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Thread: UTI + Neck / Head Pain

  1. #1

    UTI + Neck / Head Pain

    Recently I've had a UTI that just doesnt want to go away. Over the years I've taken many scripts of cipro and doubt it does me any good anymore, but it was prescribed again for me maybe 2 months ago, the UTI came back (per my diag, based on increased spasms and dark urine, and very sediment ridden urine), then I saw a different doctor and they were going to do a uro-dynamics on me, but before hand needed to do a culture. Sure enough the UTI was in fact back, and they decided to give me 5 days worth of shots. I came to my local clinic for 5 mornings and got a shot in both of my legs. And of course, about 3 weeks after that was done, the cloudy urine and increased are back.

    In addition to my usual symptoms though is a new thing. About 3 days ago my neck and lower head started feeling sore and was more or less an annoyance. I took a single 800mg Ibprofen and all was fine for the next 36 hours. Then again last night, I started feeling the same neck/head pain. I woke up this morning and the same intermittent pain is there. it does go away for short moments though.

    Anyway, I've had spinal meningitis before and this is not how it started. I was pretty much incoherent within 12 hours.
    On a side note, I have a reflexive bladder and my doctor recently told me that I retain about 390cc each time I urinate, but he seemed to think that was borderline acceptable. Funny thing is, years ago, he thought my 200cc retention was borderline acceptable. *sigh* freaking doctors. I've been told by a friend that I need to look into altnerate ways of emptying my bladder and I plan on doing that in the future. My doctor did say he could do some kind of procedure that opens up the muscle down there and it would allow more urine to pass. Anyway, sorry for the wordy post. I am about to go take another ibprofen as I cannot go to the ER right now and want to wait until tomorrow when I can see my normal doc.

    Has anyone experienced this before? What was your diaganosis/outcome? Thanks in advance.

  2. #2
    Hi Platypus,

    I used to retain a high volume of 300 cc's. This retainment resulted in my having constant uti's. I started CIC which reduced the residual to almost 0. My urologist tells me now (as well as the SCI nurse) to cath between 350 to 450 cc's and not to fill more than this. With these numbers in mind, I would think that 390 cc's retention is very high and you'll never get rid of uti's and will eventually reflux into your kidneys and possible damage them.

    Good luck.
    Millard
    ''Life's tough... it's even tougher if you're stupid!'' -- John Wayne


  3. #3
    Yeah, i thought that number was high. So I do need to start doing IC's at some point, but when to do them is the question. Maybe once before bed and once in the morning or something. I now need to figure out how to keep a clean routine when i do it as nothing is really "clean" clean right now.

    When do you cath? Or how do you know if you're up to that CC? I am technically up to that CC every time I urinate.. if I have to start cathing multiple times a day, that's going to be a huge bummer. I'd rather get the surgery where I can reflex easier and hopefully my levels will go back down to 200.

  4. #4
    Your profile does not include your level of injury. Is it above mid-thoracic? You may be having autonomic dysreflexia. What is your blood pressure when you have these symptoms?

    I would recommend that you seriously consider no longer using reflex voiding as your bladder management method, and go over to intermittent cath full time, cathing 5-6X daily. You will probably also need to take anticholenergic medications to keep you dry between caths.

    Your residual urine is much too high. This sets you up for infections and stones. You are probably voiding with high pressures (which needs to be determined by having your urodynamics studies done). Long term, this puts your kidneys at risk. Over time, voiding with high pressures can also cause your bladder to decompensate and become less and less efficient and effective at emptying, resulting in the need to change bladder management methods anyway. In addition, this also usually means you must wear an external condom catheter and wear a bag all the time.

    The surgery your urologist is talking about is a sphincterotomy. They cut your external urinary sphincter with either a knife (old method) or laser (more modern method). This MAY reduce your residuals and decrease your voiding pressures, but there is no guarantee. It may not. What it will do is cut your bridges for going to other bladder management methods such as just IC. You will dribble urine all the time, and will have to wear an external condom catheter all the time. If you decide to go to intermittent cath, you would be unlikely to stay dry between caths. Even with an indwelling urethral catheter, you may leak urine, and it is very likely you would leak from the urethra with a suprapubic catheter.

    Please take the time to consider your options. You may want to look at the clinical practice guideline on bladder management which you can find on the Sticky Topic at the top of this forum.

    In addition, you should have tests now for possible stones or prostatitis. Repeated infections with the same bug over and over are often associated with these problems, which are more common in those who do reflex voiding.

    You should also be sure that you are treating only true infections and never colonization, and that the antibiotic used is always selected on the basis of a culture and sensitivity (C&S) test done on catheterizated urine (never on urine voided into a urinal or condom catheter).

