Kidney Stones

[Wheels]

I have a prospective student with a history of kidney stones. He states that he has had 3 stones approximately 5 years in between each instance. It has been over 5 years since his last stone. Will he be able to get a 3rd class medical without an SI and if so what will be the effect on his medical if he has another stone? His past history makes it seem that he is probably due for another stone sooner than later.

When I had my first medical I had a history of a single stone and it had been longer than 5 years since it happened, my AME issued my medical in the office. I don’t know if he can expect the same thing since his history includes more than one stone. If this is going to be a big issue for him then he would prefer to go Sport Pilot rather than spending a lot of money to meet the requirements of an SI, so I am trying to give him advice before he goes to the AME. I have already recommended that he schedule a consultation, but not physical, with the AME that issued my first medical.

 

[lbfjrmd]

Going by the kidney stone CACI, he could be issued if the dates are correct. I might be inclined to defer ( too much knowledge here) as the FAA may want to know more.

 

[bbchien]

View attachment 71774 Going by the kidney stone CACI, he could be issued if the dates are correct. I might be inclined to defer ( too much knowledge here) as the FAA may want to know more.

Def: Hydronephrosis: the dilation of a duct due to presence of a stone or past presence of a stone

This is, as Dr. Lou points out, one in which the AME has to be very careful of the dates. We also have to know that there is no hydronephrosis left behind. 5 years (to the day) is critical.

If review of the record fails on either account of dates, or of complication (and I would venture to say that it's RARE for a urologist to obtain an AFTER-stone passage ultrasound to confirm absence of hydronephrosis), the standard for the special issuance is TWO identical imaging studies capable of finding hydronephrosis, at a minimum of 90 days apart, showing NO CHANGE, no STONE movement, no new stones.

Bruce

 

[Wheels]

Thanks to both of you for your help. I will show this to the student and he can consult with the local AME to decide the best route for him to take.

 

[Morgan3820]

Curious, Why are kidney stones such a concern? While back I had a gallbladder attack and while I was in severe pain to the point of crying. I don’t think it would make me crash the airplane.

 

[Mike Smith]

Curious, Why are kidney stones such a concern? While back I had a gallbladder attack and while I was in severe pain to the point of crying. I don’t think it would make me crash the airplane.

I had my first kidney stone last month. No warning, just BAM, I was on the floor in the fetal position. I won’t say that I couldn’t fly if it happened in the air, but it would have been very difficult. Mine was 12mm. Had laser lithotripsy to break it up. It has been an ordeal, I don’t recommend it.

 

[Matthew]

Curious, Why are kidney stones such a concern? While back I had a gallbladder attack and while I was in severe pain to the point of crying. I don’t think it would make me crash the airplane.

I think FAA uses the phrase "sudden incapacitation", and they don't like the risk.

My KS dropped me to the bathroom floor with the heaves. Took me about an hour to get myself up and to the ER.

 

[Blatham489]

I’ve had three episodes, fully disclosed, no SI. I can feel them coming on and could get on the ground (I think) fast enough to avoid being incapacitated, but man those suckers hurt. Wouldn’t want to be shooting an approach while in that level of pain.

 

[Matthew]

The ER nurse asked me, "On a scale of 1-10, how much does it hurt?"

I was fighting it so hard I couldn't even talk. She said, "I'll take that as a 10."

 

[Mike Smith]

Yeah, the ER nurse started asking me “on a scale....” I said, “10, it’s 10” before she finished the question.

 

[Stingray Don]

Yeah, the ER nurse started asking me “on a scale....” I said, “10, it’s 10” before she finished the question.

I told the nurse, “What I previously thought was a 10 is now a 7”. Worst unyielding pain of my life.

 

[Stingray Don]

I’ve had three episodes, fully disclosed, no SI. I can feel them coming on and could get on the ground (I think) fast enough to avoid being incapacitated, but man those suckers hurt. Wouldn’t want to be shooting an approach while in that level of pain.

