Wednesday, February 23, 2005

The history of my right kidney

Today is a special day for me. It is Tuesday 22 Feb.
Some body may ask why I chose this title for my posts, that is because I decided to write about how a patient suffers in Iraq, when he had a serious or chronic illness.
I personally have some medical problem. Although I am a doctor and know all the excellent doctors in Mosul and always get somehow a special management, I still suffered a lot.
Today I get rid of some (not all of the suffers), I did passed 3 stones with urination, without surgical intervention. Those stone cause me a severe pain over the last 30 days.


The story from the beginning.


In 1982 I was in the military service as medical doctor for some of the military units during the Iraq-Iran war.
It was July and we were in a desert area with no clean water supply, It was Ramadan our fasting season, I was fasting at that time , although it was very difficult but I was still 36 year old and feel strong and youth, our fasting last for one month, we stop from eating and drinking from about an hour before the sun rise to the sunset. At that time the doctors serve in the army as an ordinary soldiers, but as far as I am the only doctor in the camp. I got somewhat a special treatment, this was true specially when there is fight near by us. Our staff consists of one doctor (me), one medical assistant (male nurse), an ambulance and driver.
Our equipments are all brand new, all the drugs and medicine are available, and our ambulance was Chevrolet 1982. There were no other facilities, as laboratory test or x-ray. All what we could offer to the patients is the first aids for the casualties and some medicine for the common illnesses. The more serious condition, we refer them to the military hospital, and this take a complex routine procedure.

At that time I started to have some pain in my right loin, the pain was mild at the start and I was a strong youth man, I have a lot of medicine at my hand. So I treated my self with simple analgesic and antispasmodics. Also the general condition of the whole situation was not encouraged me to consult the military hospital.


Two years later, I still in the military service but this time in the north front, I started to complain of more severe loin pain and occasional renal colic, I was the only doctor in that unit, we have no any facilities as X ray, or lab. exam. But we have almost all type of medicine we need.
when I discharged from the military service at the mid of 1984, I started to check my self. The result was surprising to me, there was a large stone in my right kidney filling all the renal pelvis. I consult the best urology surgeon in Mosul, he decided surgery with possibility of kidney removal if there is a noticeable damage to the kidney. During the operation he decided to preserve the kidney as he found it still in a healthy condition.
The stone was very big and friable it fragmented in his hands during removal, although he made washing to the area but many fragments are left in place, to become multiple new stones afterward.
That mean I started with single big stone, and ended with multiple small stones.
I tried to take some medication to dissolve the stones, both pharmaceutical and traditional drugs that prepared from herbs. The result I get; I ended with three stones in the renal pelvis, there sizes are 8-10 mm. in diameter. These stones continue to enlarged and cause more pain.

The decision come again from the urology surgeon, operation.
In 1986 I had the second operation to remove the renal stones. This time the stones were solid and non friable, but,
this happen only to me, the surgeon remove two stones and lost the third. He couldn't found it. At that time, the facilities in the hospital was too poor, they didn't have portable x-ray machine or an ultra sound devise. So the close the wound when they give up and can't found the stone.
That mean I ended with one large stone in my kidney after two major operations.


At 1988 the date of introduction of a shock wave therapy in Iraq (a procedure of breakdown the stones by supersonic waves) .
I was the first who try this procedure in Iraq. I did it in Baghdad in a private hospital, several sessions one month a part.
The stone breakdown and most of it get out with urine, but little pieces left, built their selves to more stone later on.

That mean I ended with multiple renal stones again.


From 1989 to 1995, I had several shock wave therapy with transient relieve of pain, the stone and pain relapsed within few months to about a year. During this period the sanction against Iraq was started and involved the medical appliances and most of the known drugs.
Our instruments get old and without maintenance.
In 1995, one of the urology surgeon who was worked previously in x ray department, with the help of the medical city (the biggest and best general hospital in Iraq), introduced a recent way of removing renal stones by a method called percutaneous nephrolithotripsy.
what is percutaneous nephrolithotripsy? :

"Percutaneous nephrolithotripsy (PNL): A technique for removing large and/or dense stones and staghorn stones.

