Kidney stones and the Camino

[Tom Conklin]

I can't remember seeing this before so here goes. After my 2017 Camino Portuguese my wife came over from Canada and we travelled in Spain for a while. At a roundabout in Cordoba I was forced to pull over in my rental car and dry heave due to some very serious pain. This was not my first experience with kidney stones so I knew what was coming. Luckily we managed to complete our trip with no serious incident (and a lot of water) but six hours after landing home in Ottawa I was in emergency. In the ER shortly after landing they filled me up with three litres of saline so I was clearly very dehydrated. I also discovered that I actually had two stones making their way through very narrow passages. One passed quite quickly but the other took much medication and three procedures to vacate the premises. But I digress.

On all of my Caminos, one before and two after the Portuguese, I have not felt the urge to drink except on very hot days. I made sure to irrigate on my Via in 2017 and had no issues. After my most recent trip through northern Spain I made sure to stay hydrated through the first hot days on the Norte but I kind of lost my rhythm in the last couple of cooler and rainy weeks of the Primitivo. On the bus from Santiago to Madrid I felt the early stirrings of stones and passed out when we stopped in Lugo but the searing pain passed and I continue on to Madrid. I visited the ER in Madrid, was given some meds and have had no real stirrings since. Having said that, I have had an ultrasound and consultation since and I have been gifted once again with a stone in each kidney.

My point here is not to share my unfortunate medical history but to wonder if anyone else has dealt with dehydration and stones. I know everyone says the Camino provides and all, but this I was not expecting.

 

[davejsy]

Well I haven't been blessed with kidney stones yet, so can't comment on that. Sounds nasty though and I'm glad you managed to complete your trips despite this.

On a very slightly related note though I can say I had to pee way less on the Camino, I guess because with the constant walking, you burn a lot of it off. I also think that I get very tight round the midrift at home with maybe stress and sitting, which probably adds to the requirement to attempt to break the Guinness book of records for the amount of wee's in one day record. The Camino sorted all this out - while I was there, but it soon returned once home.

 

[Jarrad]

Chronic producer of renal calculii here! Sorry to hear about your experience. Way more info here than you probably want, but this is an issue near to my kidneys, uh, I mean heart.

It's important to note that there are several different kinds of stones and a variety of risk factors. Dehydration is a major risk factor, especially if dehydration occurs repeatedly, but not the only factor and those vary by stone type. The best thing you can do is get medical advice before heading out on a long trek in a foreign country. I have tons of advice, but remember that I'm just some random dude on the internet.

Taking care of existing stones in advance of a Camino (I'm personally going through that process right now) and then avoiding those risk factors before and while on the Camino is the way to go. A urologist is great for dealing with the stones after they are produced, but if you too are a regular producer (sounds like you are), then I recommend you see a nephrologist who can give more exacting advice on preventative measures.

It may not be a bad idea to get a medical alert bracelet or similar in case you find yourself incapacitated. If you take doctor-prescribed medication or supplements, bring enough with you for the whole Camino. Having pain medication in the original prescription container is also worth considering and carry them where they are easily accessible (i.e., not buried inside a dry bag at the bottom of your pack).

Side note on the dehydration: Lack of adequate fluid intake is certainly a significant factor for most types of stones. Most people should be drinking enough to produce at least 2 liters of urine a day and you should consult a doctor for recommendations on intake (and output) under conditions you expect on a Camino (obviously, consider the season, water availability, diet, etc.).

I personally tend not to carry a lot of water with me (two 0.5 liter bottles), BUT I obsessively plan my watering stops all along the Way to ensure I have good intake. I make a point of draining those bottles at every water stop (~5 miles, sometimes less) and drinking more if I can. That works out to 2.5 to 3 liters per day, not including the occasional soft drink, so despite much communication on the forum about taking electrolytes, that has not been a problem in my experience (note that I do not walk in the heat of the summer and YMMV).

 

[Tincatinker]

@Tom Conklin you’re not drinking enough water when you’re walking and you know you’re not. It’s habituated self-destruction and you badly need to break that habit. Waiting to drink until you feel thirsty is like planning for a car crash. Drink at least a litre before you leave your lodgings in the morning and carry at least another between water points. If you get to a water point with water in your bottle drink it before you refill. Don’t do that which I’ve seen so many do: arrive, empty carried water down the drain, refill water bottles and walk on without drinking a drop.

