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Thread: Is this a UTI problem?

  1. #1
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    Question Is this a UTI problem?

    Hi, known about CC for a while, but first post... I am having a possible problem w/ a UTI, and was wondering if it is one, and how to deal with it, or if there is something else going on... I've read a lot of the posts on UTI's and haven't found anything that addressed my symptoms thus far - pointers to relevant threads welcome...

    Number one symptom for the past few weeks, and getting worse lately, is that I've been spending WAY more time in bed than normal for me, and feeling very sleepy a lot of the time I'm not in bed... If nothing is making me get up, I will spend 12-16 hours / day in bed.

    I do intermittent cathing, and have usually cloudy urine, with almost white sediment coming out during the last bit of a session. In addition, when prepping, I usually am able to squeeze out 1-3 drops of a yellow / white pussy looking fluid, which is thick and slippery, but does not have a noticeable odor. I often detect a bit of moisture in the area, and have some staining on my underwear that makes me think I may drip a bit regularly... The drips have been an issue pretty much all the time since my injury in 3/2010.

    I'm finding that I need to cath more often than usual, but get lower volumes each time (I have some feeling, and tend to cath based on perceived pressure as opposed to a time clock - and will fairly often let myself get quite uncomfortable to make it fit my schedule otherwise. This usually leads to me cathing less often and getting larger volumes than the medical folks really like, so the increased frequency isn't ALL bad...)

    I had a severe UTI a couple of months ago that put me in the hospital for a few days of IV abx followed by 30 days of the same thing orally. Not sure what the bug was, but peed clear while on the abx, the cloudiness started up again shortly after I came off, so I'm wondering if it's the same thing that didn't get K'O'ed and is now staging a comeback...

    Other relevant details -

    I use "Cure" closed system kits (which IMHO are the best kits of all the ones I've trialed by far) which come with a pack of three Povidone swabs that I use before hand, on the entire glans, and attempting to get as much into the tip as possible. The catheter is pre-lubed (I believe w/ K-Y or equivalent), touchless, and has an "insertion tip" that is supposed to get the catheter tip past the worst of the bacteria at the tip. The kit also has a BZK wipe that I have never really gotten a clear use instruction on, so I use it afterwards to clean off the extra iodine and excess lube, etc...

    I drink a half gallon bottle of Langers "ZSA" cranberry juice cocktail (25% juice, sweetened w/ Splenda & ACE-K, not sugar) every 2-3 days. One glass is mixed with a scoop of "Green Vibrance" - a mix of 25 probiotics and "greens" In addition I drink several large glasses of water daily. I occasionally do coffee and/or tea, but not regularly - when I do it tends to be large amounts. I also drink alcohol once or twice a month in moderate amounts, primarily home-brewed meads, and a bit of single malt... Very seldom do I drink other sorts of beverages.

    I also do a lot of heavy supplements including multivitamins, calcium, D3, saw palmetto, and about 5,000mg of Vit. C (Omitting most of the long list...)

    Other meds are fairly minimal, as I've been trying to get off as much as possible. I now do Prilosec OTC (2x day for reflux) Lopressor (for aorta repair) and several laxatives and stool softeners. I also started using 60mg Cymbalta / day about 3 weeks ago at the suggestion of the local pain clinic to see if it helps some fairly mild neuropathic pain (Gapapentin and Lyrica didn't help, and I've dropped them)

    I had one abx resistant e-coli UTI while I was in rehab, and another mild one a few months after I got out, but had been "clean" for over a year before the one that put me in the hospital mentioned above.

    Sorry to be so long winded, but I was trying to include the details I saw being asked about in other posts (and I may try doing some of the things suggested like going to cranberry pills, and possibly that VF stuff...)

    Suggestions welcomed...

    Thanks,
    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  2. #2
    When I had the whitish fluid you mentioned I was always diagnosed with a prostrate infection, if you feel a lot of pressure in your groin, it could be from that. The frequent urge to cath and less volume is a sign of a uti, along with your fatigue. Myself I am prone to uti's, would have them constantly without Vetericyn. I have much fewer now but I can't get lax, I didn't do a flush for 3 days this month and got a kidney infection.

