> It will also give astronauts the go ahead they need from NASA to travel to Mars.
Wait, what? Everything else was worked out, but NASA just went "hold on, we can't go to Mars just yet until we figure out what to do if an astronaut gets kidney stones on the way"?
Did the writer just throw this in to make the procedure seem more hip and exciting?
> Because space travel makes astronauts prone to kidney stones due, in part to bone demineralization from weightlessness, they are at increased risk. The NASA evidence base and publications note that astronauts have had more than 30 instances of kidney stones within two years of space travel. Medical assistance is a formidable challenge for those orbiting this planet or heading to other solar system destinations.
We really should be working on artificial gravity via spinning. It solves so many issues.
I know smaller craft can’t do this but we can always do a long tether with a counterweight.
(My personal pet idea is to go for super low gravity like .05G to start out to simplify things. You still get to walk around, go to the bathroom, spill liquids and clean up, cook, etc. )
This podcast covers a lot of the status on international studies for artificial gravity.
"Now we did try to fly a centrifuge on station around 2009 or 2010. And again, it was the same international community and we put together an international proposal to do it on station. And it turns out after a lot of hemming and hawing and the U.S. was going to provide the crew and the integration, the Japanese were going to fly it and the Europeans were going to pay for the device and have it built, and flight certified. It turns out that the station really isn’t designed for that much vibration. So instead of just having a person laying there, we were going to have a person with a cycle ergometer that would spin and do the ergometer. And that much vibration was bad for the station and it was decided that you would have to have a very expensive vibration isolation system that the Europeans weren’t willing to pay for to be able to do it. So, we kind of lost the possibility of doing human centrifuge work on station at this time."
So it looks like this is the current issue, and there is a large amount of work going into the physiological side of research to find out exactly what amounts and methods of artificial gravity achieve desired results.
We have years of experience with both short and long-term missions in zero or micro gravity but we know a lot less about how low gravity affects the human body. We can hope that it is beneficial but what we actually need is a way to study it.
And there's a very good chance that what we do know about zero/microgravity will still be beneficial with low gravity too. Definitely a reason to work on this even if we do ultimately wait until we have some kind of low gravity solution too.
I mean if it was only blocking a ureter for ten minutes tops, then sure? Compared to what hydronephrosis feels like, merely voiding one isn't so much of a much, really.
Chronic stone former here, and I can confirm this. That said, I did have a stone large enough to get stuck in the urethra -- not the ureter. The doctor was quite impressed. Unfortunately, I passed it in a public toilet shortly after leaving the doctor, so I wasn't able to capture and measure it.
At any rate, hydronephrosis is the real thing to fear in most cases.
> The NASA evidence base and publications note that astronauts have had more than 30 instances of kidney stones within two years of space travel.
What does this mean? Surely the average astronaut doesn't pass 30 kidney stones every two years, that's more than one a month. So it's either over a specific two year period (for every astronaut in space at the time, probably a lot?) or it's for a specific number of astronauts. Confusing sentence.
I think they mean there have been 30 reported cases of an astronaut getting a kidney stone less than 2 years after their latest space flight.
Given that astronauts are exceptionally physically fit individuals to start with, at least at the time of their space missions, this is probably quite significant evidence that space flight causes kidney stones.
NASA currently considers kidney stones an unacceptable risk for a Mars mission that requires mitigation.[1] There are also about 10 other risks requiring mitigation, though.[1]
NASA saying there is a “research gap” and that it “needs mitigation” is very different from it being an “unacceptable risk” which implies that no mission can happen until it happens. if there was a ship ready to go with a hab and propellant for the return trip sitting on mars, I can guarantee they would take the very next transfer window, kidney stone risk notwithstanding- particularly if the chinese or russians were about to do so and might get there first!
According to the method by which NASA measures risk, it is indeed an "unacceptable risk". The red 4x4 "LxC" box stands for "likelihood x consequence". So they consider it a high likelihood and a severe consequence. It's red because that puts it in the unacceptable category.
If you look at the medical risk matrix it puts the likelihood between 60% - 80% and consequence at "loss time injury or illness per OSHA criteria" On a score of 1 (least risky) to 25 (most risky), a 4x4 scores 22.
Now to your point about "guaranteeing" they would still go, they are allowed to waive these risks through a formal process. It tends to make managers squeamish though, because nobody wants to be the person who's signature is attached to a known risk that eventually causes a mishap.
What’s your definition of rubber stamping? Usually it means approving without any consideration. In both of those cases, there was a lot of deliberation. Their end conclusion may have been wrong, but it’s really quite different than “rubber stamping”
Maybe I'm not looking at the right terms but the appendix isn't on it. Is there a requirement for astronauts to have an appendectomy? Like researches in Antarctica.
Probably because the Soviets famously had only one doctor at one of their stations and he happened to get appendicitis. Had to do his own appendectomy with two assistants to hold a mirror and light, and also what I assume were copious amounts of vodka.
Returning from space in a hurry is a lot quicker than returning from Antarctica over winter. I don't know, but I've never heard of that being in their risk profile or requirements.