Break your current bad habit. Set an alarm on your phone and drink every time it buzzes. Try retaining and measuring your urine output for a while at home. Two litres is good, 2.5 possibly better, 3 excessive. Learn to drink water.

I’ve never suffered stones but I have suffered an expedition medic considering my “output” bottle and giving me a severe bollocking and two litres of water to drink before he’d let me leave the tent.

Buena suerte

 

[ElCee]

Maybe slightly related? I’m following the Global Solo Challenge which is an around the world nonstop solo sailing race. Two of the 15 (I think?) competitors have passed kidney stones during the race. Ugh, can you imagine?! Anyway I’m guessing these sailors could be prone to dehydration too but also wondering if physical stress could be a factor? Maybe lack of sleep?

 

[Tom Conklin]

Thanks for all of this. As you say, I am a regular stone production factory and I have had numerous visits with my doctors. I've also had mine blown up. It is more of a travel insurance issue now because stones are "pre-existing condition" personified. The medic alert bracelet is a good idea too because I did wake up on the sidewalk in Lugo (after tumbling down the stairs at the front of the bus, I think), luckily surrounded by wonderful, caring Spanish women and a bus driver getting ready to call an ambulance. I carry Naproxen and Floxmax (Tamsulosin) with me and so far have been able to deal with smaller stones (less than 5mm) relatively painlessly. I have had many, many stones so I know when things are getting serious.

 

[Tom Conklin]

Thanks for the tips, many of which I have used in the past. My problem is following my own guidelines.

 

[Tom Conklin]

Maybe slightly related? I’m following the Global Solo Challenge which is an around the world nonstop solo sailing race. Two of the 15 (I think?) competitors have passed kidney stones during the race. Ugh, can you imagine?! Anyway I’m guessing these sailors could be prone to dehydration too but also wondering if physical stress could be a factor? Maybe lack of sleep?

Interesting thoughts and what I am wondering about as well. The physical exertion suggestion is one that has not crossed my mind outside of the dehydration issue. I am also wondering whether the sliced meats and other Camino staples might also be contributory.

 

[Tincatinker]

Maybe slightly related? I’m following the Global Solo Challenge which is an around the world nonstop solo sailing race. Two of the 15 (I think?) competitors have passed kidney stones during the race. Ugh, can you imagine?! Anyway I’m guessing these sailors could be prone to dehydration too but also wondering if physical stress could be a factor? Maybe lack of sleep?

Maybe, there’s not a lot of drinkable water in the oceans. In a couple of Sahel trips we were limited to 3 litres per day for all purposes. Our Bedu guides could do it with apparent ease, we struggled.

An aside, but with some possible relevance. After 11 days trekking, strictly rationed water and unusual humidity which meant we sweated more than expected, we arrived at one of the very few sweet water sources. You don’t gulp, very bad to gulp, but you do drink readily and steadily. After a few hours I noticed one of the team wasn’t drinking, or at least not drinking much. Challenged their response was “there’s nowhere private to pee, I’ll have to wait till dark”. Piloting a racing yacht solo doesn’t offer many peeing opportunities either.

Regular readers of these columns will know that I can complete a Camino on one daily shot of Orujo but the rest of you are advised to drink water

 

[dbier]

Maybe, there’s not a lot of drinkable water in the oceans....

Regular readers of these columns will know that I can complete a Camino on one daily shot of Orujo but the rest of you are advised to drink water

Yes, please leave Orujo to the professionals.

Tom, you've pretty much identified both the problem and, for you, what contributes to it. I'm sure that , either on these boards or not, you have lots of company...but that may or may not be relevant.

You * haven't* mentioned whether you've told your doctors about your pilgrimage habits and experiences. If you haven't...please start there. I'd bet my paycheck that some of them wonder what you *haven't* told them.

Dehydration and electrolyte depletion cause or contribute to alot of generally bad things..and those things change and worsen as we age.

