When in doubt, ask the experts.....

[Ruth P]

After 2 weeks of fever, chills, aches & pains, inability to exercise, emotional meltdown, weakness and severe finger cramping (i know, weird) I submitted a urine sample.
Psuedamonas, sensitive to cipro.

(Before you all get on at me about vetericyn VF, I know it already and believe the reason I have this UTI is because I got sloppy about doing daily installations (staff issues). Once I finish the course of antibiotics and change the catheter, I'll get back on the VVF - big slap on the wrist received).

I digress. The issue I need help with is this:

My doctor was very reluctant to prescibe the antibiotics because although I was symptomatic, she said without 'sepsis', antibiotics were not necessary. As I said above, the full C & S revealed pseudamonas sensitive to cipro.

Is it just me, or is she crazy? How ill do I need to be? Does anyone have any information that can help me to understand her perspective? I assumed that feeling like a bear has sh** in my head AND a pure growth was sufficient to warrent treatment.

I started the cipro yesterday and already feel much better. I wanted 10 days but she said she was reluctant to give me the 7 days as she didn't feel the pseudamonas was even responsible for my symptoms.

Should I push for 10 days?

TIA

[Liz321]

Did she give a reason for your symptoms?

[Ruth P]

Great question......one which I repeated to her. She was unable to answer. She said that my symptoms were 'vague'. I repeated them saying that they were actually quite specific. She said they could be due to anything. I replied that with a positive C & S they were blindingly obviously linked to the pseudamonas. Her reply: sepsis required to treat infection.

I'm going round in circles with her, have already changed doctors and have such a poor relationship with her . She seems to be reluctant to accept that I have more knowledge about SCI/UTI issues . My empowerment seems to have pissed her off.

What to do? Does anyone agree that full on sepsis is required to treat a UTI?

[metronycguy]

i am not sure if i understand this. Your urologist is telling you in spite of you being symptomatic and a positive culture with c/s for cipro, you need to be sepsis to get treatment. i dont know what sepsis is, septic i know a little about, and it is real bad and life threatening.
Weird with my current UTI klebsiella pneumoniae my hands at time were killing me and i also had this extreme craving for sugar, i must have had it for awhile, i finished the antibiotics last night and i lost the sugar desire as soon as i started treatment . I was eating a big tub if pudding, as often as i could pass by a store that sold it and was always buying candy bars. Things i never do , unless meds cause the cravings. i didn't catch on that pissing myself was a uti symptom. The urine had a sweet smell not the e-coli smell form feet away.
i just looked sepsis up, it is what i thought septic was. a blood infection that can cause failure of organs. One of me neighbors had it, luckily someoen found her in her open apartment door. She is lucky she lived, she was in a nursing home for a couple months , when i first saw her after release, with the walker, i didn't recognize her, she looked 20 plus years older and this was getting released from the nursing home. I think about 7 or 8 months in the hospitals and nursing home. skin flaps, wound vacs , organ failure. She fell and cracked a rib and didn't realize it

[gac3rd]

If I understand what I am reading about sepis, you will need a lot more than antibiotics if it goes that far.

Does the doctor propose any alternative treatment?

Do you have the option of getting a new doctor or asking for a second opinion?

[zillazangel]

Sepsis is treated in the friggin' ICU and I had a quad friend DIE of a UTI-related episode of sepsis from pseuedomonas specifically .... I can't quite figure out how she expects you to wait until death's door before treating you. The biggest danger is from the infection crawling up to your kidneys. Hopefully KLD can post some definitive information on when to treat, as this doc's philosophy is not only wrong but dangerous!

[Ruth P]

Thanks guys. My dr's warped arguement seems to be that pseudomonas symptoms would be severe, ie, sepsis. She argues that my symptoms are a result of being colonised with the bacteria and therefore do not require antibiotics. She doesn't take my symptoms seriously.

gac3rd - This is the second surgery/practice I've been registered with - the last one was even worse! This is also the second Dr I've been assigned to. I made a formal complaint against the first when after I reported UTI symptoms she suggested that 'getting out more' might make me feel better. A pure growth was later confirmed through C & S and only when I literally pissed blood for her did she prescribe antibiotics. Weeks of ill health could have been avoided.

Taking antibiotics is the last resort for me and I don't take them lightly. But sometimes, there is no other option. My Dr has yet to suggest an alternative and I'm worried that only taking 7 days won't kill it.

Metronycguy - weird about the hand/finger pain and cramps. I wonder if its common?

I think i'll try and speak with the urologist at the spinal unit to see what his opinion is.

I know dealing with ill-informed medical professionals is a common problem with folks here. Their ignorance/arrogance never fails to astound me!

[Ruth P]

Thanks Zilla - just saw your post. Looking forward to hearing what the nurse can add. Sorry to hear about your friend. I've heard of mortality related pseudomonas/sepsis hence my concern.

[Sue Pendleton]

Ask your doctor how other first world countries treat this infection or how your doctor would treat it if the NHS was not involved?

[gjnl]

According to an article published by The National Center for Biotechnology Information, "if you have sepsis, you will be admitted to a hospital, usually the intensive care unit (ICU). Antibiotics are given through a vein (intravenously).

Oxygen, fluids given through a vein, and medications that increase blood pressure may be needed. Dialysis may be necessary if there is kidney failure. A breathing machine (mechanical ventilation) is necessary if there is lung failure.

For some patients, treatment with powerful anti-inflammatory medications called corticosteroids or recombinant human activated protein C may be helpful."

This article includes a definition of Sepsis, symptoms of Sepsis, and testing for Sepsis: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001687/

It unconscionable for this physician to refuse to treat a uninary tract infection until it gets to the point that you have to admitted to the hospital.

Typical urinary tract infection (UTI) symptoms in the able bodied population are:
A strong, persistent urge to urinate
A burning sensation when urinating
Passing frequent, small amounts of urine
Urine that appears cloudy
Urine that appears bright pink or cola colored — a sign of blood in the urine
Strong-smelling urine
Pelvic pain, in women
Rectal pain, in men
Fever
Soreness may occur in the lower abdomen, back, or sides (also known as flank pain)
Malaise

In someone with a spinal cord injury (SCI), many of these symptoms can not be experienced as described above. Because of lack of sensation, it is possible that symptoms cause autonomic responses that may manifest themselves in many other ways in your body. For instance, when I have had (Culture and Sensitivity confirmed urinary tract infections), I have hardly ever had a fever, but I experience almost uncontrollable shivering, sweating above my level of injury, post nasal drip, high blood pressure, along with the typical infection appearance/odor of the urine.

For me, these symptoms continue about 4 hours after I have taken an antibiotic. I would be at deaths door if I had to wait for a Culture and Sensitivity. It is for this reason, that I have always had an arrangement with my urologists (5 urologists in 29 years). I have a supply of 100mg Macrobid on hand, urine specimen cups, and a standing order at my local medical laboratory for a Urinalysis (UA) and a Culture and Sensitivity (C & S). When I have the symptoms I have mentioned, my wife takes a urine sample to the lab (on weekends and after hours to the hospital lab) and I take one Macrobid. I continue Macrobid twice a day until the C & S comes in. My doctor will then call in a prescription to the pharmacy for the medication that has been determined to be the best to treat the bacteria. If I didn't take the macrobid, I would be in full blown autonomic crisis.

This arrangement has worked very well. It does take a frank discussion with the urologist so he/she understands the problem. Your physician has to trust your judgement, but isn't that what a doctor/patient relationship should be???

PS to "Ruth P"
You can start instilling Vetericyn about half way through the course of antibiotics.

All the best,
GJ