PNL is done via a port created by puncturing the kidney through the skin and enlarging the access port to 1 cm (about 3/8 inch) in diameter. There is no surgical incision.

PNL is done under anesthesia and real-time live x-ray control (fluoroscopy). Because x-rays are involved, a super-specialist in radiology (an interventional radiologist) may perform this part of the procedure.

The urologist (an endourologist, another super-specialist) then inserts instruments via this port into the kidney to break up the stone and remove most of the debris from the stone."

I did the PNL in 1995, but it was not as easy as it looks to be, may be that happen to me only, during the procedure I felt a severe pain that made be shout "Aayyee" loudly, by the way this is never happened to me before this time, the surgeon asked the anesthetist," why he feel pain" guess what? She forgot to give the anesthesia before the operation!!. But at the end, this time, I get rid of the stones for very long time! About 8 years of stone free life, thanks God because they were very hard years on all Iraqi peoples.

Two years ago I started to have the same pain again, and the x ray showed multiple stones in the same kidney!

This time I have a decision, "No more operations". I started some diet modification and plenty fluid, no more fasting in summer time.

It was OK till last month when me and the family were in Baghdad for the holiday of the Aid, when I developed a severe renal colic, there were no hospitals, but plenty of relative doctors, they gave me the strongest analgesic available,but with limited response.
The colic lasted for 10 days with no relapse, I managed to returne to Mosul driving all the way back. It was the days before the election, there were curfew for the cars, and also no hospital and no doctors.
At the end of the election days when every thing returned to its ordinary state. I took an x ray, there were three stones in the right ureter in the lower third.
They took about 20 days of suffering and taking different analgesic.
Today the Tuesday 22 after I get back home from the hospital, I passed one stone with the urine, it was 6 mm. in size, at night about 11:30 pm, I passed two stones the larger one about 9 mm the other about 7 mm in diameters.
By the way, all these problems are in my right kidney only. The left kidney is perfectly normal.
I told you it is great day for me.
I hope I didn't make you bored. If I did , let me know.

22 comments:

Mad Canuck said...

Hi truth teller,

I'm glad to hear you managed to pass those kidney stones. You're probably relieved you won't need surgery to get them out.

Best regards,
Shawn.

Anonymous said...

You are a brave man, Dr. Truth.

My God!

Yours aching in sympathy,

Tilli (Mojave Desert)

David in NYC said...

I sincerely hope that you have seen (and felt) the last of these kidney problems.

I have enjoyed reading your discussions of the health care system in Iraq. It is very interesting to begin to get a sense of the your system.

I have a couple of questions that I would enjoy seeing you discuss and elaborate on at your leisure.

1) Respect and compensation for doctors in Iraq.

In the US, doctors, in general, are highly respected and highly compensated. The field of medicine usually attracts some of the brightest students, who then make the substantial sacrifice of a long, long education and training program with low pay and often incurring large debt. Finally, as doctors become full-fledged service providers, they can earn a very good living and enjoy the fruits of their prior sacrifice. Patients and the community at large give a large amount of respect to doctors for their education, commitment, service to the community, and even possibly due to their economic position in society.

How do Iraqis perceive there doctors? How do doctors perceive their place in Iraqi society?

2) Inequities in the Iraqi health care system

You mentioned that all Iraqis get free health care. On the surface, that sounds great. In reality, I imagine that certain people (whether Baath party members, bureaucrats, clerics?, other doctors?) had advantages versus the normal Iraqi. Can you comment on this, maybe with some read-world examples? Was there any separate private health care options setup for wealthier people willing to pay for better or faster service? Would wealthy Iraqis receive their health care in Iraq or would they travel elsewhere for potential better care due to better facilities / more up-to-date training / etc.

Thanks in advance for your feedback.

If you enjoy answering these questions, I am sure that I have a full list that could keep you engaged for quite a while.

Anonymous said...

Glad to hear you managed to avoid surgery this time around. Your story of forgotten anaethesia reminds me of the time a urologist biopsied my right testicle in connection with a sterility problem - whatever there was in the needle he claimed was anesthetic, it was less than totally effective.