I have had a few kidney stones and my experience is similar. The pain builds for several hours before it becomes intolerable and I have to go to the ER for pain management. If I would have been flying at the time, I wouldn’t have had any problem getting down before things got bad. I hope I never pass another one, but it does not cause a safety concern for me.

 

[Matthew]

My pain built up, too, but I didn’t know what it was. I was in bed and couldn’t get comfortable. I thought maybe I had strained my lower back earlier in the day, not unusual for me. I tossed and turned for a while and then it hit. I got to the bathroom before I puked, then dropped to the floor and curled up with the dry heaves for a while. If that happened while flying, dunno. I might have shifted around in the seat for a while, figuring it was just muscle tightness in my back until it hit.

 

[BillTIZ]

Mine was a slow on set of pain. Very small stone. About 4 hrs from first notice I decided to drive myself to ER. CT showed a small stone and the Doc said it was about 90% through the duct. Some pain killers and sent home to pass it.

More than 6 months later it was time to renew my medical. CT and then MRI showed no stones. AME was able to issue following the CACI format.

 

[wrbix]

Something for all those with kidney stones to consider:
- Way too many physicians (Urologists included) manage stones as an acute illness, with no thought to prevention.
- Everyone with stones should be worked up for etiology with stone analysis and urinary studies to define their propensity to stone formation, then have a treatment plan formulated to prevent recurrences.

An ounce of prevention is truly worth a pound of cure.

 

[Cam Bender]

The ER nurse asked me, "On a scale of 1-10, how much does it hurt?"

I was fighting it so hard I couldn't even talk. She said, "I'll take that as a 10."

If you’d said 11, they’d have given you a spinal tap.

 

[Matthew]

If you’d said 11, they’d have given you a spinal tap.

I think they gave me morphine...can't remember. I know they gave me something for the nausea.

When she said, "I'll take that as a 10", all I could do was nod. If I could have said "11", I would have.

 

[AggieMike88]

If you’d said 11, they’d have given you a spinal tap.

Your Doctor wouldn't be named Nigel Tufnel, would he?

(if this isn't a sufficient clue to the pop culture reference...)

 

[arnoha]

View attachment 71774 Going by the kidney stone CACI, he could be issued if the dates are correct. I might be inclined to defer ( too much knowledge here) as the FAA may want to know more.

Where was that chart when I got my third class six years ago? I've had one incidence of kidney stones about 15 years ago. Painful, wouldn't want to repeat it, but it passed quickly. Had a CT at the time, but it had passed by the time I got to CT.

Fast forward to getting my student pilot license six years ago and the AME forwards my case to Oklahoma immediately on learning I've had that one incident. That chart seems to indicate he had no reason to do so. Didn't end up with an SI, but did need an ultrasound and another CT. Cost, delays, for no reason. And I was too green to know to resist it. Lessons learned and I never went back to that AME.

 

[FastEddieB]

- Way too many physicians (Urologists included) manage stones as an acute illness, with no thought to prevention.
- Everyone with stones should be worked up for etiology with stone analysis and urinary studies to define their propensity to stone formation, then have a treatment plan formulated to prevent recurrences.

An ounce of prevention is truly worth a pound of cure.

I’ve dealt with kidney stones since the 1980’s. Prevention was always addressed.

Proper hydration is probably the most important single factor.

In the beginning, they recommended limiting calcium in the diet for calcium oxylate stones, the most common type. They no longer do. In fact, limiting calcium may make things worse.

I take prescribed potassium citrate tablets 3x a day. It seems to help. They also recommend avoiding tea, cola drinks and certain dark green leafy vegetables.

All in all, I see kidney stones as a relatively simple plumbing problem. I’d rather have them than many of the other far more serious maladies people face.

 

[Matthew]

I’ve dealt with kidney stones since the 1980’s. Prevention was always addressed.

Proper hydration is probably the most important single factor.

In the beginning, they recommended limiting calcium in the diet for calcium oxylate stones, the most common type. They no longer do. In fact, limiting calcium may make things worse.

