And it came to pass. . . or not

Disclaimer: This post documents a painful medical condition I suffered and includes my own memories of the unpleasant details. It's also very long. I couldn't help it.

Two weeks ago, when I was 26 weeks pregnant, Damon took me into the hospital at about 8:00pm after I'd been suffering with severe back pain and some Braxton-Hicks (i.e. fake) contractions since the late afternoon. When the back pain started I figured I must have just picked up Gunnar wrong that day and tweaked my back a little. I'm pregnant. A backache comes with the territory. However, the tightening in my tummy became worrisome as the back pain didn't let up with heat or any new positioning of a pillow.

In the tiny OB ward of our local hospital, the nurse initially suspected I had a UTI. (I'd also been visiting the bathroom like every 10 minutes with nothing much to show for it.) She immediately put me on a fetal monitor. I had been feeling the baby move around a lot, so I wasn't too concerned about her. Her wiggling made it a little difficult to find her heart rate on the monitor, which just meant I had to sit there in pain wishing we could skip the monitoring and go right to relieving me. Eventually the nurse decided she'd had enough and we moved on.

I can't remember all the details of what happened after that. There was some vomiting and the nurse conferring with the doctor on call (who I never actually saw in person), and the bottom line was that the doctor and the nurse both suspected I might have a KIDNEY STONE. We were sent home with an antibiotic prescription (in case of the UTI) and the okay to take acetaminophen (Tylenol), from which I normally abstain during pregnancy.

We returned home where a kind and worried ward member had put the girls in bed (Gunnar went to bed before we went to the hospital). I went straight to bed and proceeded to have one of the worst nights of my life. I was awake every couple of hours throwing up into a bowl on my nightstand, using the bathroom (where I was supposed to dutifully strain my urine for possible stones), and then trying to get back to sleep despite the horrible pain in my right flank (basically my right side, towards my back).

I finally got a bit more sleep in the 5:30-8:30 time range and woke up able to eat some toast, applesauce, and peppermint tea before we headed across the river for an ultrasound at a neighboring hospital. (The ultrasound tech at our hospital was apparently out of town. "There's only one?" you ask. So did we.) One of their techs had gone home sick and they had squeezed me in at the last minute anyway, so we ended up having a really long wait--during which time I was supposed to have had a lot to drink and then not use the bathroom. Come on, people. I'm pregnant! I had a little outburst after being told it would just be a few more minutes and then having another patient called in ahead of me (granted, they were also doing MRIs, CT scans, and X-rays through that door) and the receptionists took pity on me and let me "go." Then I totally chugged 20 oz. in about 3 minutes and the tech never suspected a thing when I was called back about 2 minutes after that.

The ultrasound showed that my right kidney was totally full of fluid, a pretty strong indication that a kidney stone was lodged in my ureter and preventing the fluid in the kidney from being released into my bladder. We waited a little longer hoping to hear from the in-house urologist, however he was in surgery so we were sent back across the river to the doctor's appointment at my home clinic (but not with my usual doc, who was not working that day).

During all this waiting I was in continual pain and by the time we headed back to White Salmon it was time for another Tylenol dose (Damon had to buy some in the gift shop since we hadn't brought any with us) and I was getting seriously nauseous again. Back at home I was able to get a nap and have a little snack before the doctor's appointment. The doc prescribed a stronger pain med and said he was still waiting to hear from the urologist. He was also very sympathetic, having suffered from kidney stones himself.

Eventually, in the late afternoon at home, I got a call from a different urologist's office. This doctor prescribed another pill (read: Jillaire makes a 3rd trip to the pharmacy in as many hours) which was supposed to dilate my ureter and hopefully help the kidney stone to pass. They also made me an appointment for the following Monday. Now, keep in mind, it was Wednesday at this point. Inside I was yelling, "Monday?! Monday?! I'm supposed to wait until Monday?!" but instead I politely asked, "Why not until Monday?" The receptionist said he [the doctor] wanted to wait and see if the drug would work and I'd pass the stone on my own. Sigh.

Thus started the waiting game. Damon read up on the Internet and started plying me with distilled water (of no worth) and oranges (we're not sure--lemon juice/lemonade is a good stone preventer, though). Otherwise it was just a matter of coping with the pain, eating when I had an appetite, and trying to get a good night's sleep. There were times when the pain was definitely more intense than usual and I couldn't do much other than lie on the couch and moan. Other times I was able to be up and around, taking a shower (the heat felt great on my back) and getting my own food. Picking up Gunnar was pretty much out of the question, though. Damon worked a few hours here and there while the girls were in school and I put Gunnar in front of the TV, but mostly Damon just tried to work from home and take care of everyone.

By the time we went into the urologist's office on late Monday morning, I was pretty much ready to beg them to just go in and remove my entire kidney. "Just pull it out!" I thought. However, I was also resigning myself to having the doctor say, "You're pregnant. There's not much we can do," and then just have him tell me about possible ways of helping the stone to pass (like drinking distilled water and eating oranges?). Most of what we'd heard and read was that they can't really do anything for pregnant women with kidney stones.

Gratefully, we--and everything we'd heard and read--were wrong! The doctor wanted to do a few X-rays utilizing a kind of dye so that they could see the path through my kidney, ureter, etc. He said that the guideline for radiation with pregnant women is "as little as possible." He felt that I was far enough along in my pregnancy to do these quick images and we agreed. (Usually they do CT scans for kidney stones, so this was definitely the more conservative route.) So, across the street we went to yet another hospital in the Gorge, and then back to the urologist's office for consultation.

