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Thread: Questions about Dr. Young's post on recurrent urinary tract infections

  1. #1

    Questions about Dr. Young's post on recurrent urinary tract infections

    After reading through many posts in the Care forum and trying a few things to stop my current never ending UTI's since my Mitrofanoff surgery, I came across a post written by Dr. Young. I was specifically interested in two things. One is adding the extra protein to my diet, and the other is attempting to achieve more acidic urine in my bladder.

    How much protein is recommended to increase the effectiveness of your immune system? I weigh around 110 lbs if that helps determine the amount.

    How low of a ph is recommended to keep urine acidic? Is there a point at which the urine is too acidic to be healthy/effective?

    What is the easiest way to measure the pH at home? Is litmus paper the best and most cost effective way? We checked with the pharmacists here to see if they had any recommendations and they could not seem to grasp what we were trying to test.

    Thank you so much for your help. I am really hoping we can figure out a way to get my bladder healthy again as I am getting very worn out, and these ideas are my next step after trying Vetericyn.

    I almost forgot to mention that I am also trying to see an infectious disease specialist, but I want to try these ideas in the meantime. Thank you, Melissa


    From this original thread
    http://sci.rutgers.edu/forum/showthr...onized+bladder


    Quote Originally Posted by Wise Young View Post
    Curt, I just advised a person who has recurrent urinary tract infections and hope what I said would be helpful.

    Recurrent urinary tract infections that recur soon after you stop taking antibiotics result from many causes:
    • Overuse of antibiotics, resulting in resistant bacteria.
    • Renal or bladder calculi (stones) in which the bacteria can hide.
    • Immune compromise and susceptibility to urinary tract infections.
    • Absence of non-pathogenic flora (bacteria).
    • Insufficient fluid intake/output.
    • High pH (basic) urine.


    Let me discuss each of these in turn.

    Overuse of Antibiotics
    The most common cause of antibiotic resistant bacteria is overuse of antibiotics leading the antibiotic resistance. It is a self-perpetuating situation that usually begins with the person taking antibiotics as soon as they think they have an infection or doctors who break all recommended conventions and give prophylactic antibiotics to people. Bacteria in your guts, skin, nose, and mouth become resistant to antibiotics that you take because the antibiotic will select out bacteria that are resistant (due to killing of the sensitive bacteria). Resistant bacteria are often in hospitals (where lots of antibiotics are being used). For example, methicillin-resistant staphylococcus aureus (MRSA) is a skin bacterium that has become resistant to methicillin, a penicillin-type of antibiotic. Staphylococcus is usually a skin and nose bacteria and people can become carriers of MRSA, spreading it into the community.

    So, how do you stop overuse of antibiotics?
    1. Save the use of antibiotics only for the times when you have a true infection. Until the early 1990's, doctors use to give antibiotics to treat any sign of urinary tract infections , i.e. if the urine becomes cloudy or smelly, even when the patient does not have any evidence of systemic infections, i.e. fever and elevated white blood cell count. In 1990, doctors who specialize in spinal cord injury got together and agreed not to give antibiotics for urinary tract infections unless there is evidence of a systemic infection. Before that practice became prevalent, urinary tract infection was the leading cause of death of people with spinal cord injury, despite sterile catheterization and every effort to stop infection. In the less than a decade, in the United States, death from urinary tract infection has become so rare so that it is not even in the top ten causes of death of people with spinal cord injury today.
    2. Take the full course of antibiotics if you start the antibiotics. If you take the antibiotic for only a few days (by the way, there are some that last a long time in your body and you may only have to take it once), the antibiotic may kill off some of the bacteria and leave the resistant ones. Not completing the course of antibiotics is a common reason why one get resistant bugs. For example, a person keeps some Cipro around from a previous urinary tract infection. At the first time of irritation, spasticity, or smelly urine, the person takes the antibiotic. The symptoms go away after a day or two and then the person stops the antibiotic. Please, this is a very effective way to create antibiotic resistant bacteria.
    3. Try to get a "clean catch" urine sample for culture before you start antibiotics when you have fever and other systemic symptoms of urinary tract infection. You can start the antibiotics and then, when the antibiotic sensitivity of the infecting organisms has been determined and is different from the antibiotic that you are taking, switch to the appropriate antibiotic.