I take prescribed potassium citrate tablets 3x a day. It seems to help. They also recommend avoiding tea, cola drinks and certain dark green leafy vegetables.

All in all, I see kidney stones as a relatively simple plumbing problem. I’d rather have them than many of the other far more serious maladies people face.

I remember looking all this up after I had my one stone incident:

The potassium citrate changes the pH in your system to help prevent calcium oxalate stone formation. The other thing my doc recommended was vitamin D that promotes the absorption of calcium into your bones, also lowering the amount of calcium in your system available to form into stones.

The dietary changes are to minimize food that is high in oxalate.

The biggest change I made, though, is drinking more water. I went and got a one liter water bottle. I fill it up every morning, and try to have it finished by the end of the afternoon. I may drink multiple glasses of water at lunch, dinner, or throughout the day from other sources, but I know that at least one liter of water has gotten into me.

 

[wrbix]

I’ve dealt with kidney stones since the 1980’s. Prevention was always addressed.

Proper hydration is probably the most important single factor.

In the beginning, they recommended limiting calcium in the diet for calcium oxylate stones, the most common type. They no longer do. In fact, limiting calcium may make things worse.

I take prescribed potassium citrate tablets 3x a day. It seems to help. They also recommend avoiding tea, cola drinks and certain dark green leafy vegetables.

All in all, I see kidney stones as a relatively simple plumbing problem. I’d rather have them than many of the other far more serious maladies people face.

Sounds like a bit of a broad brush approach.
While hydration is important to lower urinary concentration of stone forming compounds, the issue of calcium in diet is complex (to which you’ve alluded), citrate can help bind Ca and acidify urine which is useful for some types of stones, tea/cola/certain food avoidance is only helpful in those with oxalate stones.

I would say that nephrolithiasis is much more than a simple plumbing problem...more of a chemical problem.
A complete stone prevention diagnostic stratagem should include chemical analysis of a passed stone and 24 hour urine studies to define the chemical propensity toward stone formation.

<fully expect some conspiracy theorist to be along shortly to disparage all of this as Big Med trying to profit >

 

[bbchien]

THIS! there is a poster here who is pretty bitter about being grounded with stones because either he was unable or his HMO was unwilling to let him see the nephrologist to get this figured out....

 

[Vf6cruiser]

Popeye has steered us wrong......spinach is the worst for causing stones with chocolate being bad also......look for the amount of oxalate in the food.....

 

[wrbix]

Popeye has steered us wrong......spinach is the worst for causing stones with chocolate being bad also......look for the amount of oxalate in the food.....

Again.....only if your stones are Ca-oxalate containing.....want to spend your life avoiding foods, or would you rather have your stone and urine analyzed?

 

[bflynn]

Curious, Why are kidney stones such a concern? While back I had a gallbladder attack and while I was in severe pain to the point of crying. I don’t think it would make me crash the airplane.

Women disagree out of pride but kidney stone pain has been compared to childbirth. A large stone is probably worse and there is no relief from it. My nurse friend has seen grown men on the floor vomiting from the pain, but she acknowledges that’s probably from a large, impassable stone. The largest she ever saw was 10mm, which is freaking huge. 6-7mm is usually considered about the largest than can be passed. As was noted earlier, you will have no notice of it until it hits suddenly and at that pint being a pilot may become impossible.

Btw, proof that the kidney stone is worse? You will never see anyone say they want to have another kidney stone, but many women will willingly have another baby.

 

[SkyHog]

No getting around it - stones suck and they’re painful. Very painful. Predictable, in my experience, so not as debilitating as the FAA thinks, but very painful.

I would recommend that once he gets his 3rd class, go Basic Med from then on. It’s not worth playing with fire on them because the FAA doesn’t understand stones as well as they should before they start disqualifying airmen for something that is not instantaneously impactful.

Btw, I’m the bitter airman referenced above. But basicmed got me flying again.

