Kidney stones seem like an ailment begging for a symbiotic solution, like maybe there's some micro organism (perhaps even Oxalobacter formigenes!) we should be promoting in our guts that could break down oxalates as a preventative measure or even one that we could host within the kidneys themselves to break down a stone and then starve when their job is done. I'd love to see a GMO bacteria built for this purpose too, I bet an aspiring Craig Venter type could make beaucoup bucks off of the demand inelastic kidney stone sufferers out there.

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Jul 15, 2022Liked by Dan Elton

I stumbled across this blog post. I've had the misfortune of suffering through three episodes of kidney stones that wouldn't pass on their own, and I can confirm that the pain is intense. In all three cases, I underwent laser lithotripsy to break up the stones, and the urologist inserted a temporary JJ stent between the kidney and the bladder. The recovery was about as painful as the period before the procedure. Urinating with the stent in place caused a huge spike in pain. It felt like a hot poker being inserted into my abdomen. Eventually, the stent was removed and the pain went away, but the memory lingers. I also want to note that I dealt with three different urologists over the years, and they were all unsympathetic and generally unpleasant. In my last kidney stone episode, the urologist didn't want to prescribe pain meds and said I should go to the emergency room if I wanted opiates. Luckily, the nurse practitioner in my primary care practice took pity on me and prescribed Vicodin, which made a substantial difference. I have about 20 pills left, and I'm guarding them with my life, in case I suffer another episode.

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May 3, 2022Liked by Dan Elton

I’m a bit skeptical about the premise that avoiding pain is preferable to gaining pleasure. As you point out, the aversion is not consistent over time - people block out and downrate past pains. I would like to see the survey repeated asking about whether someone would prefer the worst pain or greatest pleasure that they have already experienced to have never happened. If one is to count up QALYs, it should weight it equally across someone’s lifetime.

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May 3, 2022·edited May 3, 2022Liked by Dan Elton

Totally agree about the long-tail distribution. I have never had a kidney stone or any other health problem that involves truly godawful pain, though of course I've had various things that hurt quite a lot. But I have always been skeptical about that pain scale where they tell the person that a 10 is "the worst pain you can imagine." Well the worst pain I can imagine is something like having my entire body plunged in boiling water. And compared to that, I am sure that the absolute worst pain I have felt is a 2 on a 0-10 linear scale. (And btw, I just cannot understand people's being ok with dropping live lobsters into boiling water.)

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May 1, 2022Liked by Dan Elton

Great article.

However.... unsure why imaging screening is really needed.

Once a stone is in the ureter, lemon juice is not going to help. Ouch, ouch, ouch!! Too bad there are not better ways for it to pass (eg, a lubricant drink one could drink) (yes, I know alpha blockers are supposed to help a bit). At this point imaging is not screening but part of treatment management planning.

Ok for the other cases, unless I am off to Mars with SpaceX does a person really need to be screened by imaging for renal stones?

I agree with screening for risk factors and change lifestyle -- lose weight!! stop eating all the sodium including so call low call sodium prepared foods!! citrate is good!! stop eating so much meat!! ... not only will kidney stones go down but so will dementia, heart disease, etc.

Anyway.... majority of kidney stones probably preventable.... however, I enjoyed and support the thesis of the article.

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Thanks for writing this! By the way, you might be interested in this study in which people suffering from cluster headaches were asked to provide pain scores for other conditions they had also had. Cluster headaches were rated by far the most painful condition. Of course, there is a strong possibility of recall bias, and the sample might not have fully captured the range of intensities of kidney stone pain in a population. As kidney stones can be excruciatingly painful to the point of unbearabilitry, I fully agree that this is a highly important cause area.

"Cluster headache is one of the most intensely painful human conditions: Results from the international cluster headache questionnaire." https://doi.org/10.1111/head.14021 (See Figure 1)

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