Kidney Stones Causing Severe Back Pain (in the Airplane!)

I had this slightly stressful ordeal on the flight going to Manila from Bahrain.  The woman sitting beside me was asked to transfer to another seat to give way to a female passenger so that she can sit beside her cousin because she is sick.  So, my doctor instinct kicked and did an initial assessment.

She was slightly pale, weak but able to walk. She didn't look that sick after all. But yes, paranoia also kicked in, maybe she was infectious.  During take off, she didn't complain and didn't have any symptoms. Two hours after, she started to moan and her cousin was massaging her back. Thinking that maybe she just had a nasty back pain, I resumed watching my favorite Pinoy movie.  After a couple of minutes, she was still moaning but this time little bit louder.  That's when I decided to be a concerned seatmate.

I asked her cousin the history of the illness, how many days did she have the symptoms, does she have any fever, etc... you know, complete medical history. Apparently, she had the symptoms for a month and no consultations done.  No medications taken. She was laid off from work because she is sick.

She changed position many times hoping to alleviate the pain. My first impression was renal colic (to be discussed later).  I called the cabin crew,  asked them what pain medications are available on board.  They only have paracetamol, I knew this will not help much.  I introduced myself that I am a doctor and told the cabin crew to give her two tablets.  After a minute, she became silent.  I was relieved.  But then again, the pain returned and she was moaning again.  The surrounding passengers started to notice her.  I asked the cabin crew what other medications are available, seeing that her condition is not getting better, they told me they have Tramadol . Now, that's promising. However, they cannot give it unless prescribed by a doctor, so, I showed them my ID.  They have protocols to follow before we can administer the drug.  They have to tell the captain and there is a possibility that we are going to have an emergency landing.  It took them a long time to decide whether they will release the Tramadol or not.  Fortunately, the pain again subsided.  Thank God.  Throughout the flight (8 1/2 hours), she was experiencing moderate-severe on and off pain.  Thankfully, we did not have an emergency landing and we arrived to our destination on time.

This is a classic picture of renal colic.  Colic means contraction of a hollow tube, in this case, the urinary tube.  It contracts when a stone from the kidney passes through it. It can cause severe pain and the patient moves and changes position hoping to stop the pain. Other patients vomit and feel dizzy. The pain is intermittent,  it comes and it goes.

Photo by:  Dr. M. Batucan

Formation of stones result from low fluid intake.  When your urine is very concentrated, there is a high chance of stone formation.  Other metabolic diseases and repeated urinary tract infection can also lead to stone formation.

A urine test, ultrasound of the urinary system and CT scan can detect the stones. If confirmed, medications will be prescribed.  Larger stones require shockwave lithotripsy and even surgery. Shockwave treatment is used to pulverize stones (2 cm or less) inside your kidney without cutting you open.  The pulverized stones will then be excreted as part of the urine.

What you need to do:  You should keep yourself hydrated, drink 8 glasses of water per day.  Avoid excessive salt and protein intake.  Urinary tract infections should be treated properly (I mean, by a doctor) and practice personal hygiene.

Morals of the story:  1. Don't fly if you are sick. 2. Don't fly if you think you are sick,  there is so little we can do inside the aircraft. 3. If you have felt the symptoms for a long time,  then something might be really wrong, do see a doctor.

It is quite stressful being on a plane with this kind of patient.  I mean, I know what to do in a hospital setting, but I'm so helpless inside the aircraft.  All I did really was to assure her that the pain will subside eventually and give the 2 tablets of paracetamol.  Maybe, something higher was at work there.  Why did they transfer to the seat next to me in the first place?