  3. #3
    I would also like to know when you last had screening for stones or other abnormalities such as prostate enlargement or prostatitis, abscesses, or anything else that could be harboring bacteria.

    How much do you cath for, and how often?

    Have you seen a good neurologic urologist?

    (KLD)

  4. #4
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    Quote Originally Posted by SCI-Nurse View Post
    I would also like to know when you last had screening for stones or other abnormalities such as prostate enlargement or prostatitis, abscesses, or anything else that could be harboring bacteria.
    The UTI that put me in the hospital also involved a "reactive hydrocele (sp?) that caused my left testicle to become painful and tennis ball sized. After the hospital stay and during the abx that they had me on, I shrank down to almost normal sized - they want to wait until I've been off the abx for a while to see what happens and see if further treatment is needed. They did quite a few ultrasounds and other tests related to that, and I have had a lot of other tests, including a couple of urodynamics since I was injured.

    I'm not sure if they have done any explicit screenings for stones, but there has been no mentions of anything abnormal, other than my last PSA being higher than they liked - which they said could have been from the UTI, and are waiting a while before doing a repeat to see if it comes back down. They have done prostate exams during my last physicals, and said they didn't detect any swellings.

    At any rate, they haven't said that they've found anything problematic.

    How much do you cath for, and how often?
    Before this latest problem, I was not always as "good" as I should have been. I have fairly good feeling below my injury, and basically cath when I feel pressure, though I often waited until I got quite uncomfortable. I would go 3-4x day, and typically get 6-900ml, though I have hit as much as 1200ml on occasion (I try to avoid getting that high)

    Now I'm finding that I get pressure feelings sooner, with the entire sensation scale shifting down, so that I'm feeling the need to cath 5-6x day, getting 4-600ml each, with the high discomfort point only being around 8-900...

    It is hard to define, but it seems like I also don't feel like I'm draining quite as completely (but effort does not produce more) and I feel like I have more discomfort when removing the cath, and for a while after each time.

    Given what I'm told by the urologists I've seen (and what has been mentioned here) about the recommended timing / volumes, this new pattern isn't all bad, but the change seems noteworthy.

    Is there some kind of UTI where there is growth in the bladder that reduces it's volume?

    Have you seen a good neurologic urologist?
    (KLD)
    Not sure about her neuro experience, but I am getting 99% of my health care at the Lahey Clinic / Hospital in Burlington, MA (everything but my physiatrist, which they don't have) The urologist I was seeing had some serious SCI experience, but he has left to take a dept head position at a hospital in another state. The doctor I'm seeing since has seemed quite competent. (Aside from the "unfortunate outcome" of the emergency aorta repair surgery that put me in the chair, I have been VERY impressed by the quality of care I've gotten from Lahey, and as a hospital they let me get all my care in one system which is convenient and avoids most of the records exchange hassles that HIPAA causes)

    ---------

    For what it's worth, I called my PCP's support people this afternoon, and they suggested I come in to the evening "walk-in" clinic tonight and give a sample. I did so, and they have put me on a seven day course of Cipro, 250mg, 2x / day.

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  5. #5
    If you had epididymitis, then you should have been on the longer course of antibiotics. People with SCI should also nearly always have true UTIs (fever, chills, elevated white blood count, malaise, AD, etc.) treated as a complex UTI, which requires oral antibiotics (based always on culture and sensitivity or C&S results) for 10-14 days, not the 5-7 days used for the simple UTIs that ABs have.

    Cathing should always be done 5-6X daily with volumes never allowed to go over 450 cc. at any time. This is a "normal" volume for someone with a neurogenic bladder. Higher volumes and less frequent cathing are associated with higher rates of UTI, as well as with reflux and long term kidney problems (as well as conditions such as epididymitis).

    A higher PSA can also be associated with prostatitis (which cannot be detected by a manual exam of the prostate alone).

    When did you last have urodynamics? You should have this tests every 1-2 years. You should be screened annually for stones (usually by full urinary tract ultrasound or CT or KUB).