    Renal or Bladder Stones
    Bacteria can hide from antibiotics, particularly in kidney or bladder stones. Most stones can have some calcium in them and therefore can be visualized with an x-ray (or CT scan). If there is a stone, it may explain recurrent infections. It is possible to remove the stone or hasten its removal.

    Immune incompetence
    Immune incompetence may encourage urinary tract infections. A lot of people with spinal cord injury have low immunity to infections. This may be from low proteins and general poor health. Of course repeated infections may reduce the immune system. If so, eating more protein is good.

    Absence of "good" flora
    A lot of bacteria do not invade into the mucosa (the lining of the bladder). Only certain bacteria can do so. Contrary to what most people think, the mucosa of the bladder is not usually sterile. There are some "good" bacteria that live on the surfaces of the mucosa. Because they do not invade into the mucosa, they don't cause infections. However, they compete for surface and may prevent disease-causing bacteria colonizing the mucosa.

    Inadequate urine output
    Urine dilutes bacteria. So, the more urine you make, the more it washes the bladder mucosal surface and prevents urinary tract infections. Most people should drink 4 liters a day of fluids when they have urinary tract infections.

    Basic urine pH
    Bacteria don't grow well in acid environments. Also, many antibiotics work better in acid environment. Finally, certain bacteria actually change the pH of the urine to more basic (opposite of acid) pH. So, it is useful to eat food that contain acids, such as ascorbic acid. Cranberry juice and even red wine contain tannic acid which inhibits bacteria growth. There is a chemical called mandelamine which changes into a chemical that is toxic to bacteria in urine. By the way, people don't always produce acid urine when they take ascorbic acid or cranberry juice. You can cut through all the guesswork by measuring the pH of your urine and find out what and how much ascorbic acid or juices actually makes your urine more acid (pH<7.4).

    There are many other tricks that I am sure that people have used but, in my experience, the above help reduce recurrent urinary tract infections in animals and in people as well, in my experience.

    Wise.
    Life is a lesson you learn when you're through.

  2. #2
    I just went to see a local urologist who told me that it is ok to take nitrofurantoin as a prophylactic/antiseptic. Being that it is an antibiotic, I am skeptical.
    T6 complete (or so I think), SCI since September 21, 2003

  3. #3
    [QUOTE=paramoto;1505429]I just went to see a local urologist who told me that it is ok to take nitrofurantoin as a prophylactic/antiseptic. Being that it is an antibiotic, I am skeptical.[/QUOTE

    Many "old school" urologists seem to recommend this practice and swear by its effectiveness. But, it is absolutely contrary to current best practice care for people with recurrent urinary tract infections because of the possibilities of developing multiply drug resistant organisms.

    Nitrofurantoin (Macrobid/Macrodantin) is really only effective against e. coli and staph aureus. It is not a side effect free drug Nitrofurantoin has been implicated in liver problems, aplastic anemia, pulmonary conditions, EK changes, and has effects on several blood tests.

    Melliska, since it seems you have already tried Vetericyn, I would be interested to know how you used it and why you don't seem to be satisfied with it. Maybe we can help you tweak your usage to get better results.
    Last edited by gjnl; 03-19-2012 at 02:46 PM.

  4. #4
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  5. #5

    Nitrofurantoin

    I am using Nitrofurantoin
    Hope I dont have liver problems, aplastic anemia, pulmonary conditions.
    Sounds Scary

  6. #6
    Rarely is long term use of Macrodantin warrented in someone with SCI. Although technically a urinary antiseptic, it works much like an antibiotic. If taken on a long term basis, it can have side effects such as aplastic anemia and pulmonary fibrosis. In addition, you are just likely to develop a superbug strain of colonization that is resistant to Macrodantin as well as other antibiotics, and end up worse off.

