Urinary Infection and osteopena question

[sherocksandsherolls]

My primary just called. I love her so I am not second guessing her, but she is not a sci doc so...I did my bone density finally after like 10 years of not having one..as I was having pain on my stim bike..and yea, of course..osteopenia -1.8 left hip and -1.9 right hip. she said -2.5 is osteoporosis..so I am close.

So she said I could take Boniva-but I do not want to take this as for side effects. I always get sick on rx meds.

She recommended:

Vit D 5000 units every day until re-tested
Calcuim Citrate 1500 a day

Also have e-coli greater than 100,000 in bladder and she wants me to take a low dose cipro as she is afraid I will colinize and go systemic with the foley I will have to use for my plane trip and longer depending on what I find once I get to Europe: re accessible bathrooms. I ic now as needed.

I just wanted to check with you guys and the Nurse to get your opinions. Is that level infection need treatment if I am not symptomatic given the trip coming up in less than 2 weeks?

Any other recommendations for the bones? Thanks..

[gjnl]

Osteopenia/Osteoporosis
The oral bisphosphonates may cause some people ill effects, but there are options to oral osteopenia and osteoporosis drugs that are either injected or infused and don't have to be absorbed through the digestive tract.

Forteo - Teriparatide (rDNA origin) Injection is administered subcutaneously at home, once a day for two years. "Teriparatide injection contains a synthetic form of natural human hormone called parathyroid hormone (PTH). It works by causing the body to build new bone and by increasing bone strength and density (thickness)."
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000227/

Reclast - Zoledronic acid is administered as a 30 minute venous infusion once a year. "Zoledronic acid is in a class of medications called bisphosphonates. It works by slowing bone breakdown, increasing bone density (thickness), and decreasing the amount of calcium released from the bones into the blood." Even though, Zoledronic acid is a bisphosphonate, it may be taken by people who have esophageal risks and gastric reflux issues because it is not orally administrated.
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000306/

Granted, both of these medications come with their own side effects and warnings (what drugs don't) that need to be considered for risk and benefit.

Unfortunately, most insurance companies and Medicare will not authorize these alternatives unless the patient has demonstrated an inability to tolerate Fosamax, Actonel, Boniva etc.

My doctor has given me the same recommendation on Vitamin D and Calcium. He has stressed the importance of monitoring Vitamin D levels on a regular basis.

E-coli
I would not want to be taking off on a trip to Europe with e-coli counts as high as that, symptoms now or no symptoms now. 100,000 colony-forming units (CFU) per milliliter of urine is generally considered significant bacteriuria. What are your white blood cell and nitrite counts? They can often be used as factors to confirm urinary tract infections without symptoms. We all know that there is an understandable reluctance not to treat an infection without symptoms, but I think going out of the country puts things in a different perspective. E-coli can bloom into a full blown infection very quickly. That said, I don't know whether low dose Cipro is the best alternative now. E-coli is becoming so resistant to so many antibiotics, you can run through the list of most effective drugs pretty quickly. It is a tricky call.

By the way, do antibiotics make you sick like other Rx medications do? For some, antibiotics can cause difficulty with bowel management. If you end up taking a short term prophylactic antibiotic to get you through your trip, taking a probiotic supplement may be helpful.

Many people here have written about taking d-mannose to prevent e-coli infections. It is available over the counter without prescription. You can search the thread for testimonials and information on dosing.

Hope you enjoy your trip

All the best,
GJ

[sherocksandsherolls]

Thank you for coming through to help gjnl! Just to clarify:

I am glad I am good on the suppliments recommended. Are there any brands you recommend?

You said "That said, I don't know whether low dose Cipro is the best alternative now." Does this mean you think I should have a stronger dose? or another option? I do hate antibiotics as I get all the darn side effects and generally feel like hell. I surely don;t need gastric issues now I get sick even on bc pills!

So the low dose is considered "prophylactic" and I think was a compromize as I didn't want to take a full on treatment just before my trip? not sure..but you think this is ok? I do take probiotic daily,.