 

[trecile]

I'm not a proponent of (over)filling my bladder before I start walking - we aren't camels! But one reason that I like carrying and using a hydration bladder is because I can constantly sip as I walk, keeping my fluid intake up. I go by the urine color test.

 

[exrayray]

I can't remember seeing this before so here goes. After my 2017 Camino Portuguese my wife came over from Canada and we travelled in Spain for a while. At a roundabout in Cordoba I was forced to pull over in my rental car and dry heave due to some very serious pain. This was not my first experience with kidney stones so I knew what was coming. Luckily we managed to complete our trip with no serious incident (and a lot of water) but six hours after landing home in Ottawa I was in emergency. In the ER shortly after landing they filled me up with three litres of saline so I was clearly very dehydrated. I also discovered that I actually had two stones making their way through very narrow passages. One passed quite quickly but the other took much medication and three procedures to vacate the premises. But I digress.

On all of my Caminos, one before and two after the Portuguese, I have not felt the urge to drink except on very hot days. I made sure to irrigate on my Via in 2017 and had no issues. After my most recent trip through northern Spain I made sure to stay hydrated through the first hot days on the Norte but I kind of lost my rhythm in the last couple of cooler and rainy weeks of the Primitivo. On the bus from Santiago to Madrid I felt the early stirrings of stones and passed out when we stopped in Lugo but the searing pain passed and I continue on to Madrid. I visited the ER in Madrid, was given some meds and have had no real stirrings since. Having said that, I have had an ultrasound and consultation since and I have been gifted once again with a stone in each kidney.

My point here is not to share my unfortunate medical history but to wonder if anyone else has dealt with dehydration and stones. I know everyone says the Camino provides and all, but this I was not expecting.

I had a stone once, after geting dehydrated in southern France. Drink plenty. If your urine is anything other than a pale yellow you are not drinking enough, Did your consult include blood tests for the (rare) abnormalities that might make you prone to stone formation?

 

[Tom Conklin]

I had a stone once, after geting dehydrated in southern France. Drink plenty. If your urine is anything other than a pale yellow you are not drinking enough, Did your consult include blood tests for the (rare) abnormalities that might make you prone to stone formation?

I had my first stone over 30 years ago and I've had two or three serious incidents since so I am well aware of tests and treatments! The big change in that time is medication. As I said earlier Naproxen (a strong anti-inflammatory) and Flomax (Tamsulosin - a muscle relaxant treatment primarily for prostrate issues) work very well for dealing with the smaller stones and day to day particulates. Needless to say I am also aware of nutritional concerns and water intake as well as pee colour indicators etc.

What I am interested in is anecdotal evidence from others on the Camino who may have had the same issues, particularly post-Camino. Interestingly, in four rather extended walks I have never had stone incidents. In fact, I find that walking cures the many ailments that afflict me (back spasms, multiple meniscus tears and other arthritis related ailments). It is a great testament to the power of walking if nothing else. And to some it might be one of those Camino miracles we like to attribute to challenging hiking in beautiful places with like-minded human beings.

 

[Wicked]

I, too, had an incident while walking the Camino Frances a few years ago. I do not like water. Never have and I do believe it had a lot to do with the attack I had in the middle of the night. The EM's who spoke only Spanish told me it was a gall bladder attack. Medicine was given to me, and I continued to walk for another 4 or 5 days until I realized I need to go home before I have another attack. At home, I was referred to a Urologist and determined I had two large stones that would not pass. Surgery followed and conversations around my drinking habits was a big part of them. I try each day to drink a 28 oz. of water daily. I know it is not enough, but it is 28 oz that I never drank before. I have not had any more stone attacks and I do have a yearly checkup with my Dr.

 

[Tom Conklin]

I, too, had an incident while walking the Camino Frances a few years ago. I do not like water. Never have and I do believe it had a lot to do with the attack I had in the middle of the night. The EM's who spoke only Spanish told me it was a gall bladder attack. Medicine was given to me, and I continued to walk for another 4 or 5 days until I realized I need to go home before I have another attack. At home, I was referred to a Urologist and determined I had two large stones that would not pass. Surgery followed and conversations around my drinking habits was a big part of them. I try each day to drink a 28 oz. of water daily. I know it is not enough, but it is 28 oz that I never drank before. I have not had any more stone attacks and I do have a yearly checkup with my Dr.