    Colonization is NORMAL in most people with SCI, and should not be treated, nor can it usually be successfully prevented by the use of drugs. Acidification of the urine is an old and outdated method to attempt to do this. We now know that some bacteria actually prefer acid urine. Some stones actually develop better in acid urine as well. Your body can make urine as acid as 4.5 pH, which generally takes a lot of vitamin C and an acid ash diet (which is not very pleasant to eat) to achieve. Studies have shown that those who go to all the effort to achieve this do not actually have fewer symptomatic UTIs than those who do not, so we don't push this like we did 30 years ago. Litmus paper is generally used for measuring urine pH, for what it is worth.

    You need to eat enough protein for your skin to keep your pre-albumin lab levels above 25, and your albumin should be at least 3.5. Proper nutrition, of not just protein, but also normal blood sugar levels, vitamins and minerals is necessary to maintain a healthy immune system and also to maintain protein stores for healing and red blood cells to carry oxygen to your tissues.

    I assume you have had tests for urinary stones? You are sure you are emptying your bladder completely when you cath? How much do you drink daily, and of what types of fluids? How much do you cath for, and how often? What are your most recent urodynamics results for your PdetMax?

    (KLD)

  7. #7
    I started using the Vetericyn while I was finishing taking my prescribed Ampicillin. I cleaned the outside of my urethra and Mitrofanoff stoma, I rinsed the inside of my urethra and the inside of the Mitrofanoff conduit, I used Vetericyn gel on the catheters, and I instilled between 30 and 60 cc in my bladder once a day. Within 5 days of the last Ampicillin, my symptomatic UTI was back with a vengeance and my symptoms were stronger than they had ever been. It could be a coincidence that it happened to be worse, but it has also made me scared to try the Vetericyn again. I know it has worked really well for some people, but maybe my body just doesn’t react in the same way. If I can’t figure something else out I might try again though


    Quote Originally Posted by gjnl View Post
    Many "old school" urologists seem to recommend this practice and swear by its effectiveness. But, it is absolutely contrary to current best practice care for people with recurrent urinary tract infections because of the possibilities of developing multiply drug resistant organisms.

    Nitrofurantoin (Macrobid/Macrodantin) is really only effective against e. coli and staph aureus. It is not a side effect free drug Nitrofurantoin has been implicated in liver problems, aplastic anemia, pulmonary conditions, EK changes, and has effects on several blood tests.

    Melliska, since it seems you have already tried Vetericyn, I would be interested to know how you used it and why you don't seem to be satisfied with it. Maybe we can help you tweak your usage to get better results.
    Life is a lesson you learn when you're through.

  8. #8
    Ok, so I guess the acidic pH isn’t something important to try since I am definitely trying to decrease my symptomatic UTI’s. That is too bad, because I would eat all the ash in the world if it would work. I make sure to only treat symptomatic UTI’s, but I have been getting one within a week or so of stopping the previous UTI’s antibiotic and the last 7 have all been the same bacteria.

    I think I will ask my doctor if they’ve checked all my immune system blood levels lately. Hopefully I’m in the healthy range for everything.

    Yes, they tested me for stones. I am not draining my bladder using the Mitrofanoff stoma currently so I am using the natural urethra like I always have. I never had a problem draining completely before, but now I’m wondering if the surgery could’ve changed the way my bladder drains. (I didn’t think it would greatly change my bladder because I didn’t have an augmentation, but maybe there is a chance.) I drink about 60oz a day. I cath between 5 - 6 times a day, but the volumes vary each time even though I drink my fluid around the same times each day. I had my urodynamics study done before my surgery and they said that my bladder and kidneys were healthy. I can ask specifically about the PdetMax if that could help. I wonder if I should be asking about having a new urodynamics study done now.

    The two urologists that I talked to gave me some suggestions that I would rather not try. The first wanted me to take 3 days worth of Ampicillin every time I felt like I was coming down with a UTI and the second wanted me to only cath 4 times a day. I am pretty sure that neither is a good idea in my situation.

    I have been looking for an infectious disease doctor, but I’m not sure if that is the best type of doctor for this problem. I am really hoping to get some ideas because this has been going on since last October.