I will look up the d-massose. If I already have an infection, should I start that now? or wait till I get back..in other words, will it help with current infection?

Good to see there are alternatives to current bone meds..maybe there is hope for future and I won't progress. I need my hips

Originally Posted by gjnl

Osteopenia/Osteoporosis
The oral bisphosphonates may cause some people ill effects, but there are options to oral osteopenia and osteoporosis drugs that are either injected or infused and don't have to be absorbed through the digestive tract.

Forteo - Teriparatide (rDNA origin) Injection is administered subcutaneously at home, once a day for two years. "Teriparatide injection contains a synthetic form of natural human hormone called parathyroid hormone (PTH). It works by causing the body to build new bone and by increasing bone strength and density (thickness)."
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000227/

Reclast - Zoledronic acid is administered as a 30 minute venous infusion once a year. "Zoledronic acid is in a class of medications called bisphosphonates. It works by slowing bone breakdown, increasing bone density (thickness), and decreasing the amount of calcium released from the bones into the blood." Even though, Zoledronic acid is a bisphosphonate, it may be taken by people who have esophageal risks and gastric reflux issues because it is not orally administrated.
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000306/

Granted, both of these medications come with their own side effects and warnings (what drugs don't) that need to be considered for risk and benefit.

Unfortunately, most insurance companies and Medicare will not authorize these alternatives unless the patient has demonstrated an inability to tolerate Fosamax, Actonel, Boniva etc.

My doctor has given me the same recommendation on Vitamin D and Calcium. He has stressed the importance of monitoring Vitamin D levels on a regular basis.

E-coli
I would not want to be taking off on a trip to Europe with e-coli counts as high as that, symptoms now or no symptoms now. 100,000 colony-forming units (CFU) per milliliter of urine is generally considered significant bacteriuria. What are your white blood cell and nitrite counts? They can often be used as factors to confirm urinary tract infections without symptoms. We all know that there is an understandable reluctance not to treat an infection without symptoms, but I think going out of the country puts things in a different perspective. E-coli can bloom into a full blown infection very quickly. That said, I don't know whether low dose Cipro is the best alternative now. E-coli is becoming so resistant to so many antibiotics, you can run through the list of most effective drugs pretty quickly. It is a tricky call.

By the way, do antibiotics make you sick like other Rx medications do? For some, antibiotics can cause difficulty with bowel management. If you end up taking a short term prophylactic antibiotic to get you through your trip, taking a probiotic supplement may be helpful.

Many people here have written about taking d-mannose to prevent e-coli infections. It is available over the counter without prescription. You can search the thread for testimonials and information on dosing.

Hope you enjoy your trip

All the best,
GJ

[gjnl]

Like I said, tricky call.

Did you have a culture and sensitivity of this specimen? What antibiotic was considered the most effective, Cipro, Levaquin, etc?

Personally, I would be very uneasy about leaving for Europe with such a high bacteria count. If something does develop (when you travel you may not be drinking as much, emptying your leg bag in less sanitary conditions than normal, not sleeping as well) it will be difficult to get an order for a UA/C&S, wait for 3-5 days to get results, get someone to prescribe an appropriate antibiotic for an appropriate course, and pay for it in the bargain. If you are moving around and won't be in the same city for more than a couple days, it compounds the problem.

But, you have discussed your plans with your physician and you trust her, so beyond that... I guess in your position, I would call my doctor back and ask if it might be more appropriate to treat this as you would any other UTI, most effective antibiotic for 10 -14 days, and then go on a prophylactic dose of Macrobid while you are away. When I was on an intermittent cath program and traveling, I would quite frequently take prophylactic Macrobid while wearing a foley catheter. I would wear the foley for the full term of my trip (sometimes 3 weeks), because I was in and out of meetings all day, business dinners at night and sometimes on a plane twice in one day. Generally, I was successful and didn't get an infection, but there are no guarantees. I remember a couple times, toward the end of a trip, the bladder would become colonized, characterized by cloudy, foul smelling urine, then I would get a full on UTI once I removed the foley and started cathing again.