Sacramento, California

Kerrville Bill said...

The first time I had a kidney stone was in Houston, Texas in 2001. I went to the emergency room about Midnight on a Saturday night.

The pain was so bad I actually layed down on the waiting room floor to try to ease the pain. This shocked some of the patients coming to register, because in a Houston emergency room on Saturday night you can see just about anything. The receptionist promptly put me in a room so as not to scare any more patients.

I hope your kidney gets better.

Kerrville Bill

Mark Kilmer said...

Doctor...

You most certainly did not bore me, and I hope all will be well with you.

I live in the United States, and we had no way of knowing what life was like for you in Iraq during Saddam's time. We never thought, say, "There is a doctor in the Iraq army, fighting in the war against Iran, who is suffering from kidney stones." I didn't consider that you had specialists who performed the procedures that are performed here. To me, Iraq was Saddam. That is all he allowed us to find out.

I know that your country is going through a very difficult time right now, but I am grateful that we can relate to each other as human beings.

I am also grateful that you, your daughter, your countrymen have weblogs to share your stories.

Never, boring, doctor. We've waited too long for this.

JJ said...

Wow Doc, what a story! I certainly was not bored. In fact, I think you should send your story into Readers Digest. I think they'd love it.

I hope your right kidney is finished causing you problems but unfortunately it will probably continue to produce stones.

Anonymous said...

Wow, I can't imagine passing that many stones. Let alone all the surgery. Only have passed one, that was quite "Brutal" enough. I'm getting severe ghost pains just thinking about it.

Was very lucky, it only took about 13 hours start to finish. Started a slow,faint pain about 10pm, by 4am I was squirming. Then the pain subsided enough that I went to work & it hit again, hard. Was contorted, sweating hard, getting very pale at my desk, teeth clinched. Co-workers were freaking out demanding to drive me to the ER. Told them I can drive myself & didn't go to the ER. Went to my Doctor's office instead, who was booked up solid. STUDID, the ER was only 2 blocks further. No opointment, Squirmed for two hours in the waiting room lobby. Had the feeling most of the night I needed to urinate, but couldn't go much. Finally about 10:30am went to the restroom & WHA-La, Relief. Passed it, the doctor saw me 15 minutes later. Told him I was alright now, he insisted on tests, x-rays & an hour later told me I had a lot of blood in my urine, elevated white blood cell count & had obviously passed a kidney stone. He excused himself & spoke to his head nurse & staff. Through the door I could hear much, but enough to know he wasn't happy a patient was left squirming in pain in his lobby. He wrote a couple prescriptions. Gave me a hard time about being a smoker ,told me to go home rest up, and when in severe pain, get straight to the ER even if you have to call an ambulance. This Clinic was operated by one of the worst, most notorious, hated & worst run, often sued HMO's in the U.S. at the time. Not naming names but their initials were K-P.
But, most of Doctors were just great,especially this Fellow. A lot of us from work had this fellow for a Doctor & really liked him. Personable, cool, friendly calm matter of fact way of speaking. From the Muslim world, but raised & educated in Britain. The accent was VERY British. We cracked (jokes)on him at work becasue of the accent, but not a form of disrespect. But because we did like him, Cracks like, "Bond, Ali Bond, licensed to heal", "Doctor Ali Swavay", "Doc Swavay", "Ali(roger)Moore" , "Ali Swavay, M.D.". Unfortunately,none of us had the verbal skills to acually pronounce his real name correctly beyond "Ali" was another reason.

The clinic administration was terrible. I can only imagine it was the evil plan devised by some penny pinching corporate accountant, not user/customer friendly at all.

Dr. Truth Teller, your post wasn't boring. In fact, I think it's great people from differnt nations, cultures, back grounds can talk about something we all share , Human Frailties.
Hope my comment weren't boring too.

Anonymous said...

Wow, I can't imagine passing that many stones. Let alone all the surgery. Only have passed one, that was quite "Brutal" enough. I'm getting severe ghost pains just thinking about it.