    Thanks so much for your help, KLD! Melissa


    Quote Originally Posted by SCI-Nurse View Post
    Colonization is NORMAL in most people with SCI, and should not be treated, nor can it usually be successfully prevented by the use of drugs. Acidification of the urine is an old and outdated method to attempt to do this. We now know that some bacteria actually prefer acid urine. Some stones actually develop better in acid urine as well. Your body can make urine as acid as 4.5 pH, which generally takes a lot of vitamin C and an acid ash diet (which is not very pleasant to eat) to achieve. Studies have shown that those who go to all the effort to achieve this do not actually have fewer symptomatic UTIs than those who do not, so we don't push this like we did 30 years ago. Litmus paper is generally used for measuring urine pH, for what it is worth.

    You need to eat enough protein for your skin to keep your pre-albumin lab levels above 25, and your albumin should be at least 3.5. Proper nutrition, of not just protein, but also normal blood sugar levels, vitamins and minerals is necessary to maintain a healthy immune system and also to maintain protein stores for healing and red blood cells to carry oxygen to your tissues.

    I assume you have had tests for urinary stones? You are sure you are emptying your bladder completely when you cath? How much do you drink daily, and of what types of fluids? How much do you cath for, and how often? What are your most recent urodynamics results for your PdetMax?

    (KLD)
    Life is a lesson you learn when you're through.

  9. #9
    Two questions:

    (1) Something about white blood cell count important in diagnosing UTI. Does this imply one should always get a blood test when one suspects UTI? I only get the C&S thing.

    (2) Recommendation is to drink 4L/day when has UTI. If one wants cathing to be at 500cc, does this mean one might cat every 3 hours or so? [I had a strange situation once where I increased fluid intake and had a 1700cc output only 5 hours from last cath.]

    By the way in reality is a urologist really going to appreciate a patient coming to them and saying the way they are prescribing antibiotics is wrong? How would this conversation go, exactly: "Hi, I read on the internet your UTI antibiotic protocol is incorrect, here is how to do it." I am not certain that some people recognize the gulf in care one might get at an SCI rehab center specializing in SCI, and the typical doctor who maybe sees a few SCI patients in a lifetime.

  10. #10
    Quote Originally Posted by melliska View Post
    Ok, so I guess the acidic pH isn’t something important to try since I am definitely trying to decrease my symptomatic UTI’s. That is too bad, because I would eat all the ash in the world if it would work. I make sure to only treat symptomatic UTI’s, but I have been getting one within a week or so of stopping the previous UTI’s antibiotic and the last 7 have all been the same bacteria.

    I think I will ask my doctor if they’ve checked all my immune system blood levels lately. Hopefully I’m in the healthy range for everything.

    Yes, they tested me for stones. I am not draining my bladder using the Mitrofanoff stoma currently so I am using the natural urethra like I always have. I never had a problem draining completely before, but now I’m wondering if the surgery could’ve changed the way my bladder drains. (I didn’t think it would greatly change my bladder because I didn’t have an augmentation, but maybe there is a chance.) I drink about 60oz a day. I cath between 5 - 6 times a day, but the volumes vary each time even though I drink my fluid around the same times each day. I had my urodynamics study done before my surgery and they said that my bladder and kidneys were healthy. I can ask specifically about the PdetMax if that could help. I wonder if I should be asking about having a new urodynamics study done now.

    The two urologists that I talked to gave me some suggestions that I would rather not try. The first wanted me to take 3 days worth of Ampicillin every time I felt like I was coming down with a UTI and the second wanted me to only cath 4 times a day. I am pretty sure that neither is a good idea in my situation.

    I have been looking for an infectious disease doctor, but I’m not sure if that is the best type of doctor for this problem. I am really hoping to get some ideas because this has been going on since last October.

    Thanks so much for your help, KLD! Melissa
    Yes, Melissa, the infectious disease doctor is a great idea at this stage of the game. I experienced a period of recurrent urinary tract infections while I was managing my bladder with intermittent catheterization. The infectious disease physician made a great difference. You may indeed need to take a round or two of intravenous antibiotics.

    Just a note about Vetericyn use. I recall reading here about a few folks who use 60cc of Vetericyn two times a day when they have an active infection and/or when they are taking a 10-14 day course of antibiotics for an infection.

    All the best,
    GJ

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