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Kidney stones seem like an ailment begging for a symbiotic solution, like maybe there's some micro organism (perhaps even Oxalobacter formigenes!) we should be promoting in our guts that could break down oxalates as a preventative measure or even one that we could host within the kidneys themselves to break down a stone and then starve when their job is done. I'd love to see a GMO bacteria built for this purpose too, I bet an aspiring Craig Venter type could make beaucoup bucks off of the demand inelastic kidney stone sufferers out there.

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Awesome Connor -- I love the idea of idea of a GMO bacteria for breaking down stones.

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Jul 15, 2022Liked by Dan Elton

I stumbled across this blog post. I've had the misfortune of suffering through three episodes of kidney stones that wouldn't pass on their own, and I can confirm that the pain is intense. In all three cases, I underwent laser lithotripsy to break up the stones, and the urologist inserted a temporary JJ stent between the kidney and the bladder. The recovery was about as painful as the period before the procedure. Urinating with the stent in place caused a huge spike in pain. It felt like a hot poker being inserted into my abdomen. Eventually, the stent was removed and the pain went away, but the memory lingers. I also want to note that I dealt with three different urologists over the years, and they were all unsympathetic and generally unpleasant. In my last kidney stone episode, the urologist didn't want to prescribe pain meds and said I should go to the emergency room if I wanted opiates. Luckily, the nurse practitioner in my primary care practice took pity on me and prescribed Vicodin, which made a substantial difference. I have about 20 pills left, and I'm guarding them with my life, in case I suffer another episode.

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Hi, I'm just seeing your comment now, 10 months later. I'm so sorry to hear about your suffering with kidney stones. I think in the past opioids were over-prescribed, now from what I see the pendulum has swung in the other directions. The truth is that opiods are a powerful tool for eliminating suffering and helping people recover from intensely painful medical conditions, but they must be used carefully and judiciously.

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May 3, 2022Liked by Dan Elton

I’m a bit skeptical about the premise that avoiding pain is preferable to gaining pleasure. As you point out, the aversion is not consistent over time - people block out and downrate past pains. I would like to see the survey repeated asking about whether someone would prefer the worst pain or greatest pleasure that they have already experienced to have never happened. If one is to count up QALYs, it should weight it equally across someone’s lifetime.

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Hm, it seems to me that survey would probably still show a preference for eliminating pain but I agree it would be interesting to do. I'm not sure I follow how it would "weight it equally across someone's lifetime".

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May 3, 2022·edited May 3, 2022Liked by Dan Elton

Totally agree about the long-tail distribution. I have never had a kidney stone or any other health problem that involves truly godawful pain, though of course I've had various things that hurt quite a lot. But I have always been skeptical about that pain scale where they tell the person that a 10 is "the worst pain you can imagine." Well the worst pain I can imagine is something like having my entire body plunged in boiling water. And compared to that, I am sure that the absolute worst pain I have felt is a 2 on a 0-10 linear scale. (And btw, I just cannot understand people's being ok with dropping live lobsters into boiling water.)

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May 3, 2022·edited May 3, 2022Author

Cool. I don't have a good sense of how many people in EA are convinced that painful experiences fall on into a lognormal distribution rather than something without a long tail. The details of how long the tail is (ie the exponent in the power law) are actually pretty important - if it drops off sharply than the tail events may be too rare to make treating them competitive as an EA cause area. It seems very important to get a better grasp of these things, and I hope to do a deeper dive into the question at some point.

As a side note, I suspect psychological pain also has a long tail. It certainly has the property that you probably can't imagine something like major depression or trauma very well unless you've experienced it.

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May 1, 2022Liked by Dan Elton

Great article.

However.... unsure why imaging screening is really needed.

Once a stone is in the ureter, lemon juice is not going to help. Ouch, ouch, ouch!! Too bad there are not better ways for it to pass (eg, a lubricant drink one could drink) (yes, I know alpha blockers are supposed to help a bit). At this point imaging is not screening but part of treatment management planning.

Ok for the other cases, unless I am off to Mars with SpaceX does a person really need to be screened by imaging for renal stones?

I agree with screening for risk factors and change lifestyle -- lose weight!! stop eating all the sodium including so call low call sodium prepared foods!! citrate is good!! stop eating so much meat!! ... not only will kidney stones go down but so will dementia, heart disease, etc.

Anyway.... majority of kidney stones probably preventable.... however, I enjoyed and support the thesis of the article.

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May 1, 2022·edited May 1, 2022Author

Alpha blockers like flomax kinda suck from what I have heard because they have a lot of side effects. Apparently they are not very selective at targeting the alpha-blocking to the urinary track, it seems.

With screening you can try to start taking things to dissolve the stone while it's in the kidney so that it becomes easier to pass and also start doing easy general preventative things like drinking more water to prevent more stones from forming. The idea is to detect the stone while it is small before symptoms start to manifest.

My understanding is stones generally always form inside the kidneys and then migrate into the renal pelvis and to the ureter and bladder. There might be other scenarios I don't know about, though. I think in some cases stones form in the bladder.

I agree the vast majority of stones are probably preventable with better diet and lifestyle although there are rare stories of people who have been forming stones since their teens. They probably just have really bad genetics.

One thing I forgot to mention is that diet and lifestyle interventions might be recommended on the basis of genetic screening, too. Blood tests can also be used to determine stone risk.

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Thanks for writing this! By the way, you might be interested in this study in which people suffering from cluster headaches were asked to provide pain scores for other conditions they had also had. Cluster headaches were rated by far the most painful condition. Of course, there is a strong possibility of recall bias, and the sample might not have fully captured the range of intensities of kidney stone pain in a population. As kidney stones can be excruciatingly painful to the point of unbearabilitry, I fully agree that this is a highly important cause area.

"Cluster headache is one of the most intensely painful human conditions: Results from the international cluster headache questionnaire." https://doi.org/10.1111/head.14021 (See Figure 1)

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May 8, 2022·edited May 8, 2022Author

Very cool, thank you. I'm going to do some Fermi estimates and this will help. I need to do some digging to find data on kidney stone passing frequency and pain duration though, which I haven't been able to find.

Yeah, we (Andres and I) both recognize that cluster headaches are rated as more painful, but our impression is kidney stones are more frequent. We need to do some better Fermi estimates on this though. As I said, my bias towards kidney stones here is largely because I happen to have been doing some work on automated kidney stone detection and volumetry from CT scans.

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