    (KLD)

  6. #6
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    Quote Originally Posted by SCI-Nurse View Post
    If you had epididymitis, then you should have been on the longer course of antibiotics. People with SCI should also nearly always have true UTIs (fever, chills, elevated white blood count, malaise, AD, etc.) treated as a complex UTI, which requires oral antibiotics (based always on culture and sensitivity or C&S results) for 10-14 days, not the 5-7 days used for the simple UTIs that ABs have.
    The last UTI, besides the three days in hospital on IV, they had me on 30 days of the oral version of the same abx, I think it was toxopherol or something like that - can't find my notes with the exact name at any rate, a red pill, 2x / day.

    This time, I think the Dr. wanted to get me going on something, so he started me with the 7 day Cipro script, which does have a single refill allowed on it, so I can go 14 days w/o problems - he said that they would be doing a culture on the sample I left them, and presumably they may change the abx depending on what shows...

    Cathing should always be done 5-6X daily with volumes never allowed to go over 450 cc. at any time. This is a "normal" volume for someone with a neurogenic bladder. Higher volumes and less frequent cathing are associated with higher rates of UTI, as well as with reflux and long term kidney problems (as well as conditions such as epididymitis).
    I definitely tend to go higher than that - when not having an issue I don't seem to even start feeling 'pressured' until around 600cc or so. Even now, I'm running in the 500cc range. When I was in rehab (Spaulding, Boston), they were saying 4x-day and that I didn't want to be much UNDER 300cc... I am trying to do more often, but sometimes it's a challenge to figure the timing.

    A higher PSA can also be associated with prostatitis (which cannot be detected by a manual exam of the prostate alone).

    When did you last have urodynamics? You should have this tests every 1-2 years. You should be screened annually for stones (usually by full urinary tract ultrasound or CT or KUB).
    (KLD)
    The last time was probably about six or seven months ago, and they said I had no problems at that time - I've had it done twice since I was injured in March 2010. I am scheduled for an ultrasound on the testicle problem around the end of December, with followup early January, I will try to mention it then, unless it should be seen as more urgent...

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  7. #7
    Senior Member danielgr's Avatar
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    I take a multivitamin & a vitamin B complex once a day and I have reduced my UTIs from 2-3 times ever couple of months to 2-3 times a year. This works for me, but might not work for you. Good luck!!

  8. #8
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    Well I have finished the first week of Cipro, and it hasn't seemed to have much effect... I called the Dr's office today, and asked if they had gotten results on the C&S back yet. They said that they had, and it was a Cipro-Resistant E.Coli, so they are switching me to Bactrim, (sulfamethoxazole / trimethoprim) 2 x day. Hopefully that will work better.

    I'm also planning to order some Veterycin VF and will start that shortly as well...

    ex-Gooserider
    Last edited by ex-Gooserider; 11-29-2011 at 01:07 AM. Reason: Got the drug wrong -fixed...
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

  9. #9
    Good thing you called them
    CWO

  10. #10
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    Red face

    Haven't done any tests, but judging by clarity, I seem to be responding well to the Bactrim. I went from cloudy, and lots of extra crud at the end of a cath, to nice and clear, with no visible crud...

    My original scrip was only for 7 days, but in light of the comments I've seen about SCI UTI's being more difficult, I asked for some additional and they have given me 5 more days worth. Mildly annoying because it means two co-pays, if I'd gotten it all in one scrip, it would have just been one. The amounts aren't big though so not a huge deal...

    Still trying to figure out optimal choices for catheters and syringes to use with Veterycin, but should have that soon... As an initial trial, I'm trying 4 bottles of VVF, and syringes in 12 & 60cc sizes...

    On catheters - it looks like I can get one-use catheters for irrigation, any reason to prefer hydrophilic or silicone intermittents from the standpoint of using M/V, either for the bladder irrigation or the urethral irrigation w/ a small length of catheter?

    ex-Gooserider
    T-5 ASIA-B para, currently working on building own power chair, as being in a manual is an EXTRA handicap.

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