Kidney Stoned: Dr. Mistry Explains Why Tiny Stones Hurt So Much And What You Can Do For The Pain

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in medical and urology care and the best urology humor out there.

In this segment,  Dr. Mistry and Donna Lee answer a listener's question about treatment for kidney stones. As many people are painfully aware, passing a kidney stone can be a nasty business. The pain from kidney stones can be felt in the flank, the bladder, the testicle, or even in the abdomen. Typically, this pain is caused when the stone moves through the narrow tube from the kidney down to the bladder, NOT when it passes through the urethra during excretion. Furthermore, the size of the stone does not necessarily correlate with the pain it causes--even 1-2 millimeter stones can be very painful while some people pass much larger ones without difficulty. Anti-inflammatory medications like Toradol or ibuprofen can help patients cope with this pain. If you haven't passed your stone within two weeks, it is unlikely to pass on its own and will likely require surgical intervention.  Remember that your pain may abate BEFORE your stone has been passed--don't assume it is gone unless you've actually seen it! When in doubt, a follow-up X-ray or test for blood in the urine is always the safest way to ensure your kidney stone is gone for good.

This episode was previously aired on 1.16.21. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Welcome back to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: Hello, this is Dr. Mistry of the Armor Men's Health Hour. I'm your host along with my co-host, Donna Lee .

Donna Lee: That's right, that's me. Hello everybody. I'm a board certified co-host.

Dr. Mistry: You know, Donna Lee, you are a professional comedienne.

Donna Lee: Mhh. I am the 7th funniest mom in America per Nick at Night.

Dr. Mistry: That's right.

Donna Lee: ...from like the seventies.

Dr. Mistry: We're so, we're so happy to have you as part of our practice. We have a men's health show. This show is brought to you by NAU Urology Specialists, which is the urology practice.

Donna Lee: Mecca?

Dr. Mistry: I guess.

Donna Lee: Empire?

Dr. Mistry: ...which I started in 2007. I trained at Baylor College of Medicine in Houston, Texas, where I did my medical school and my urologic surgical training.

Donna Lee: I hear that's a good place.

Dr. Mistry: Well, you know, there is none better, in fact.

Donna Lee: Drinking water.

Dr. Mistry: I know, I love talking to the doctors that come on the show. I always have to insult their [inaudible] of colleges.

Donna Lee: I know. They always handle it so well. Nobody's like, looked at you funny . They just carry on.

Dr. Mistry: Well, they know Baylor College of Medicine.

Donna Lee: I'm sure.

Dr. Mistry: They've seen the t-shirt.

Donna Lee: They continue.

Dr. Mistry: I think they're not even fully virtual anymore. That's pretty good. It's hard to treat patients, you know, virtually.

Donna Lee: You don't like that. You like you like that touchy feely, "Hey, I'm Dr. Mistry!"

Dr. Mistry: For your safety, we do lots of telemedicine and virtual. For your safety.

Donna Lee: We do. And you know, we started doing that way before the pandemic.

Dr. Mistry: And we will continue doing it as long as we need to for your safe.

Donna Lee: For an extra copay, I'll wipe the patient down myself.

Dr. Mistry: For an extra copay! Wait, wait, is that oil? Or is that anti-infective spray ? What is this? But for those of you that have problems that need to be examined. We have a very safe environment. We really dedicated to, to your safety. We see all sorts of things about social distancing out there. But I mean, you know, our waiting rooms empty. We can, we try to keep it really WellSpace and get you in the room right away.

Donna Lee: We do. We tell people to step on outside after you check in.

Dr. Mistry: Step on outside! That's right. We need to see you. Yeah . We'll text you in your car. You'll come in and go straight to the room. It'll just be all you. We wipe down the rooms in between. I mean...

Donna Lee: Like I said, extra copays. Make it happen.

Dr. Mistry: That's right. Everybody wears mask. Everybody protects your privacy and your safety. And if you need to be seen, we are seeing you. We have availability. It's been one of the hallmarks of this practice is the availability, is we want to make sure that you are seen regardless of how much it just kind of wreaks havoc on this [ inaudible]. I want to see you right away.

Donna Lee: That's right. You will see 45 patients if you can a day.

Dr. Mistry: Yes, that's right.