"NASA does not mandate astronauts to undergo an appendectomy before embarking on a mission. This decision stems from the understanding that the risks associated with surgery frequently outweigh the potential benefits."
As I understand it, it was not literally the last thing holding back. But NASA worries about everything and we have centuries of examples of remote missions failing because of medical problems that could not be solved in the field. Billions of dollars, tens of years, and a ship full of lives can't be risked on a 3mm pebble if it can possibly be prevented.
I assume they’re including sailing ships dealing with scurvy, and things like that. We haven’t been in space very long, but we’re a species of explorers.
The Franklin Expedition of 1845 comes to mind. There were even theories about new-ish technology (tinned food) accidentally poisoning the crew with lead.
The article has a bit in it "This technology is also making it possible for astronauts to travel to Mars, since astronauts are at a greater risk for developing kidney stones during space travel." And then a hyperlink to more information.
I did read; I saw the additional sentence that, yes, astronauts are at increased risk of kidney stones. I get that.
My surprise comes from the fact that a trip to Mars is already incredibly risky and any astronaut signing up likely is at peace with never coming home. I would think "painful kidney stones" or "non-ideal kidney stone treatment" is far enough down the list of potential concerns for such an astronaut that it wouldn't block NASA from giving "the go ahead they need to travel to Mars", which is what the article says.
Like, I get that NASA funds all sorts of things like this. I just can't quite believe that this is considered a showstopper. Like the famous apocryphal anecdote about needing to develop a zero-gravity pen before the moon mission; I'd have been equally surprised, even knowing that story, to hear that NASA wouldn't have launched the moon mission until they figured the pen out.
Sure, but none of that surprise warrants accusing the writer of anything like you did. It's not an article about the space program. It mentions the relevance to the space program and links to more information about it.
whether or not the astronaut is willing to take the risk, kidney stones can be so painful that someone suffering from them could potentially jeopardize the mission from incapacity or increased risk of making a mistake. Even if the astronaut were personally signed up for a suicide mission, there's a lot of incredibly expensive and difficult science and exploration to be done.
I know the Internet cloak of anonymity makes us feel comfortable saying things we wouldn't feel comfortable saying face-to-face to a colleague, but HN tries to promote civility in our comments, and yours demonstrates a lack of it.
I've broken bones, including a leg, and a kidney stone was the most painful thing I've experienced.
It was so painful it resulted in a blackout as it was moving through my innards and getting to my bladder. Anything to save myself from that non-invasively would be welcome. Thankfully, they have not returned as I think I know what triggers them for me.
In the same boat, and agree that the first one was the worst because of the unknowns and associated pain.
That does not mean the later ones were less painful, but knowing what to expect, recognizing the symptoms early, and getting mentally ready go a long way. A well stocked medical cabinet with potent pain killers is a must, and I don't take long trips without them either.
Unfortunately, not all will pass naturally, depending on size and shape, so I'm looking forward to having this option available when needed.
If you've not had it, I cannot more highly recommend ESWL. In my case, it just felt like some light bruising for a day or two, and otherwise an 8mm stone in my kidney was obliterated with no effects.
Had it a couple times. I usually try to let the stones pass naturally, unless of course they get stuck. Success rate for the targeted stone has been 100%. Recovery has been quick with minimal bruising, first day getting up was a bit painful without painkillers. I do have a bit of concern about the impact of ESWL on the long term health of my kidneys.
If you get one, try to catch it and have it analyzed. I had a calcium oxalate stone. My urologist suggested adding some milk to my coffee (I had been drinking it black). Haven’t had another in 10 years.
most citrus fruits help to reduce kidney stones, but not grapefruit. grapefruit has different weird interaction with medication and does increase risk of kidney stones, contrary to other citrus fruits.
As far as I understand it, the interaction of Grapefruits with for example statins is because it has Furocumarine, but that isn't unique to it. Other citrus fruits have it as well. It's just that Grapefruit isn't as sour and it's consumed in much higher doses compared to say lemon juice.
> Still being run through clinical trials at UW Medicine, the procedure called _ burst wave lithotripsy _ uses an ultrasound wand and soundwaves to break apart the kidney stone
> Ultrasonic propulsion is then used to move the stone fragments out, potentially giving patients relief in 10 minutes or less
One of their demo videos explains how inverting the scattering caused by the occluding body yields the mass-density at least (?). [Radio]Spectroscopy and quantum crystallography may have additional insight for tissue identification with low-cost NIRS sensor data?
I've had conventional lithotripsy a few times, and I now have CKD. I have none of the typical CKD risk factors, and I suspect that the ultrasonic energy caused some damage. Unfortunately there is no way to know.
it could just be the stress that having kidney stones put on your kidneys in addition to the stress the ultrasonic waves impart. but also, probably the worst part of lithotripsy is that they usually use a strong x-ray to see what they are doing live. if they are slow in completing the procedure, you can end up being exposed to quite a lot of radiation.
I just, 2 days ago, starting to experience slight discomfort in the liver/kidney area. The feeling was very similar to how it was with my gallbladder. At least until it was removed.