 

[C E Roberts]

... the standard for the special issuance is TWO identical imaging studies capable of finding hydronephrosis, at a minimum of 90 days apart, showing NO CHANGE, no STONE movement, no new stones.

Bruce

What he said. My case was almost identical to that of your student, except for a longer time since the last one. Doc Bruce walked me through the process last year with (almost) no issues. The only glitch was that my two imaging studies were 85 days apart; not 90 (dumb calculation error on my part when I scheduled the second one)... so I had to pay for a third one. But I got my medical! And currently hold a valid student pilot certificate, so I'm pretty happy now!

Thanks, Doc!

 

[bbchien]

Where was that chart when I got my third class six years ago? I've had one incidence of kidney stones about 15 years ago. Painful, wouldn't want to repeat it, but it passed quickly. Had a CT at the time, but it had passed by the time I got to CT.

Fast forward to getting my student pilot license six years ago and the AME forwards my case to Oklahoma immediately on learning I've had that one incident. That chart seems to indicate he had no reason to do so. Didn't end up with an SI, but did need an ultrasound and another CT. Cost, delays, for no reason. And I was too green to know to resist it. Lessons learned and I never went back to that AME.

Six years ago there was no “CACI for renal stones....”

 

[murphey]

Something for all those with kidney stones to consider:
- Way too many physicians (Urologists included) manage stones as an acute illness, with no thought to prevention.
- Everyone with stones should be worked up for etiology with stone analysis and urinary studies to define their propensity to stone formation, then have a treatment plan formulated to prevent recurrences.

An ounce of prevention is truly worth a pound of cure.

When I had my single stone, after 2 attempts at removal (one the bug zapper, the other one thru the plumbing) I don't remember who recommended it (the urologist or my GP) I ended up at the nephrologist. Blood test, 24 hr urine test and KUB every 6 months for 2 years, and a recommended diet. Nephrologist gave me a clean bill of health in late 17. As Dr B explained, the urologist is a plumber, the nephrologist can provide help on monitoring and avoiding future stones.

 

[gprellwitz]

I have an incident of this morning where my side was really giving me pain. Probably 4 to 5 on my pain scale;Nothing like the 10 that I’m reading described above. Had a CT scan and was diagnosed with a 3 mm kidney stone. While waiting 30 minutes for the scan to be read, the pain started to dissipate. So far, I haven’t passed anything that I’m aware of, but will make a point to capture it and get it analyzed. This lack of pain however seems atypical based on the above descriptions. I’m already on basic med, so hopefully there won’t be any consequences for a medical. I am self around in until I know that I have passed the stone or that the doctor says it safe to go back up. Of course, I haven’t flown in two years now. Dang!

Edit: passed the stone with no incident or pain the same day.

 

[Mike Smith]

“The largest she ever saw was 10mm, which is freaking huge.”

Mine was 12mm.

 

[SkyHog]

I have an incident of this morning where my side was really giving me pain. Probably 4 to 5 on my pain scale;Nothing like the 10 that I’m reading described above. Had a CT scan and was diagnosed with a 3 mm kidney stone. While waiting 30 minutes for the scan to be read, the pain started to dissipate. So far, I haven’t passed anything that I’m aware of, but will make a point to capture it and get it analyzed. This lack of pain however seems atypical based on the above descriptions. I’m already on basic med, so hopefully there won’t be any consequences for a medical. I am self around in until I know that I have passed the stone or that the doctor says it safe to go back up. Of course, I haven’t flown in two years now. Dang!

Edit: passed the stone with no incident or pain the same day.

I hate you.

 

[Kenny Phillips]

“The largest she ever saw was 10mm, which is freaking huge.”

Mine was 12mm.

You win! And that's a contest I'd never want to win ...

 

[FastEddieB]

My personal record is about 10mm.

 

[Mike Smith]

You win! And that's a contest I'd never want to win ...

I didn’t even want to play, much less win. I hope I never have to go through that again.

 

[Mike Smith]

My personal record is about 10mm.

View attachment 73176

You passed that??? I would never want to up against you in a bar fight!