Have COVID-19 Fears Affected Treatment of Kidney Stones?

Have COVID-19 Fears Affected Treatment of Kidney Stones?

04/06/2021

Photo: Bruce R. Bennett/The Palm Beach Post

palmbeachpost.com

As a former collegiate sprinter and lifelong competitive athlete, Russell Perlman has experienced his fair share of pain. 

Ruptured Achilles tendon. 

Bruised bones. 

Aching joints and pulled muscles galore. 

Heck, back in 2013, despite having undiagnosed massive congenital blockages in three of the arteries to his heart — “I just felt a little more tired than usual,” he says — he soldiered on for several months in his nearly daily adult softball league games.

It was only after he acceded to loved ones’ admonitions that he get a full cardiological workup that he learned he’d need immediate quintuple bypass open-heart surgery. 

And even that experience — and recovery — pales in comparison pain-wise to another condition the 69-year-old Wellington resident has been dealing with for the past decade and a half: kidney stones. 

“Since 2007, I’ve been to the ER for them seven times — and have had at least that many episodes that I decided not to go to the hospital and probably should have,” he says.

The discomfort “starts in my lower back and builds. It becomes a throbbing pain with every heartbeat. Every breath, I feel like someone is punching me in the back. And then at the worst point, I roll on the floor in agony. There is nothing that gives me any relief.” 

His most recent episode, which was last month, was perhaps the worst: “It lasted three weeks. There was constant pain, throbbing and no way to relieve it or find a comfortable position.”

Perlman, who has three adult children, says that when his suffering is at its apex “it’s what I imagine labor pains must feel like.”

And believe it or not, as we close out March’s National Kidney Month, most experts would consider Perlman among the fortunate kidney-stone sufferers — because at least he has sought medical treatment for them when necessary. 

Last month, the University of California at Los Angeles (UCLA) released a report that noted “according to an examination of posts on Reddit, the pandemic has had a significant effect on the management of kidney stone disease.” 

In real-time monitoring of the social media site’s posts, UCLA investigative researchers “found that patients’ decision-making about how and when to seek treatment for kidney stones was driven by logistical barriers and patients’ reluctance to risk exposure to COVID-19 in health care facilities. Over a quarter of Reddit users who reported their stone sizes opted for conservative at-home treatment even when clinical guidelines would have suggested that they needed care from a medical professional. People reported on the site that they often held off on visiting an emergency room until they had larger stones, often creating serious additional health risks.” 

Kidney stones are among the most commonplace reasons why people emergency rooms. Pre-pandemic, they accounted for some 500,000 ER visits annually. 

And the first time folks experience one, they can mistake the symptoms for something else. 

Famously in 2018 during the World Gymnastics Championships, Olympic gold medalist Simon Biles was rushed to the ER after suffering two days of acute abdominal pain. Her doctors suspected she had a burst appendix. 

Once they determined she had a kidney stone and could return to competition for as long as she could tolerate the pain, she went on to win three gold medals. 

Indeed, one of the ways that Perlman says he’s been able to hasten the passing of his kidney stones is “to move as much as I can with either fast walking or playing ball or just being as active as I can.”  

According to the National Kidney Foundation, kidney stones usually afflict men more often than women. The organization says men have a 19% lifetime risk of developing a kidney stone while women have a 9% lifetime risk.  

But once you develop your first kidney stone, the risk for recurrence within five to seven years shoots up 50%. 

As Palm Beach urologist Dr. Diego Rubinowicz explains, “Kidney stones form from the crystallization of minerals in the urine. This is due to saturation of certain substances, which can cause sediment and small crystals, which can then create a larger stone.”

Kidney stones come in four types — with the vast majority being either calcium oxalate (80 percent) or uric acid (10 percent). They usually range in size from as small as a poppy seed to as big as a pea. 

Rubinowicz says that the symptoms kidney-stone sufferers may experience “can range from back, flank, or abdominal pain, to pain with urination, urinary frequency, and urinary urgency, to blood in the urine, nausea, and vomiting. The pain can be chronic or sudden and some patients — including women who have given birth — describe it as the worst pain they have ever had. The bottom line is that it can vary greatly from patient to patient.”

While some people may have a genetic predisposition to develop kidney stones, Rubinowicz cites the following factors as most often being the primary causes: 

1. Insufficient water intake. 

2. Excess salt intake.

3. Excess consumption of animal protein. 

4. Insufficient amounts of citrate or citric acid (these are found in lemons and/or oranges). 

5. Diets that are too high or too low in certain minerals (depending on the patient). 

Rubinowicz also notes that “people with a high body mass index (BMI) may have up to twice the risk of developing kidney stones.” 

The good news, though, is that he believes in most cases, kidney stones are preventable — provided patients are willing to be proactive. 

“For patients with repeated urinary stones, I recommend they consult with both their urologist and nephrologist. A metabolic study of blood and urine can be done to find out the cause(s) and then they can formulate a treatment plan, which could include dietary changes and if deemed necessary, medical intervention.” 

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