I am totally a ticking time bomb. So, yes.. please bring on even better treatments.
just FYI, AFAIK, kidney stone pain is sudden and unbearable, when the stone starts moving out of the kidney. Slight discomfort may not be a sign of kidney stone.
Chronic stone former here, requiring surgical intervention a few times a year.
It definitely can be sudden and debilitating but for most of my teenage years I had mistaken the pain for ‘sleeping wrong’. Sometimes when I would bend over and then stand it would feel like someone had stapled my back together at the bend and I had to rip it out. It hurt, but not anything like what I expected. A couple of years later I wound up having a few stones that had grown to larger than an inch.
If you have unusual and unexpected pain it’s definitely worth getting checked out. I didn’t have health insurance at the time and since the pain was intermittent I never suspected anything serious and just chalked it up to sleeping in a poor posture or maybe not getting enough exercise to be limber. It almost killed me!
Pain from 'dem stones moving around in the bladder I think - but I don't really know, since the USG after passing didn't indicate anything.
For a long time any significant g-forces would cause pain in the abdomen, which I unwittingly started ignoring at one point. But the fear of that pain stayed and I couldn't identify where it came from.
When I the plane started its ascent and I felt nothing, I connected the dots - especially that the passing and flying were just a few months apart.
This is "burst wave lithotripsy," compared to the somewhat-similar existing "shock wave lithotripsy." The new iteration apparently works more quickly and causes less pain, so can be performed while the patient is awake rather than requiring general anesthesia, which would make it practical to do it in, say, an ER or regular doctor's office. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10117400/#sec2t... for a comparison of the mechanisms.
> Ureteroscopy is another minimally invasive way to treat stones but often requires a temporary stent, which can be quite uncomfortable.
"The ways we have to currently treat stones have some downsides," he said. "Most involve anesthesia."
In contrast to the shock waves used in ESWL, the BWL procedure uses "short harmonic bursts" of ultrasound energy, potentially enabling the stones to be broken up in a shorter procedure without the need for sedation or anesthesia. Pre-clinical studies supported the effectiveness of BWL in breaking experimental stones of varying size and composition, the study noted.
Having had a Ureteroscopy procedure, I can say it sure as hell doesn’t feel minimally invasive. It (well, post-op until they remove the stint) was almost as unpleasant as the kidney stone.
I agree. the stint was awful and I wasn't able to pass most of the stone fragments until the stint was removed. the strange thing is that my dad had a similarly sized stone about a year after me and had the same procedure. his doctor did not place a stint and he passed all the stone fragments without issue.
Breakthrough? You could buy these machines on Alibaba years ago marketed for this purpose. I assume this means there was a cottage industry of private kidney stone treatment in Asia.
it may be good to know that we aren’t talking about an entirely new process, shock(!) wave lithotripsy has been around for quite some time now. The "game-changer" is the introduction of burst wave lithotripsy, which apparently is less painful and thus possible to go through without general anaesthisia, which, don’t get me wrong, is definitely an improvement. But I’m not sure I’d call it a game changer.
I’m not convinced it’s entirely painless as it’s still the same "crush and drive out via ultrasound" idea. Combine this with the fact that just existing is excruciating with stones, i don’t see a way around opioid analgesia. Additionally, the game hasn’t changed in the regard of the human pelvis being great at keeping out ultrasound, so if your stones are out of reach that way, you’re SOL.
I've had lithotripsy and it certainly wasn't done under general anaesthetic. They just gave me painkillers and the procedure was fine. I was in and out very quickly - something like an hour or so.
Shock or burst wave lithotripsy is not new either, but it is being improved all the time. So I guess that's what this article is about, just another recent improvement.
Had my latest one lasered a few months ago. It all went well, except for the annoying stent that had to be removed a month later. IMHO, the laser approach to removing the stone (by obliterating it) is safer for the kidneys.
I’m used to accepting cookies, but after the download I checked the list of “required cookies”. Insane. I clicked on one privacy policy and was met with the same download and required cookies in order to read it.
I was asked if I wanted to sign up in 2020, and said yes. No word back from the team though :(. I ended up getting the normal EWST, at UW Medicine.
I had a stone kicking around for 2 years that would cause pain off and on. Went to normal primary care, but they had no idea. We thought it was a gastro issue, since it felt like constipation (or so I thought). The problem was I was always fine when I actually went to see the doc. Until I finally went to the ER and they ordered a simple x-ray and found it :/
I have 19 mm left and 14 mm right stones that I generally don't notice and don't have any pain.
ESWL seemed like a scam because there was no redness on back tissue and not a single grain or fragment was passed. I wonder if they set the machine to a high enough power or if they skipped the actual procedure while I was anesthetized.
I'm wondering if BWL would be any better where ESWL fails.
Hope that the ticking bomb in my right kidney (that was found during CT scan when the stone from my left kidney was coming out) can wait for the next year.
In all seriousness the article doesn't have anything about general availability and cost, alas. How soon it can be offered at your typical hospital instead of vicodin and lots of water?
Wait, what? Everything else was worked out, but NASA just went "hold on, we can't go to Mars just yet until we figure out what to do if an astronaut gets kidney stones on the way"?
Did the writer just throw this in to make the procedure seem more hip and exciting?