I have read that d-mannose creates an environment that won't allow e-coli to adhere to the bladder wall. It can cause loose stools and bloating and in high doses damage the kidneys. The following is an excerpt from an article on the Livestrong website:
"The sugars in D-mannose coat the lining of the urinary tract and bladder as they pass through the body. These sugars not only cover mucus membranes but they surround bacterial cells making it impossible for them to stick to the walls of the bladder or urinary tract. The bacteria remain free floating and are passed out of the body in the urine.
Up to half of all women will have some experience with a urinary tract infection. The main culprit in these infections is Escherichia coli(E.coli). This is the bacteria responsible for about 90% of all UTIs(reference 2). E.coli is a normal bacteria found in the gastrointestinal system but it does not belong in the urinary tract. Overgrowth of E.coli in the urinary system will lead to an infection. D-mannose specifically rids the body of E.coli. The results of a Pub Med study done at NIH indicate that D-mannose can significantly reduce bacteria in the urine within one day of use. If you are suffering from a UTI D-mannose can effectively be used as a natural antibiotic against E.coli."
Reference: http://www.livestrong.com/article/12...its-d-mannose/

All the best,
GJ

[Wise Young]

Originally Posted by sherocksandsherolls

My primary just called. I love her so I am not second guessing her, but she is not a sci doc so...I did my bone density finally after like 10 years of not having one..as I was having pain on my stim bike..and yea, of course..osteopenia -1.8 left hip and -1.9 right hip. she said -2.5 is osteoporosis..so I am close.

So she said I could take Boniva-but I do not want to take this as for side effects. I always get sick on rx meds.

She recommended:

Vit D 5000 units every day until re-tested
Calcuim Citrate 1500 a day

Also have e-coli greater than 100,000 in bladder and she wants me to take a low dose cipro as she is afraid I will colinize and go systemic with the foley I will have to use for my plane trip and longer depending on what I find once I get to Europe: re accessible bathrooms. I ic now as needed.

I just wanted to check with you guys and the Nurse to get your opinions. Is that level infection need treatment if I am not symptomatic given the trip coming up in less than 2 weeks?

Any other recommendations for the bones? Thanks..

When you get surprising results like 100,000 E. coli per ml in your urine and you are a symptomatic, it is probably a good idea to get a repeat test. It may have been due to contamination of the urine at the time of collection and delays in culture of the urine. One the Orr hand, taking some prophylactic Corpo because you will have a foley for your airplane ride is a reasonable idea.

Your bone density seems quite reasonable, considering that you have two risk factors: chronic spinal cord injury and presumably not weight-bearing more than an hour a day. If you are a female in your 40's, you have a third risk factor. No medication has yet been shown to reverse osteopenia in spinal cord injury although the hope is that it may prevent progression. it is probably worth trying once you get back from your trip.

Wise.

[sherocksandsherolls]

Originally Posted by Wise Young

When you get surprising results like 100,000 E. coli per ml in your urine and you are a symptomatic, it is probably a good idea to get a repeat test. It may have been due to contamination of the urine at the time of collection and delays in culture of the urine. One the Orr hand, taking some prophylactic Corpo because you will have a foley for your airplane ride is a reasonable idea.

Your bone density seems quite reasonable, considering that you have two risk factors: chronic spinal cord injury and presumably not weight-bearing more than an hour a day. If you are a female in your 40's, you have a third risk factor. No medication has yet been shown to reverse osteopenia in spinal cord injury although the hope is that it may prevent progression. it is probably worth trying once you get back from your trip.

Wise.

Thank you so much for responding Dr. Wise. This is reassuring that it could be a false result due to my not having symptoms. I mean I do have urge to go often ( I can feel it), but I thought that as just me and I drink bottles of water a day. I really have little to no experience with uti's except during pregnancies where I had 2 episodes each one..and it was full on Kidney with iv antibioitics in maternity ward.

