Frequent Kidney Stone in Inactive SMA Patients
Individuals that are sedentary, like my patient Michael, are more prone to having kidney stones secondary to too little activity as well as possible reduced fluid intake due to other restrictions, such as reduced upper extremity strength and ability to self-nourish. In the past 20 years, Michael has undergone surgery numerous times to remove kidney stones. While most kidney stones at or below 4 mm can be passed without too many problems, Michael’s kidney stones have been well over this threshold. He went to the hospital on Friday, December 31, and his CT scan showed 3 kidney stones. After his diagnosis, he wanted to speak with the urologist on call to inquire about having these kidney stones removed, but the urologist said that he was not going to do surgery because all 3 of his kidney stones were under 4 mm in size, therefore classifying as a “voluntary procedure,” which would take longer to complete due to an increase in COVID in the area.
On Sunday, January 2, Michael’s pain increased to the point where he was unable to take a deep breath. He was then taken by ambulance to another hospital close to his house, where another CT scan was performed that revealed that one of his kidney stones was under 4 mm in size, but the other 2 kidney stones were over 10 mm. The doctor who saw him on Sunday said that the doctor misdiagnosed the size of these other 2 kidney stones and that he was going to need surgery to remove these other 2 kidney stones.
After surgery, the surgeon told Michael that one of his kidney stones was blocking the urethra, and the other large kidney stone was dangerously close to blocking his ureter. His surgeon told him that if he had waited another week to address this problem, he could’ve become septic, and given Michael’s condition, this could have very easily been deadly. During surgery, Michael’s surgeon blasted the 2 large kidney stones, but he was unable to do anything regarding the kidney stone that was under 4 mm in size. He said that since this was such a small kidney stone, Michael would be able to pass this stone, but the doctor advised him to come back to the hospital if he was having any problems.
Michael has continued to lose an exorbitant amount of blood in his urine, but doctors said that this blood loss would only be temporary while he recovers. This blood loss has caused Michael to be very lethargic and weak, so over the next couple of weeks, we will continue to modify his physical therapy sessions. These modifications to his sessions will be based on how he’s feeling when he comes in, but we should still be able to work on his range of motion and flexibility exercises without any problems.
Individuals who suffer from spinal muscular atrophy already suffer from reduced strength with regards to their muscle tone, so we’ll have to accommodate his physical needs during his recovery. His feelings of lethargy and overall weakness will continue to improve as he recovers from his surgery, but there is really no timetable as to how long it will take him to make a full recovery.
It is important to remember that patients with SMA who go through procedures like this may require a longer time to recover and experience reduced energy levels and ability to perform activities. We will continue to monitor Michael’s condition each week when he comes in and make the necessary changes in order to continue his progression.
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