Just as fears over the coronavirus were heating up last February, Trishna Patel thought she had a bad cold or the flu. She tried to ride out her fever and chills, but a friend was worried about how weak she was and took her to urgent care. “Once I got there, I had a seizure. The EMT said I was dehydrated and told me I needed to go to the ER,” says Patel.
The ER doctor quickly determined Patel was suffering from serious sepsis. “He said if I’d waited any longer it would have been very bad,” she remembers.
It wasn’t immediately apparent what was causing the massive infection, but a CT scan revealed a very large kidney stone in Patel’s right kidney. The stone was blocking the flow of urine, which caused a urinary tract infection that led to sepsis.
“The RN looked at me and asked, ‘Are you sure you’re not in any pain? We think you have a really large kidney stone and it seems like you’d be in pain, but you’re not.’ I said, ‘No, zero pain.’ I’d had a kidney stone when I was in eighth grade and the pain was excruciating then, but I passed it by the time I got to the hospital. This stone was such an anomaly. What brought me to the hospital was the sepsis and not the stone itself.”
The Man with a Plan
Patel underwent emergency surgery to have a stent placed in her kidney to open up her urinary tract. During her five day stay in the hospital, Keith Bloom, MD, a kidney stone specialist with Urology Partners of North Texas, visited her to discuss a plan for eliminating the monster stone. Patel says she felt comfortable with Dr. Bloom right away.
“Being able to ask questions and hear his reassurances really helped me,” she adds. “He answered all my questions and explained everything in a way I could understand.”
Patel also appreciated that Dr. Bloom answered questions from her family and friends. “He was really open and didn’t make me feel like he was rushing to the next patient.”
By the time Patel’s infection had cleared, Dr. Bloom had a plan for getting rid of the stone. “Trishna’s large calcium-based stone had likely been growing for several years in her kidney, but not blocking the flow of urine,” Dr. Bloom notes. “As a result, she didn’t experience any pain. When a stone suddenly drifts into a position that blocks the flow of urine—combined with a urinary tract infection—sepsis can occur, and that’s what happened to Trishna.”
Shock Waves Smash Stones
Dr. Bloom recommended a non-invasive treatment option, extracorporeal shock wave lithotripsy (also known as ESWL or lithotripsy). Guided by X-rays, a machine called a lithotripter uses mild shock waves to penetrate the body and break the stone into small fragments the body can easily pass. With ESWL, there aren’t any incisions. Patients recover quickly and can resume their normal activities within a few days.
“Trishna’s stone was on the large side, so it was best to start with a shock wave lithotripsy,” Dr. Bloom explains. “Lithotripsy caused the stone to crumble into smaller, more manageable fragments.”
A month after Patel was released from the hospital, she underwent ESWL with Dr. Bloom. Because her stone was unusually large, two treatment sessions were needed.
“After the initial shock wave treatment, we were able to look into Trishna’s kidney through her bladder, a procedure called ureteroscopy,” says Dr. Bloom. “While the initial ESWL treated the majority of her stone, there were a few remaining fragments. The ureteroscopy—which doesn’t require any incisions—allowed us to clean-up the area and remove those fragments.”
During the second lithotripsy, Dr. Bloom also replaced the uncomfortable stent Patel received during her emergency surgery as a precaution. She wore it for a week to make sure the kidney was functioning properly and inflammation wasn’t an issue.
“Both procedures went really, really well,” Patel says. “I was under general anesthesia both times and didn’t feel anything. Throughout the entire process, Dr. Bloom, the surgical team and his office staff were so amazing. My mom was so impressed, too. She’s normally quite skeptical, but she was very impressed with everything and everyone involved throughout the entire process.”
The Road to Recovery
Patel experienced some soreness and weakness for a few days after her procedures, but she attributes a lot of that to her recovery from sepsis and the temporary stent she had to wear for a while.
“Dr. Bloom did an ultrasound at my first follow-up visit with him and found there was a little bit of inflammation, but my kidney is recovering very well,” Patel adds. Her six-month follow-up appointment is coming up soon and she looks forward to getting the results of her blood tests and talking with Dr. Bloom about ways she can help avoid kidney stones in her future.
“I was happy to help Trishna get back to better health and back to work,” says Dr. Bloom. “UPNT is all about delivering fast relief to our stone patients. We don’t want anyone to struggle with painful kidney stones.”