After looking at my 3 images, he informed us that my right kidney was completely blocked. NO fluid was getting through on that side. He recommended a procedure for the next day: ureteroscopy laser ablation of the kidney stone. Essentially, he'd put a scope up through my urethra and bladder and then into the ureter where he'd blast the stone with a laser and scoop it all out with a tiny little basket that would also prevent the stone from going back up into my kidney. The risk: possible premature labor. The doctor left the decision up to us. He said that if I thought I could handle a few more days of the pain, he thought I would probably pass the stone. But, if I had had enough, we could do the surgery. Hmmm....while earlier in the day I'd been ready for them to just amputate below the waist, now the possible reality of a very premature baby definitely gave us pause.

At this point it was past 5:00. Damon had dropped off Gunnar and Maggie with a friend around 8:30 a.m. so he could go to work for a couple of hours before my appointment. Adah had gone to their house after school when things went long. Needless to say, we were feeling a lot of stress about picking up the kids, getting them in bed, and then making this big decision. And, of course, I was at the end of my 6th day in constant pain.

Back at home, we talked to a retired urologist friend of my dad's who recommended a different procedure which he felt was less risky for a pregnant woman. It might not remove the stone, but it would relieve the pressure of the blocked fluid and the risk of infection that is the ultimate danger of a kidney stone. This procedure, however, required an invasive radiologist, a specialist that we weren't sure was practicing at any of the Gorge hospitals.

Side note: Most people think the pain of a kidney stone is from the sharp little "rock" poking the tubes in your body and scraping you up as it moves along and eventually out. That's not true. The pain is from the swollen/blocked kidney. Once the stone passes out of your ureter and the fluid can go into the bladder and out your body, the pain is relieved. The other "passages" are plenty large enough to accommodate the stone and so the passing itself is pretty much a non-event--except that you're supposed to catch it for analysis. It is true what they say about kidney stones being worse than childbirth. It was seriously like being in labor for a week, without breaks in between contractions, and without the reward of a baby at the end.

Monday evening we also got ahold of my own doctor who put me at ease about the risks of premature labor (she felt they were very small) and also expressed her extreme trust in the urologist. In regards to the alternative procedure, she said that there were no invasive radiologists in the Gorge and that a referral to a doctor in Portland would probably result in a delay of several more days. She also indicated that this urologist was not a "surgery-happy" surgeon. She said that if he felt it was safe and necessary, she would trust him. Damon and I went to bed resolved to ask the urologist about this other procedure in the morning, so that we had really explored all our options.

Before the doctor's office opened in the morning, I left a message with his answering service. However, before they got the message, the doc called his office from the operating room (it must have been his surgery day; I was 5th in line for that afternoon). He had looked at my 4th and final x-ray--taken after we'd left his office the evening before--and was now strongly advising me to go ahead with the surgery. The receptionist said she'd ask him about the other procedure, and we eventually got a callback about that, indicating that it really wasn't a good option given the situation. (At this point, I was feeling very good about having the surgery and really ready to go with whatever he recommended.)

I spent the morning making phone calls and figuring out the logistics of childcare, including getting the girls to their piano and dance lessons. (I was pretty proud that I was able to work that in--and so grateful for willing friends.) I think Damon went to work briefly. I can't really remember. In the midst of all this, Damon was up against an important deadline at work that had him going in after the kids were in bed and coming back home after midnight. His boss was very understanding and the deadline got pushed back. Nevertheless, it was a stressful week for Damon and he handled it all very well.

We reported to the OB ward of the hospital for some pre-op fetal monitoring, where we were visited by the urologist and anesthesiologist. The urologist talked to us a little more about the other procedure and why he felt the ureteroscopy was the best choice. The anesthesiologist informed us that general anesthesia would not be necessary and that he would be doing a spinal block instead. This was good for the baby, but freaked me out a little at first. I was kind of looking forward to the nap and wasn't sure I wanted to know what was going on.

In the end, I got to see the whole surgery on a screen and it was pretty cool! It was like Star Wars, watching them blast away at that stone with a laser. That stone, which the doctor estimated at 5 mm, ended up being 15 mm!! (That's 1.5 centimeters, in case you're a little rusty on your metric.) When he saw it, he said, "Jillaire, there's no way you were going to pass this. It's a good thing we're here."

The surgery lasted about an hour--I think--and after a short time in a recovery room right by the operating room, I was wheeled back to my room in OB for further baby monitoring and wearing off of the anesthesia before being released to go home. At least, that was the plan. The numbness took forever to wear off--about 7 hours after the surgery, to be more precise. And, as Damon put it, they wouldn't let me go until I could "go," so I ended up spending the night in the hospital. At 10:00pm Damon finally went home, leaving me until the next morning when he, Gunnar, and Maggie came to pick me up.

I was definitely worn out after a week of coping with pain and not getting good sleep, but the pain was immediately relieved after the surgery and it was remarkable how much better I felt. After about 2 nights back in my own bed where I could sleep 5-6 hours at a time (instead of 2), I was back to myself--more or less. I did find that during a week of being doped up on Tylenol every 4 hours, my basic pregnancy aches and pains were gone. Now that I was off pain meds, my hips were sore and my back (not at the site of my kidney) got stiff much more easily. No matter. I'm happy to trade in the kidney stones for maternity discomfort.

So, to any of you who actually made it all the way through this post and are wondering what's next: I return to the urologist next Monday for a follow-up. Hopefully we'll be able to get to the bottom of what caused my kidney stone. There is more than one type, so analyzing it can help determine what you need to do (usually diet-wise) to prevent them. I'm actually just hoping this had something to do with my pregnancy. I've never had a problem before, but since I don't plan to be pregnant again, I'm hoping this was a one-time ailment.