Question
Hello:

I am a 38 year old male.  I am also a recovering addict.  I became addicted to pain medications in 1991 after having three surgeries on my right knee and then having two disks removed from my lumbar spine.  In 1994 I started Methadone for my addiction and have been "clean" from any illicit drug use since.  The first year I had a kidney stone was in 1997.  I have had between 1 to 2 kidney stones per year ever since.  My Urologist and I have tried everything from diet to medications etc but they just keep coming and that includes drinking a gallon of water daily in order to keep my urine as diluted as possible.  Here is my problem.  I have a kidney stone in my left kindney as I type this e-mail to you.  It is approx 3.5mm in size and depending on any number of factors, it could move into my ureter today or a month from today.  On Christmas morning my Parents surprised my sisters and I with tickets to go on a cruise leaving Saturday Jan 5th.  My biggest fear is that I am in the middle of the ocean and the stone drops into my ureter thus causing insurmountable pain.  What do I do?  Being on Methadone makes me an automatic "target" for any doctor I go to. Most think I am a "drug seeker" even though I am up front with them about my past drug history.  Over the past 10 years I have passed 14 kidney stones.  Each time I went to the E.R. and explained my story to the nurse and E.R. doctor and as soon as the MRI confirmed the presence of a stone, they had no problem giving me a narcotic such as Morphine for the pain. Most doctors realize that I need more than a normal kidney stone patient because the morphine has to "go over" the methadone that is already in my system in order to give me any type of pain relief. I have spoken to my urologist about this concern and he is only willing to prescribe me vicodin for my vacation. He might as well give me a handful of M&M's if he is only willing to prescribe vicodin.  I have done much research over the past ten years in regard to methadone and pain management and I have also witnessed that over the past ten or so physicians have become a little more flexible in writing narcotic prescriptions.  Could you give me any advice on what I could possibly say to my urologist in order to get a stronger medication? Maybe I should make an appointment with a pain management specialist before we leave a week from tomorrow? But then again, I don't want my urologist thinking I went "over his head" or am "seeking" drugs by going to a different doctor.  I even offered to return all the pills to him when we get back on Jan 11th. There is a 50% chance that the stone won't move.  But there is also a 50% chance that it will. I am in a huge bind here and don't know where to turn. Any advice will be appreciated.  Giving the nature of the e-mail, if you don't feel comfortable answering me, I understand.

Thank You,

Paul DePietro

Answer
Hi Paul and thanks for writing,

I am surprised your Urologist isn't more help for you knowing what you've been through. I know the cruise ships have doctors and full medical supplies onboard so my advice is to get a letter from your family doctor or Urologist simply summarizing your history; both no doubt already have a similar patient history letter on your file and could easily copy it for you. Then if you do experience any kidney stone issues onboard the cruise physician can see what's going on with the ships' ultrasound, review your history and provide adequate medications.

I hope this helps and I wish you all the best for your cruise.

Happy New Year,
Margot