Was very lucky, it only took about 13 hours start to finish. Started a slow,faint pain about 10pm, by 4am I was squirming. Then the pain subsided enough that I went to work & it hit again, hard. Was contorted, sweating hard, getting very pale at my desk, teeth clinched. Co-workers were freaking out demanding to drive me to the ER. Told them I can drive myself & didn't go to the ER. Went to my Doctor's office instead, who was booked up solid. STUDID, the ER was only 2 blocks further. No opointment, Squirmed for two hours in the waiting room lobby. Had the feeling most of the night I needed to urinate, but couldn't go much. Finally about 10:30am went to the restroom & WHA-La, Relief. Passed it, the doctor saw me 15 minutes later. Told him I was alright now, he insisted on tests, x-rays & an hour later told me I had a lot of blood in my urine, elevated white blood cell count & had obviously passed a kidney stone. He excused himself & spoke to his head nurse & staff. Through the door I could hear much, but enough to know he wasn't happy a patient was left squirming in pain in his lobby. He wrote a couple prescriptions. Gave me a hard time about being a smoker ,told me to go home rest up, and when in severe pain, get straight to the ER even if you have to call an ambulance. This Clinic was operated by one of the worst, most notorious, hated & worst run, often sued HMO's in the U.S. at the time. Not naming names but their initials were K-P.
But, most of Doctors were just great,especially this Fellow. A lot of us from work had this fellow for a Doctor & really liked him. Personable, cool, friendly calm matter of fact way of speaking. From the Muslim world, but raised & educated in Britain. The accent was VERY British. We cracked (jokes)on him at work becasue of the accent, but not a form of disrespect. But because we did like him, Cracks like, "Bond, Ali Bond, licensed to heal", "Doctor Ali Swavay", "Doc Swavay", "Ali(roger)Moore" , "Ali Swavay, M.D.". Unfortunately,none of us had the verbal skills to acually pronounce his real name correctly beyond "Ali" was another reason.

The clinic administration was terrible. I can only imagine it was the evil plan devised by some penny pinching corporate accountant, not user/customer friendly at all.

Dr. Truth Teller, your post wasn't boring. In fact, I think it's great people from differnt nations, cultures, back grounds can talk about something we all share , Human Frailties.
Hope my comment weren't boring too.

Jeff said...

Congratulations, Doctor!

I've been praying about your problem ever since I first heard about it! I'm delighted with the new developments. Not a boring post at all, for those who care about you and your family!

Jeff

Truth teller said...

David in NYC
Thank you for your feelings
You asked about:

1) Respect and compensation for doctors in Iraq. ?
In general the look of the people to doctors is differ from place to place and from time to time!
The cause as I think is that we have here ignorant peoples (the majority),and as medicine is free in Iraq, and peoples can find any medical services they need day and night free of charge, they think that this is a right, and no body should be thanked for that. But the educated people usually repect the doctors very well.

During the time of Saddam, (He disliked doctors !)as well as all educated person in Iraq.(This a well known fact). He many times insults doctors in his speechs. this is reflected to the people who look to Saddam as their symbol, and at time they were the majority!.

About compensation for doctors in Iraq. It is unbelievable. The salary of the doctor who wark for the government is so law that it is insufficient to cover the transportation from & to their wark. For eaxample: I have more than 30 year service in the Ministry of Health, head a highly specialised department. My salary during the years from 1993-2000 is almost equal to 3$ !! Yes three dollars a month, increased during the last 3 years befor the war to be about 9$. This trivial amount of money, made every doctors to resign or even to leave Iraq for better living standard. But Saddam prevent any one from being resign by putting a law preventing any resigned doctor from warking any where in Iraq, or leaving Iraq.
we had the right to open private clinic, so we could managed to live in some what reasonable standard. There were no health insurance in Iraq. The patient have to pay for their visits, but the charges are very low, It is about 0.25$ for the visit, increased lately to be a bout 0.75$. These are the costs of clinical examination and prescriptions. The cost of the surgery or other medical procedures are different. If you consider that all the goverment officers have simmilar or even less salaries, you can imagine why we accepted with too much complains.
I have to add, that after Saddam, the sallary increased more than 30 folds, my salary now is about 400$ a months.
Also the cost of clinical exam in private clinic is about 2-3$.