Donna Lee: And the staff just weeps in the back corner.

Dr. Mistry: That's okay. That's okay. But , but seeing you right away, as soon as possible is very important to me, because I think that if the important, that the, that the issue is important enough for you to go see the doctor, the doctor should see you.

Donna Lee: We have a new provider, so we can get you in.

Dr. Mistry: Yeah, a little more capacity.

Donna Lee: Real quickly.

Dr. Mistry: Where do we see patients? How do they get ahold of us?

Donna Lee: Oh, we haven't talked about that in a while. We're in Round Rock, North Austin, South Austin, and Dripping Springs, Texas, where they love dripping out in Dripping. Our phone number is (512) 238-0762 . Our website is armormenshealth.com, where you can see Dr. Mistry's smiling, handsome face, and check out a real quick video or two. And you can send your questions, these amazing questions that keep us going and excited to armormenshealth@gmail.com. We have a very funny little question that a listener sent in, "Dr. Mistry. What is the cost of a John Deere tractor?" They start from $1699 to $2,500. Just wanted you to know.

Dr. Mistry: Thank you so much.

Donna Lee: You're welcome. Would you like another question?

Dr. Mistry: No. We just built a space. We're going to build a nice big building so we can offer more, more things, but we forgot to mow the lawn.

Donna Lee: If you mow the lawns out there, please reach out to us.

Dr. Mistry: I guess I'm doing it myself.

Donna Lee: Oh, for a free vasectomy, you can mow a lawn.

Dr. Mistry: We had traded vasectomies for, in the past, a security system for my house, one year of pool cleaning, a free access deer hunt, which got me into hunting in the first place. And then when the guy helped you push the car off at the middle of the freeway...

Donna Lee: The policeman. Our company truck broke down in the middle of the freaking road at 5:00 PM at 620. Oh my God.

Dr. Mistry: And they helped move the truck.

Donna Lee: He pushed the truck out of the way.

Dr. Mistry: And then you felt it was appropriate to offer...

Donna Lee: You! I called you on the phone panicking and you said, "Give him a free vasectomy!" And dang it, he came right in a few months later. The staff called me, "There's a note. Should we give this guy a free vasectomy?"

Dr. Mistry: And now that Dr. Richard Chop has retired, if you want your vasectomy done with, by somebody with a funny name, try Dr. Mistry.

Donna Lee: Or Dr. Yang.

Dr. Mistry: Oh! That's good .

Donna Lee: We got two of them. Dr. Jacomides is just harder to say.

Dr. Mistry: No, I don't think that makes it a funny name. But I think, I think if you want, you want your vasectomy done by Yang or Mistry.

Donna Lee: I'll do it.

Dr. Mistry: Just for a funny name.

Donna Lee: You can have Dr. Donna do your vasectomy.

Dr. Mistry: You're not a doctor. You can get us in trouble.

Donna Lee: Alright, alright.

Dr. Mistry: Do we have any questions, Donna?

Donna Lee: We do. We had a good ER question. And this patient is actually a patient of ours. He came in, but he sent us a message kind of in panic, so I did respond to him pretty quickly. He went to the emergency room at some point, had a three millimeter kidney stone. The ER doctor prescribed him generic Flomax, Toradol, and Zofran. But after reading up on side effects, like binding platelets with Toradol, I don't think I'll take it. I read that ibuprofen is sufficient for many people, so thinking about going with ibuprofen. Do you advise us?" And then the second part of his question, "I figure once I take the Flomax, this evening, things will progress if I hadn't passed the stone already. This morning, there was a small black fleck in my urine that I screened out, but not certain if it was a kidney stone, as I felt no pain." He wanted your thoughts on that.

Dr. Mistry: Very good. So , number one is when you have acute pain in your flank, a kidney stone is a very common cause.

Donna Lee: Where's your flank?

