Resolved question:
Hello,
I am a 28 year old male. I am generally healthy but have gone through chemotherapy for ALL. My treatment ended ten years ago. I have also had two calcium kidney stones in the distant past.
I am currently requesting a consultation for right flank pain. I have been to four doctors for this so far. Here is a timeline of what has happened:
September 30(ish): At work I begin to experience a dull, constant pain in my right flank. It is often accompanied by nausea. I assume the pain is kidney stone related and go to a nearby clinic. The doctor tests my urine which is positive (+++) for blood. I receive NSAID painkillers and leave.
October 10th: Pain has persisted. Go to a different doctor near my house and receive an echo ultrasound. The doctor informs me that I have about four or five kidney stones of varying sizes. The largest two seem to be six millimeters in diameter. Receive some sort of herbal medicine (it's more popular here in Japan), am told to drink a lot of water, and leave.
October 29th: Pain has persisted. This time visit a urologist at a large hospital and take a CT scan. Am informed that I actually do not have kidney stones, as they did not appear on the picture. Suggests that I have herpes, but acknowledges that I have no skin conditions so it is unlikely. Doctor tells me that he will meet me again in one week. I do not go to the next appointment.
November 11th: Pain has persisted. Go to a second urologist. Receive an echo ultrasound and X-Ray. No stones show up on the X-Ray, and neither does any bone damage, but the salt content in my urine is high and again, four or five kidney stones show on the ultrasound. Doctor puts me on a urine alkalinization medication and tells me to come back in one month.
December 12th: Pain has still persisted. Return to the same urologist, who apparently during the last month had a discussion with the first urologist I visited. Both of them re-examined the CT scan together (the one from October 29th). According to the CT scan, there actually was a white spot in my ureter. The doctor says that this was likely a kidney stone, but it must have already passed long ago. The doctor says that I do have kidney stones, but they are likely not causing the pain I am currently experiencing. He postulates that it is a condition called intercostal neuralgia. The other symptoms do not seem to fit. I am put on a twice a day NSAID. The doctor does not schedule another appointment.
After three days of taking the NSAID, I have realized that it, like the other NSAIDs I have taken, does not work. The pain is still persisting. Intercostal neuralgia's symptoms do not seem to fit my case.
Submitted:
4 Days
Category:
Urologist
Hello,
Thank you for your consult at DoctorSpring.com.
You are suffering from stone in the ureter and that is the cause of your pain as well as the initial nausea you had.
You should start yourself on the following medications under the care
of your local doctor.
T. Tamsulosin 0.4 mg once in night X 2 weeks
T. Drotaverine 40 mg thrice daily x 5 days
T. Cefixime 200 mg twice daily x 5 days
T. Deflazocort 6 mg BD x 5 days
T. Diclofenac 75 mg thrice daily x 5 days
With the help of above mentioned medications your stone shall pass out and you shall be perfectly alright.
You are not suffering from intercostal neuralagia and stop worrying about it. Please let me know if you have any queries.
Take care.
Sincerely
Dr. Rajiv,
Thank you for your response.
Is it possible for a stone in the ureter to stay for this long though? My doctor is convinced that since it was on 10/29 that the stone was seen in the ureter, it must have passed long ago. He is not convinced that the stone is still there. Can a stone remain in the ureter for this long? Is there any reason why multiple stones would show up on an ultrasound but not on a CT/X-ray?
I feel that a stone is the only thing that makes sense as well, but my doctor has lost a lot of faith in the idea that my stones are causing the pain, so I'm just very confused now.
Dear Sir,
The stone can remain in the ureter for indefinite period of time and can even damage the kidney. You should certainly follow up with the urologist and get repeat USG or CT scan.
CT scan is very sensitive and specific for stones and in significant number of patients even vessels can appear as stones on ultrasound. I shall be keen for you to have CT scan with 0.5 mmm cuts on a good CT scan machine.
Sincerely
Dr Rajiv Goel
MS (AIIMS), MCh (AIIMS), DNB ( Uro)
Hello,
Thank you for your responses! I would just like to ask one or two more questions.
First of all, in the case of a stone being stuck in the ureter, is it normal for my pain to increase proportionate to the amount of time that I am moving around? It seems that if I simply lay in bed all day my pain levels are manageable, but once I go out and start walking, the pain increases significantly.
Also, does that mean that ultrasounds will often lead to a misdiagnosis of kidney stones? The CT scan I had showed no stones in my kidney and only an uncertain one in my ureter, while the ultrasound showed several in my kidney.
Dear Sir,
The pain due to kidney stone can get aggravated with activity; however, you should certainly get evaluation by orthopaedician to rule out any bony problems causing the pain.
Ultrasound is not very specific for kidney stone and we shall rely more on CT scan rather than ultrasound for stones.