I will look into the bone issue upon my return as you suggested. I really want to prevent further progression as you say. But I do not want to have poor quality of life due to side effects of drugs

and thanks again gjnl..I will ask her if I should have a longer supply of cipro for full trip which is 5 weeks. The bloating and loose stool thing with d-mannose is scary so I will hold off till I return to try lol

[Wise Young]

Originally Posted by sherocksandsherolls

Thank you so much for responding Dr. Wise. This is reassuring that it could be a false result due to my not having symptoms. I mean I do have urge to go often ( I can feel it), but I thought that as just me and I drink bottles of water a day. I really have little to no experience with uti's except during pregnancies where I had 2 episodes each one..and it was full on Kidney with iv antibioitics in maternity ward.

I will look into the bone issue upon my return as you suggested. I really want to prevent further progression as you say. But I do not want to have poor quality of life due to side effects of drugs

and thanks again gjnl..I will ask her if I should have a longer supply of cipro for full trip which is 5 weeks. The bloating and loose stool thing with d-mannose is scary so I will hold off till I return to try lol

I am sorry about all the typographical errors. I answered your question on my iPad and its stupid spelling correction introduced all the errors.

Regarding the bacteriuria, I am only suggesting that you get a repeat culture to make sure that it is not a test error. I assumed that you normally do intermittent catheterization and will be using a foley during the airplane ride. If you have a foley catheter in throughout, it would explain why you do have a high bacterial count in your urine. I don't think that it is a good idea for you to take long term Cipro prophylactically. You will likely create Cipro-resistance bacteria.

Wise.

[sherocksandsherolls]

Originally Posted by Wise Young

I am sorry about all the typographical errors. I answered your question on my iPad and its stupid spelling correction introduced all the errors.

Regarding the bacteriuria, I am only suggesting that you get a repeat culture to make sure that it is not a test error. I assumed that you normally do intermittent catheterization and will be using a foley during the airplane ride. If you have a foley catheter in throughout, it would explain why you do have a high bacterial count in your urine. I don't think that it is a good idea for you to take long term Cipro prophylactically. You will likely create Cipro-resistance bacteria.

Wise.

Nice to see I am not the only one with typos I am the queen of typos..I feel better

I will ask her for a repeat. I do IC and only plan on foley for trip..which I have done on all my previous trips with no issues.

When you say long term Cipro..does that mean 5 weeks is long term? I hope to not have to but I may use foley as needed whole trip if I find accessibility in bathrooms an issue..but I will try that app that shows accessible bathrooms..and see if I can do it while in Paris, Amsterdam and Berlin.

How long do you think I should take the Cipro is I am leaving in 2 weeks?

Thank you again for helping me.

[Patton57]

Hiprex can be used long term (or short term) to keep a high bacteria count in you urinary tract down.

It combines with highly acidic urine and creates formaldehyde in the bladder which is pretty effective in keeping the high counts in check throughout your tract. While formaldehyde is a carcinogen, I believe that the results of most studies are inconclusive about whether it causes cancer or not. You might want to ask your urologist about using it. I am on a perpetual script but sometimes go off it for extended periods. My urine goes cloudy in about two days and when I resume taking it it clears up in about two days.

[Wise Young]

Originally Posted by sherocksandsherolls

Nice to see I am not the only one with typos I am the queen of typos..I feel better

I will ask her for a repeat. I do IC and only plan on foley for trip..which I have done on all my previous trips with no issues.

When you say long term Cipro..does that mean 5 weeks is long term? I hope to not have to but I may use foley as needed whole trip if I find accessibility in bathrooms an issue..but I will try that app that shows accessible bathrooms..and see if I can do it while in Paris, Amsterdam and Berlin.

How long do you think I should take the Cipro is I am leaving in 2 weeks?

Thank you again for helping me.

I see. Here is a clinical trial done in 1992, specifically on this subject but it was only for 1-2 weeks of foley catheterization and not 5 weeks. Note how high the incidence of pyuria is in the untreated group.