Dr. Mistry: Your flank is in your back right above or at the bottom of your rib cage in the back. So that's the flank. Now a kidney stone pain can exist there, it can exist in the bladder, people can have it in the testicle. It can, it can, and it can even even appear in the, in the abdomen. So people often are confused, why does a small stone cause a lot of pain? And the answer is that, in fact, the size of the stone and the amount of pain can have no relationship to another. The worst, most on the floor, weeping patients often will have one or two millimeter stones because they get stuck in just the right place. And what people don't, what they hear, which is that the stone actually hurts coming out, not a stone in your kidney, and that is true. But what they, what they falsely interpret by that is they think it's the pain when it comes through the urethra like peeing. And because , you know, as a guy, you're like, "Man, anything through that hole is probably going to hurt." But, but that's, that's not what we talk, that's not what we're talking about. We're talking about the tube from the kidney down to the bladder. That's the small one where the stone gets stuck. And that one, that is the location where the stone hurts. You can easily pee out a two or three millimeter stone. That your , your urine stream, you know, unless you, you know , are not a patient of ours is probably wider, wider than two or three millimeters. And so urinating that stone out is probably not going to be that big of a problem.

Donna Lee: That sounds terrible.

Dr. Mistry: Well, I mean people, I mean, you know, we've witnessed stone passing within our own family here. So the very big ones will either stay in the kidney or the moderate size ones will get stuck in the ureter, which is that tube from the kidney down to the bladder, and it can get stuck there.

Donna Lee: So when does it get stuck in a testicle? Are you saying the pain...?

Dr. Mistry: The pain is in the testicle?

Donna Lee: Oh, why is it transferred pain or something ?

Dr. Mistry: Yes. There's a nerve that runs right along the back muscle that controls, that that's right behind the other ureter. And if it gets irritated, it can cause pain all over the testicle.

Donna Lee: Wow. I've never heard of that.

Dr. Mistry: Well, I have, luckily.

Donna Lee: Thank God, because you're a doctor.

Dr. Mistry: It can also cause urgency and frequency. You can be prescribed Flomax, which is theoretically supposed to help the, the end of the ureter, right? Where it goes into the bladder to open up a little bit. And then Toradol is a very commonly prescribed anti-inflammatory. The concern that you had about effects on platelets I think is minimal, and I think you'd find the same concern with aspirin. So aspirin and Toradol cause that same kind of effect on the platelets.

Donna Lee: But not ibuprofen.

Dr. Mistry: And, and in my experience, oral Toradol does not work as well as intramuscular intravenous Toradol . But, but because the research shows that the intravenous works, I think a lot of doctors prescribe the oral thinking is the same medicine. But in my experience it doesn't work as well. But yes, ibuprofen generally works just fine. And you know, if it's severe enough to take a mild narcotic, I think is something that we do rather routinely. A small stone like that, we generally give some time to pass, anything under five millimeters. My experience tells me though, if it hasn't passed in two weeks, that it's unlikely to pass and a surgical intervention may be needed. Passing a small black fleck, like a little pepper flake, can often be kind of a red herring. That's not the stone. You know what three millimeters is. It's you know...

Donna Lee: What's the black fleck then?

Dr. Mistry: The black fleck is either a little blood clot or just a little shell piece, just like, you know, like a warning shot. And , when you finally do pass the three millimeter stone, it may not hurt at all. But if you're peeing in the middle of the night in a dark toilet or in a urinal and you're not watching, then , you know, you could easily lose that stone. It's fairly small.

Donna Lee: Sounds uncomfortable.

Dr. Mistry: And so the last thing I'll say is this: just because you don't have pain anymore, doesn't mean the stone has passed. Many a patient we've taken care of at a stone that thought was small. They said it was pass. They didn't see it pass. They think it didn't pass. And they show up a month later in worst pain.

Donna Lee: Yeah. And guess who they're mad at? You.

Dr. Mistry: No. I had, I told them what to do properly in the first place.

Donna Lee: Well, they're mad at somebody cause they want it to pass.

Dr. Mistry: If you have a stone that you never saw and you're confident that you watch , you know, and you strained your urine, then getting a follow-up x-ray or follow-up test to make sure there's not blood in your urine, I think would really be in your benefit.

Donna Lee: Oh, you're all right, well nobody get a stone . How about that?

Dr. Mistry: Well, if you get a stone come to us, we'll take care of you .

Donna Lee: You can call the number (512) 238- 0762 if you're having a stone or any sort of other penis issue of any kind. Our website is armormenshealth. Thank you so much.

Dr. Mistry wants to hear from you! Email questions to armormenshealth@gmail.com. We'll be right back with the Armor Men's Health Hour.