    (KLD)

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    Your profile does not include your level of injury. Is it above mid-thoracic? You may be having autonomic dysreflexia. What is your blood pressure when you have these symptoms?

    ....


    (KLD)
    I only have a moment as I'm running out the door, but m profile should show T3. I do know that my BP was high after relexing at a doc appointment. But I do not check it regularly.

    I currently wear a condom cath, and woudl need to change it every time I do a cath as I've tried to do ditrapan XL, etc, etc and have never been able to stay dry. This was 8 years ago of course.

    The ironic thing is my bowels have the same issue right now. My rear muscle gets super tight and does not want to let anything out, thus I have to try harder, and I end up getting some blood at times. I'm waiting to move before I try the magic bullet as I cannot afford an accident at this time. But my body is definitely angry with me for something as both bowel and bladder are acting up these days. I'm a little worries about IC's also because my doctor siad I have a "false passage" in my urethra, whatever that means, but I assume it means a path that leads to no wear.

    Must run, thanks for the time taken in replying!

  6. #6
    Senior Member Leila's Avatar
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    Recurring bladder infections are primarily caused by colonization that escalates into infection. Bladder pressure and retention are also issues that bear on this problem, but it is the microbes that cause the infections, and that should be addressed first of all. This thread deals with the issue and offers one solution that works for many:

    http://sci.rutgers.edu/forum/showthread.php?t=133414

    When my husband was colonized, he had to drink a lot of water to help keep infections at bay, and that meant cathing every two hours in order avoid excessive retention. His bladder was inflamed and he felt pressure constantly. He was spending most of his life in the bathroom.

    Now that we are using the Vetericyn bladder instillations and rinsing of the urethra (plus rigorous external hygiene), he can cath every four hours and his bladder is relaxed and more spacious. Last night he conked out and slept seven hours, not waking up for his usual 3 am cathing. When he cathed at 7 am, we got about 550 cc--it was dark but crystal clear. I then instilled 60 cc Vetericyn for ten mintues, which we do every morning.

    We don't plan on making a habit of missing the 3 am cath, but if it happens, he's in no danger.

  7. #7
    It is likely you are having AD. You need to check your blood pressure when you have the headache symptoms and take appropriate action. You could have dangerous consequences from untreated AD.

    Have you tried other anticholenergic meds? Have you discussed bladder Botox with your physician? When did you last have urodynamics or tests for possible stones?

    A false passage is usually treated by placing an indwelling urethral catheter for 2-3 weeks and then resuming intermittent cath.

    (KLD)

  8. #8
    Thanks for the helpful replies. KLD, by AD you mean autonomic dysreflexia? For as long as I can remember, my stomach will sometimes spasm and I've even gotten hot occationally when I urinate. I cannot feel anything, but I can tell by those things that I'm about to go. I've told this to doctors in the past, but they don't seem to be phased by it.

    I've only had a chance to see my less-than-useful-doctor once during this whole thing and I really need to find a new doctor as this issue does not seem to concern my other doctor very much. Although the headaches are new.

    What is an anticholenergic med? A quick google mentions spasms, and nerve blocking... I do have an indwelling baclofen pump that without, I'm pretty much unable to do anything on my own due to intense spasms. This does not seem to affect my bowel or bladder currently though, maybe i should get it increased. I've only been injured for 10 years though, and I've not changed the dosage much at all. I do also take flomax, .4mg.

    As for the false passage, I'm not sure how long it has been there, but I dont cath at all currently, so i'm not sure where it came from. The last cath in my was the docs for the scope that discovered it.

    All this talk of AD is quite disturbing though because I have had a totally blocked bladder 9 years ago and I got all blotchy and threw up... so maybe whatever has been happening for years has been mini AD or something. Not good at all from what I understand of it. Normal BP is around 70 over 120 or whatever is considered typical.

  9. #9
    Quote Originally Posted by Leila View Post
    Recurring bladder infections are primarily caused by colonization that escalates into infection.

    .....

    We don't plan on making a habit of missing the 3 am cath, but if it happens, he's in no danger.
    I'm in the middle of moving, so I can't really read that whole letter right this second, but I will soon. I'm curious what you guys do for external hygiene care? I read someone had these skin-prep-like wipes that were sterile and that seems like a nice option for situation.

  10. #10
    WHile Leila is correct that you need to address the colonization which turns into infection, I agree with KLD that you need to find out if you are having AD as soon as you can. It can be life threatening. It would be helpful for you to know your baseline bp (when you are not having any headaches) before you take it with the headache. Lastly, you really need to address your bladder management program. As KLD mentioned, the method that you are using can lead to long term problems.
    CKF

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