The stones were yellowish and fell apart easily. They were unable to retrieve any stones for analysis, but they look most like uric acid stones (my autocorrect feature is trying to change it to irate stones). Uric acid stones are not the most common type of stones, but are probably related to the breakdown of the cancer cells. The uric acid itself gets cleared through the urine (you may remember that they flood him with IV fluid to help his kidneys get rid of the dead cell garbage). But uric acid (like several other minerals) is one of the things that likes to get together with other molecules and form crystals. The conditions have to be right, kind of like the unplanned teenage party happening when the parents are out of town, (not my kids mind you). You know how the story goes, child invites friend over when parents are away, they decide to invite someone else, soon others are hearing about a party, soon there is a huge mass of teenagers ruining the house. Maybe it only happens on TV. Crystal formation is just the same. Get the correct environment and a couple molecules precipitate from their dissolved state into a solid state and start collecting more and more molecules. Soon you can see a crystal. When it's formed in the kidney, we call it a kidney stone. The environment that allows the crystal formation is acidic urine. J's urine was acidic. The solution is to raise the pH of his urine (make it less acidic) and suddenly the party is over and the stones dissolve.
The second part of the treatment is to bypass the obstruction. There are a bunch of stones at the end of J's ureter right before where the urine enters the bladder. The urine being made in the kidney is unable to get past it. The stones have basically formed a dam and his ureter and the renal pelvis (where urine collects as it comes out of the kidney) have turned into a reservoir that gets bigger and bigger until the dam is broken apart. Breaking the dam apart when things are inflamed is sometimes a good idea, but sometimes it's better to let things calm down before it's treated. To help things calm down, they can place a stent. They just push a skinny wire around the stones. Once it's through, they can run a stent (think of a tiny straw) over the top of the wire and get one end of the stent in the reservoir and the other end of the stent in the bladder. This allows the pressure to be relieved. I stole a diagram from the internet below.
J is a changed man. Pain and nausea are almost totally gone, just intermittent pain that is expected.
Our task now is to take a pill three times a day (he hates pills) to change the pH of the urine to prevent other stones from forming and to dissolve the ones already there. We also have to run his urine through a filter to try and collect a stone for formal analysis to make sure we know what we are dealing with. Fun stuff. We will also take an antibiotic to help prevent an infection since we have something in his body that doesn't belong and we would prefer to not get infected.
I love when a a medical story makes sense and we realize how all the pieces fit together. As odd as things have been with J and this lymphoma, everything makes perfectly good sense. This issue with the stones has answered some of the questions I have puzzled about. J had pain in the same spot the night that we first discovered the lymphoma, and we have never fully understood why. We couldn't find stones (except maybe one on the first ultrasound that was soon forgotten by everyone and not in a place that causes pain). The mass wasn't pushing on the ureter to make it hurt. He had a little blood in the urine. It seems odd that he would have stones as a kid (it happens, just not very frequently). When we did the first MRI that first night, part of the mass was already necrotic, meaning it was dying and turning to liquid goop. He had already started breaking down tumor cells and was probably releasing uric acid into his blood. He was probably already starting to form little crystals in his urine at that time and that ultimately caused the symptoms that helped us find the cancer. The nice thing, since the stones are related to the tumor, once the lymphoma is totally gone, he shouldn't have problems with kidney stones, at least as a kid.
Now back to home to enjoy the rest of this week at home before chemotherapy starts again next Monday.
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