Thursday 25th June 1992   Morning surgery 09:19

“We’ve seen Griff Evan’s for you, Dr Lewis. He is in terrible pain. It sounds like renal colic.”
“It’s awful,” added Dilys. “The worst ever! It starts here,” she continued and grasped her right loin just below the ribs, her fingers reaching towards her spine. “It comes around the front and goes down towards the groin.” Dilys glanced at Dr Lewis and whispered. “Sometimes it shoots right to the tip of his penis.”
Dylan winced.
“He can’t keep still. He’s been pacing around the room.  He tried sitting down and then lying flat but he had to get up again. He said that he was rolling around on the floor at home. He’s even made me feel agitated.” Dilys shuddered.
“They do say that renal colic is one of the most severe pains there is.” Dr Lewis looked very concerned.
“He doesn’t drink enough water, Dr Lewis, even in this hot weather. That’s probably why it’s happened.”
“Proper hydration is extremely important, Dilys.”
“He has felt nauseous with the pain,” said Dylan. “He’s not been sick, so far.”
“How long does the pain last?” Dr Lewis asked.
“Griff says that it builds up over about 2 hours and is really bad for 3 or 4 hours. When it subsides, there’s a slight ache that doesn’t go away completely.”
“Has he been hot or shivery?”
“No and it’s not been stinging when he passes water either and he hasn’t been going all that frequently.”
“Has he passed blood?”
“No but there were a few specks of blood when Harriet checked his urine: microscopically, I mean. He was really worried about that.”
“It is quite common to have traces of blood in the urine with kidney stones, Dilys. I think they say it occurs in about 80% of patients.”
“Yes, I told him it often happens but he was still worried.”
“Do you think we need to organise any tests?”
“I would send off a mid-stream urine test for infection and get some bloods.” “ We should do an x-ray. Is an intravenous pyelogram the best?”
“We normally get a plain x-ray of the tummy and then an intravenous pyelogram.” Dr Lewis said encouragingly. “Right, Dylan, are we going to give him some painkillers?”
“Don’t you normally use a pethidine injection, Dr Lewis? It’s very strong.”
“Good. He is going to need something very strong for this pain. What is the most important side effect of pethidine?”
“It might make him sick?”
“Yes . . . anything else? Can he drive home?”
“No, it will make him sleepy.”
“That’s correct. Is there someone with him?”
“Yes, his Dad brought him.”
“We will give him an injection then his Dad can take him home to bed. It takes about half an hour for the pethidine to work. He needs to drink as much water as he can for the next few days. Hopefully, he will pass a tiny kidney stone. They are often the size of a grain of sand. I often suggest patients pass their urine through a sieve.”
Dilys wrinkled her nose up. She had been planning to make some fairy cakes at the weekend.
“Kidney stones can be quite large though, can’t they, Dylan asked.
“Yes, they can. The biggest type of stone is called a staghorn calculus. These adopt the appearance of a staghorn because of the shape of the collecting ducts inside the kidney. However, most stones are round and can be up to half an inch or an inch in diameter. Bigger stones might need to be removed surgically.”
“Does he need to go into hospital?” Dilys asked.
“We’ll wait and see. If the pain is not improving in the next 12 hours,” Dr Lewis said, “or it’s getting worse, he might need to.”

Griff looked apprehensively at us as we explained the situation. He obviously didn’t like the idea of a large kidney stone. We did our best to give him reassuring smiles.

It sounds like renal colic.