12. Second Opinion

I met Dr. Hank, a urologist, at a retreat; we and our wives had a pleasant talk but it seemed unlikely our paths would cross again; they live 50 miles or so away, and at the time I wasn't looking for a urologist.

Fast forward a few years, and I need a second opinion, to explain if nothing else.

So last spring I talked with Hank who provided a real insight and recommended repeating an X-ray after six months or so. 

He said that the remaining large (8mm?) right stone, as well as the small stones on the left appear to be residing in ureteral ducts downhill from the ureter's kidney exit. On the diagram, the black dot presents the right stone.

So for the stone to enter the ureter proper where it cause mischief (obstruction), it has to first go uphill.  No gravity boots for me.

11. Mixed Message

A couple of months ago I underwent a renal scan to further determine the extent of this damage. I was given a tiny dose of a radioactive isotope and then for almost an hour I had to lay still while a medical geiger counter tracked the flow of this isotope as it passed through the kidneys.  I was watching the screen and it looked like my right kidney was not processing as quickly as the left.  

This is what my urologist emailed me about the scan:

"Your renal scan showed 62% function in the left kidney and 38% function in the right kidney. The right kidney has some sluggish drainage, but no obstruction.  It is likely from the chronic dilation of the ureter and collecting system."

And this is from the radiologist's interpretation:

"The arterial phase reveals prompt perfusion of the left kidney but diminished perfusion of the right kidney.  Split renal function at two minutes reveals 62% of the total perfusion to be present in the left kidney and 38% and [sic] the right kidney.  There is prompt unobstructed excretion by the left kidney. There is somewhat delayed and prolonged clearance of activity from the right collecting system."

The urologist would have me believe that both kidneys are functioning below normal--"function" being the key word here.  In fact, since 62 + 38 = 100, it would appear that my renal system operates as the equivalent of one healthy kidney. Doesn't sound good, does it?

But the radiology report suggests a different interpretation, that the left kidney is responsible for 62% of the total work done during that hour, and the right for 38%.  A normal left ovary, in other words, and a problematic but unobstructed right ovary. Here the key word is "perfusion." Is there a difference between perfusion and function?  

I'll go with the radiologist and schedule a second opinion with a second urologist.

My family practice doctor is more interested in a blood test called creatinine and the "glomerular filtration rate" derived from creatinine level, are the usual markers used to define kidney health.  My creatinine level measured in January was significantly elevated, raising concern about permanent kidney damage. But that was before any procedure, when hydronephrosis was present; a few weeks after the stone was removed, the creatine returned to normal levels.

10. 24, 46, 49, 53, 65

So, what happens to the calcium that has been leaking out of my bones--or the dietary calcium that isn't being getting into the bones in the first place? Parathyroid (PTH) and calcitonin hormones dictate a narrow range for blood calcium levels, critical for calcium's numerous roles, which include clotting mechanisms, hormone release, and muscular nerve transmission.  

Extra calcium would interfere with these tasks, so the kidney diverts extra calcium into the urine, too much in my case. When the concentration of dissolved urine calcium gets too high, the opposite of dissolve occurs: precipitation. Stalagtites, crystals, hail, kidney stones, all examples of precipitation.

Kidney stones can block the ureter, leading painful or not so painful spasms, and causing a back-up of urine upstream to the kidney--not good because that back-up creates pressure on cells, a potentially deadly process.  

24, 46, 49, 53, 63, 65: ages when I experienced kidney stones, all spontaneously passed until the most recent, which required a laser blasting. Done under general anesthesia, the most difficult part of the procedure was the temporary (about two weeks) placement of a stent: a tube inserted inside the ureter to prevent kinking and blockage by postop swelling or by a remnant of the stone.  More annoying than painful, and associated with markedly increased frequency, I decided to have it removed before a 3 week overseas trip. Been okay in the 9 months since then. I did okay

9. Yoga: Let's Get Specifical

I want a yoga routine that emphasizes poses helpful for kyphosis and osteo in general while excluding poses that might be harmful (forward bends, impact, twisting).  More than just a list of poses, yoga practice needs a sequence that allows one pose to flow into the next, critical for maintaining a meditative mindset.  Bryn Kest's original power yoga series, for example, has great sequencing, but yoga guru Rodney Lee appears oblivious to this concept.

The study cited in post # 7 promised "detailed" description of poses and sequence, but when I emailed the lead author, her reply just noted, "the future report never came to be.  Sorry that I am unable to provide more detail about the poses."

I suspect that's a common issue with research.  A "preliminary" study gathers interest ("breaking news") but really needs more patients, longer follow-up, and/or refined methodology, all which require more intense work (i.e., time and money) than available.  Initial interest wanes, researchers move on, but achieves an almost mythical status, the preliminary status left by the wayside.

That happened with a study of 12 (yes, just a dozen) adults comparing weight management with and without a nutritional breakfast.  The preliminary finding suggested that skipping breakfast was a bad idea, and has been incorporated into the conventional wisdom of modern nutrition.  All without follow-up confirmation.  For some people, sure, but not a panacea.

Same thing with yoga and kyphosis: Does it really help in the long-term for a wide range of osteoporosis patients?  Don't know and perhaps never will.

8. Power Yoga

So what about yoga and reversal of kyphosis?

Could be simple as the cobra pose, or any backward bend, opening up compressed vertebrae, giving space for remodeling, a few minutes to reduce forward pressure, promoting growth of osteoclasts, and an influx of calcium and other matrix material.  

Really? 10-20 minutes a day of a handful of specific poses will do this? 

Or maybe it's the stretching, loosening of ligaments.

Or yoga breathing: a deep, slow, rhythm that restores.... 

7. Yoga and Osteo

Bones cycle between breakdown (aka resorption) and repair (ossification).  Ossification can follow both internal resorption and external fractures.  So what about spinal wedge fractures that lead to kyphosis: can natural bone "remodeling" heal these fractures, reversing kyphosis along the way?

A recent study divided one hundred eighteen women and men aged 60 and older with kyphosis into two groups. The experimental group attended hour-long yoga classes 3 days per week for six months.  The control group attended a monthly seminar and received mailings.  The active treatment group demonstrated a 5% improvement over the control group based on measurements of the kyphotic angle.

What is it about yoga (or any other exercise) that would promote natural healing and the reversal of kyphosis?  When, if ever, is it too late to embark on an exercise regime designed for osteodudes ? (.

6. Kyphosis, aka, Dowager's Hump

Vertebrae are well supported posteriorly (the "facet" wings), but not so much anteriorly (the vertebra body).  Plus the anterior is subjected to more stress when bent over (heavy lifting), or impact stress (riding horseback). Continuous stress can cause multiple small fractures in the vertebral body, leading to compression and forward bend.

This is not bad posture--a problem of past or current weakness or discipline-- not tight ligaments that just need loosening, and not subluxation fixable by chiropractic manipulation, but an irreversible spinal curve.  Really irreversible? Completely?  Well, maybe not, as my next post will suggest.