lundin said...

Thanks, Jeff! Chest… well!