Lancet. 1992 Apr 18;339(8799):946-51.
Prophylactic ciprofloxacin for catheter-associated urinary-tract infection.
van der Wall E, Verkooyen RP, Mintjes-de Groot J, Oostinga J, van Dijk A, Hustinx WN, Verbrugh HA.
Source
Department of Medical Microbiology, Diakonessen Hospital, Utrecht, Netherlands.
Abstract
Patients receiving antibiotics during bladder drainage have a lower incidence of urinary-tract infections compared with similar patients not on antibiotics. However, antibiotic prophylaxis in patients with a urinary catheter is opposed because of the fear of inducing resistant bacterial strains. We have done a double-blind, placebo-controlled trial of prophylactic ciprofloxacin in selected groups of surgical patients who had postoperative bladder drainage scheduled to last for 3 to 14 days. Patients were randomly assigned to receive placebo (n = 61), 250 mg ciprofloxacin per day (n = 59), or 500 mg ciprofloxacin twice daily (n = 64) from postoperative day 2 until catheter removal. 75% of placebo patients were bacteriuric at catheter removal compared with 16% of ciprofloxacin-treated patients (relative risk [RR] [95% CI] 4.7 [3.0-7.4]). The prevalence of pyuria among placebo patients increased from 11% to 42% while the catheter was in place; by contrast, the rate of pyuria was 11% or less in patients receiving ciprofloxacin (RR 4.0 [2.1-7.3]). 20% of placebo patients had symptomatic urinary-tract infections, including 3 with septicaemia, compared with 5% of the ciprofloxacin groups (RR 4.0 [1.6-10.2]). Bacteria isolated from urines of placebo patients at catheter removal were mostly species of enterobacteriaceae (37%), staphylococci (26%), and Enterococcus faecalis (20%), whereas species isolated from urines of ciprofloxacin patients were virtually all gram-positive. Ciprofloxacin-resistant mutants of normally sensitive gram-negative bacteria were not observed. Ciprofloxacin prophylaxis is effective and safe in the prevention of catheter-associated urinary tract infection and related morbidity in selected groups of patients requiring 3 to 14 days of bladder drainage.

You may want to consider another approach, such as giving yourself three doses of the broad spectrum trimethroprim-sulfamethoxazole combination antibiotic 3 days before and 3 days after catheter removal.

Ann Surg. 2009 Apr;249(4):573-5.
Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infections: a prospective randomized trial.
Pfefferkorn U, Lea S, Moldenhauer J, Peterli R, von Flüe M, Ackermann C.
Source
Department of Surgery, St. Claraspital, Basel, Switzerland. urs.pfefferkorn@gmail.com
Abstract
OBJECTIVE:
To assess whether antibiotic prophylaxis at urinary catheter removal reduces the rate of urinary tract infections.
SUMMARY OF BACKGROUND DATA:
Urinary tract infections are among the most common nosocomial infections. Antibiotic prophylaxis at urinary catheter removal is used as a measure to prevent them, albeit without supporting evidence.
METHODS:
A prospective randomized study enrolled 239 patients undergoing elective abdominal surgery, who were randomized either for receiving 3 doses of trimethoprim-sulfamethoxazole at urinary catheter removal, or not. Urinary tract infections were diagnosed according to Center of Disease Control definitions. Urinary cultures were obtained before and 3 days after catheter removal. Subjective symptoms were assessed by an independent study-blind urologist.
RESULTS:
Patients who received antibiotic prophylaxis showed significantly fewer urinary tract infections (5/103, 4.9%) than those without prophylaxis (22/102, 21.6%), P < 0.001. The absolute risk reduction for the occurrence of a urinary tract infection was 16.7%; the relative risk reduction was 77.5%, and the number needed to treat was 6. Patients with antibiotic prophylaxis also had less significant bacteriuria 3 days after catheter removal (17/103, 16.5%) than those without (42/102, 41.2%), P < 0.001.
CONCLUSIONS:
Antibiotic prophylaxis with trimethoprim-sulfamethoxazole on urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients undergoing abdominal surgery with perioperative transurethral urinary catheters.

You should talk to your doctor about the approach to take if you decide to keep the foley in for the entire trip.

Wise.