Thanks so much for that. Sounds a lot like my history though my solutions were explosive rather than surgical. Not sonic explosive but actually camera and laser penetration. Luckily anesthesia meant that I attended in body only.

 

[Jermann75]

had a kidney stone on the camino. It was awful. I had just finished biking the Meseta and I guess I didn't drink enough water prior to that. In Leon I felt the familiar pain of a kidney stone (I had my first kidney stone when I was 8 months pregnant - feel sorry for me). I was on the top bunk and quickly got down.

A danish woman took me to the hospital, what an experience. They gave me some meds and we went back to the albergue. They told me to hang tight for a couple of days in Leon and then I could leave.

After 3 days and switching albergues because of bed bugs, I woke up and started throwing up due to the pain. I went back to the hospital and it's was a terrible experience before they finally checked me in (needed me to fill in a form while I was in agony) they hooked me up to morphine. relief.

Then they spent 2 days assessing my insurance to blast the stone. 2 days wondering what was going to happen to me. Was I going to finish the camino, was I going to have to fly back to Canada or to Switzerland where my family was staying. When they finally figured out that the insurance was good, they got me up on the table and couldn't find it. They then xrayed me with ink and they still couldn't find it so they assumed I had passed it and discharged me.

I went back to the albergue and washed all of my clothing due to the bed bugs and put my backpack on the balcony in a garbage bag and told the owner. After I came back, my backpack had been thrown in the garbage - unretrievable.

At this point I was wondering if the camino was telling me to not keep going. If really felt like there were some lessons here, and I'm not sure what the hell the camino was providing. (I know now but that's for another time)

I started walking and things didn't feel great. Fast forward 5 weeks, I finished the camino, went to switzerland, then Turkey, things still weren't getting better. I got a CT scan back in Switzerland and they told me I still had the stone. Insurance said they already treated the emergency in Spain and they discharged me so I was going to have to fly back to Canada to have it taken care of.

5 weeks, and I finally passed the stone in Switzerland. Happiest day of my life (save for the birth of my children and my wedding day). I have never felt that relief before.

Thanks for asking!!

 

[Tom Conklin]

Thanks so much for sharing your story. If nothing else, it lets me know that mine isn't the worst incident!

My big issue is the insurance coverage as well.

had a kidney stone on the camino. It was awful. I had just finished biking the Meseta and I guess I didn't drink enough water prior to that. In Leon I felt the familiar pain of a kidney stone (I had my first kidney stone when I was 8 months pregnant - feel sorry for me). I was on the top bunk and quickly got down.

A danish woman took me to the hospital, what an experience. They gave me some meds and we went back to the albergue. They told me to hang tight for a couple of days in Leon and then I could leave.

After 3 days and switching albergues because of bed bugs, I woke up and started throwing up due to the pain. I went back to the hospital and it's was a terrible experience before they finally checked me in (needed me to fill in a form while I was in agony) they hooked me up to morphine. relief.

Then they spent 2 days assessing my insurance to blast the stone. 2 days wondering what was going to happen to me. Was I going to finish the camino, was I going to have to fly back to Canada or to Switzerland where my family was staying. When they finally figured out that the insurance was good, they got me up on the table and couldn't find it. They then xrayed me with ink and they still couldn't find it so they assumed I had passed it and discharged me.

I went back to the albergue and washed all of my clothing due to the bed bugs and put my backpack on the balcony in a garbage bag and told the owner. After I came back, my backpack had been thrown in the garbage - unretrievable.

At this point I was wondering if the camino was telling me to not keep going. If really felt like there were some lessons here, and I'm not sure what the hell the camino was providing. (I know now but that's for another time)

I started walking and things didn't feel great. Fast forward 5 weeks, I finished the camino, went to switzerland, then Turkey, things still weren't getting better. I got a CT scan back in Switzerland and they told me I still had the stone. Insurance said they already treated the emergency in Spain and they discharged me so I was going to have to fly back to Canada to have it taken care of.

5 weeks, and I finally passed the stone in Switzerland. Happiest day of my life (save for the birth of my children and my wedding day). I have never felt that relief before.

Thanks for asking!!