2-Inequities in the Iraqi health care system?
Yes ther was some inequities,specially with high degree militery officers, Baath party members, and any body who have any relation to Saddam or one of his family, the bureaucrats, yes but not the clerics, other doctors? may be they get special attention from thier colleagues. But there were no advantages over other Iraqis because the facilities are limited. They may have bettter accomidation in the hospital, more nursing care and better doctors consultation.

For wealthier people who can offer money for their health, there were a private hospitals with better and faster services, in addition if they can get out side Iraq, they usually do because of better facilities, and more up-to-date training.

saf said...

dear truth teller: Iwas very surprised when I read your story although Iam one of your relatives,I didnt know most of the details of your suffuring . and as a new member of (the kidny club)I was afraid to develope the same pain as yours.I hope this is the end of yours and may God bless you and your wonderfull family

David said...

Ouch!!! I hope you are feeling better!I pray that you and your family stay safe and healthy !!!
Rockie

CharlesWT said...
This comment has been removed by a blog administrator.
CharlesWT said...

Many factors that increase your risk of developing kidney stones can be controlled.

Risk factors you can control

• Fluid intake
º Dehydration is a major cause of kidney stones. Make sure that you drink enough fluids each day to prevent dehydration; water is best. This is particularly important if you live in a hot, dry climate.
º Drinking colas and certain fruit juices, such as grapefruit juice, can increase your risk for developing kidney stones.

• Dietary factors
º Vitamins C and D can increase your risk of kidney stones when your intake exceeds daily recommendations. Read the labels carefully and do not exceed recommended daily doses.
º Diets high in protein, sodium, and oxalate-rich foods increase your risk for developing kidney stones. If you think that your diet may be a problem, schedule an appointment with a dietitian and review your food choices.

• Activity level. People with sedentary lifestyles may have more problems with kidney stones.

• Medications. Many medications, such as acetazolamide (Diamox) or indinavir (Crixivan), can cause kidney stones to form. Kidney Stones: What Increases Your Risk

More...

Truth teller said...

charleswy
Thank you for your advices and for the links you provided.
Just want to tell you that all these notes were known to me, the cause of the reoccurrence in my case, is probably a mechanical or anatomical rather than the risk factors you mentioned. That is because all the stones I had were only in the right kidney, the left was completely normal.

Anonymous said...

Even though your stones are likely caused by a poorly functioning kidney, changing your nutritional patterns can still help. If the kidney is having trouble processing in an effecient manner, making sure the fuel it needs to function is over-provided can help it work better (just like babying a car that is old and worn out).

I have a wonderful doctor who says "Genetics is the gun, but it is your environment that pulls the trigger."

A good friend of mine inherited kidney cancer and swears that he hasn't had a re-occuronce because of the dietary guidelines this doctor put him on.

Magnesium citrate and potassium citrate have been proven to have an impact on kidney function, as well as lemonade. It's probably because it makes it easier for your kidneys to filter your waste, and so they don't gunk up as badly.

In any case, there's not a lot of harm in drinking lemonade, so it's worth a try.

Brian H said...

You should have said you hoped that wasn't too painful to read. You've got a lot of people out here sitting with tender spots in the lower back and tingling limbs and foreheads from empathetic agony.

I hope you're satisfied!

:D
;)

emigre said...

Phew. What an ordeal, but thank goodness the right kidney has improved. It's been a while since I heard such a happy ending.

The Master Of Sound said...

AAAAGGGHHH!!!!!! How well I remember the stones I passed! I turned into a raging maniac!

I feel for you, and the dietary advice that you received is perfect. One more VERY important thing:

Parsley will dissolve kidney stones. Made into a tea, very strong, 6 big glasses a day at least; and also parsley roots, made into a tea. It used to be called 'gravel root' because of its effect on kidneys and stones. Alternate with lemon juice in water.

Don't you have some herbal healers there? herbs are cheap and very effective sometimes. I don't say stop allopathic treatment, but supplement it with herbs.

Good luck!

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