If you had “kidney stone” in the pool of things Titanium Girl would have to deal with next, come collect your prize.
Yeah…
In the afternoon, TG had some pain in her lower right abdomen. It got progressively worse, to the point where I started thinking appendicitis. DH and I evaluated the situation, and I told him I thought one of us would need to take her to the hospital, specifically the children’s hospital where all her surgeries were done, since all her records are there. We decided I would take her, so I packed her up and drove there. I drove there in a zone; we’ve made that trip so many times, it was like being on autopilot. After parking and going downstairs to the ER, Titanium Girl got sick. I figured this further pointed to appendicitis.
Upon walking in the door, there were a number of other people waiting, and I worried TG would have to wait a long time to be seen. But I told the triage nurse the symptoms and that she’d just gotten sick. She handed us an emesis basin and had us sit, but we were called only a minute or two later. After taking vitals, she walked us back to the ER bays, looking for one she thought was unoccupied. They were all occupied. TG ended up on a gurney in the hallway because they were so full, but the nurses were all very kind, and we were thankful just to be in the queue to be seen.
A doctor or nurse practitioner (can’t remember which) came to do an exam and suggested appendicitis or possibly an ovarian cyst given the location of the pain. However, she needed to do a scan of some sort, either ultrasound or CT, to determine for sure. I was really hoping an ultrasound would be enough since TG’s been through so many x-rays already in the last several months, and thankfully u/s was the option she went with. She got us into an ER room as they’d just opened up another wing, and she ordered a pain medication.
However, when she was talking about the pain med, it wasn’t something I was familiar with, and it sounded suspiciously like an NSAID, which TG isn’t allowed to have for 9-12 months as it would interfere with the fusion process. As it turns out, the medication was an NSAID, and apparently an excellent non-narcotic option for this kind of pain if your kid didn’t just undergo spinal fusion a few months ago. That there was nothing in the digital chart about NSAIDs being contraindicated for TG was a little disquieting. Thankfully I know enough about medications and thought to ask, but if I hadn’t…?
With the NSAID off the list, the next option was straight morphine which did the trick after a couple attempts to find a vein. Thankfully one of the nurses tending to TG had been one of her nurses during the fusion stay, so it was nice to have a familiar (and gentle!) face. Next, she had to be catheterized and have her bladder filled so things could be visualized more easily on the ultrasound. Thankfully they did this after the pain medication was on board! We finally got down to ultrasound, and she got through about half of it before the pain started coming back. Then it was back to the room to await results and another dose of morphine.
The MD or NP eventually came back and said the ultrasound results were in and they showed something I never would have guessed: a kidney stone blocking TG’s right ureter, almost to her bladder. Her kidney was enlarged with fluid from the blockage. I was floored. No, she had no history of kidney stones, and there’s no family history of it either, at least nothing confirmed that we know of. A urology doctor would be coming by to talk with us. I called DH and let him know what the verdict was.
When the urology attending came, she said the stone was fairly large–estimated at 6-7mm–but that size was on the cusp of passable size and they thought TG might be able to pass it, given how close it was to the bladder. Since TG’s pain seemed to have subsided a little without additional morphine, they were hoping maybe she’d passed the stone into the bladder, in which case she could go home on oral pain meds (if those worked well enough for her) until it passed completely. However, they wanted to do an x-ray and another ultrasound to check on things.
Unfortunately, the x-ray and ultrasound showed the stone still making itself comfy in her right ureter, so the urology attending said it would be best for TG to be admitted. She said she would start her on something to dilate things and hopefully help TG pass the stone. She also talked about pain relief and starting to bring up the NSAID again, at which point I had to again mention that she cannot have NSAIDs for 9-12 months. (Seriously, why is this not in the chart??). I called DH and we decided it would be best if I stayed with TG overnight, so he came and brought some things for me and helped us get settled into the all-too-familiar floor we’d said goodbye to just a few months ago.
Here’s hoping this will be a short stay….
