Rock of Ages

Old people like me are often heard to speak of the medical miseries that they have endured in a lifetime.  High upon my personal list is the misery that a Brown Recluse spider bite inflicted upon me. It happened while I was in Japan and I don’t even know if that species even exists there - possibly a similar spider named a Blown Lecruse.  At any rate, that memorable episode taught me about the resilience of a human body when the brain is begging the remainder of the body to just die and end the torment. 

However, living through that ordeal made me stronger (even though I am a wus when it comes to pain) and prepared me for my next challenge - kidney stones.  As best I can recall, there have been four such episodes in my life.  The picture gets cloudy, not so much from a decaying mind, but you see, dear reader, there are some things we just try to forget.  And kidney stone experiences are certainly one of them. Again, I guess I’m a sissy, but….

The tiny little tube that carries the pee pee from the kidney to the urinary bladder is called a ureter (your-a-tur).  This tube in innervated by a branch of the pudendal nerve.  With certainty, this nerve has absolutely no sense of humor.  A tiny 2 mm stone trying to pass from the kidney to the bladder could best be likened to a golf ball trying to flow through a garden hose. When the nerve gets excited as the little stone, and the pressure behind it, stretches the ureter, it screams directly to the brain.  What the nerve actually says and how loud it says it depends on how tough you are. Mine screamed like a little girl in a spook house uttering words that would make a hardened Marine blush. I am talking serious, nauseating, rip my guts out and walk on them PAIN.

Yall feel free to chime in with the comments, I know I am not alone.  The great thing here is that we remember the pain but the brain somehow “holds back” on most of the really bad parts.  It is sort of the same with emotional pain.  We remember how we hurt at the loss of a dear person or pet but it usually doesn’t hurt so badly as time goes by.  That’s a good thing.

Dogs and cats get stones too.  One of my wonderful little kitty buddy patients, “Peter”, lost a kidney last winter because a small stone completely obstructed his ureter as it left his kidney.  The kidney destroyed itself with the pressure that could not be relieved.  Peter suffered terribly until I sorted out his very unusual problem.  I saw him only yesterday.  He looks great and feels fine, all 21 pounds of him. He’s “big boned” you understand.

This story is about a dog and her battle with the mother of all stones. ”Blue” is a very kind natured white German Shepherd Dog.  When she was in for her annual exam and vaccines her owner told me that she had been “leaking” urine recently which was most unusual for her.  There are a number of possibly causes that

Sweet Blue

fluttered through my mind as I looked her over.  As I palpated her abdomen I could not help but notice that there was a large firm mass in the rear (caudal) part of her abdomen.  I was quite sure it was her urinary bladder and figured it was possibly a cancerous tumor in her urinary bladder wall or perhaps a stone, albeit a very large one.

I told her mom she needed an abdominal Xray and she agreed.  As the image came across the computer screen we stared in slack-jawed disbelief.  Indeed it was a calculus (stone) in her urinary bladder, but I have never seen anything approaching the size of this rock.  We all agreed that it looked to be as large as a person’s fist.

Bladder stones, called cystic calculi, generally form in the urinary bladder, not the kidneys.  A number of contributing factors often lead to bladder stones, the most common being urinary tract infection, genetics, high mineral diets and various combinations of these and other predisposing factors. In most of the cases I have seen over the years the stones are well tolerated by the dogs until they become large or numerous and irritate the bladder wall.  At that point many dogs display abnormal elimination behaviour such as wetting in the house, blood in the urine, or asking to go out numerous times each day or night.

I showed the amazing radiograph to Toni, Blue’s mom, and explained that the best fix for Blue was to surgically remove the stone.  The procedure is called a cystotomy and is a fairly routine surgical endeavor  around a veterinary hospital.  The special considerations for this cystotomy were necessitated by the large size of the stone and the length of time it must have been present in her urinary bladder. The incision to the abdomen, as well as the incision in the bladder wall, were going to be much larger than usual.  In addition, the bladder wall, which is normally quite thin, would be very vascular and quite thickened in this long-standing problem.

We scheduled Blue for surgery and a few days later she arrived for surgical  removal of the calculus.  Blue is a very large and gentle dog.  Her sweet disposition makes her a great patient and makes everyone want to go “above and beyond” to make her better.  I could sense that feeling in the staff after she was checked in at the hospital.  I went back and spoke to her a moment before we started her pre-surgical evaluation.  Her lab work was all within normal limits and he physical exam indicated was a good candidate for surgery.  At that point we all took a moment to talk over the procedure and all things necessary to make it as routine as possible. Indeed, that is exactly the way it all worked out.

After she was placed under anesthesia, and all the monitors were in place, Blue was scrubbed up for surgery.  When the incision site is all nice and clean and all the surgical supplies are at the ready, I take one more look at the monitors, the anesethesia machine, and finally a get nod from Maria that all is well and we drape her in to begin the procedure.  From that point on we endeavour to complete the surgery correctly, in a timely manner, and get our patient recovered and safely on her feet again.  Other than a few “Oh my God!” remarks from those in the O.R. as I removed the stone from her bladder and we were able to see it for the first time, the entire process went as smooth as kitten bellies.

Her bladder exteriorized from her abdomen

Removing stone from bladder

Stone in My Hand

When Toni came to take Blue home that evening I couldn’t wait to see the look on her face when she saw the stone.  She was amazed, just as we all were, and proudly took the stone home to show to her sister.  I have not asked her where the stone is now.  The darn thing weighed just one ounce short of a pound, and as far as I am concerned it should be in a museum.  Interesting story, happy ending, and I hope the photos are not to hard on a sensitive stomach.