bladder infections

[Mike_Stan]

Is there any way that a person can detect for themselves if they have a bladder infection before running in to see the doctor?

I was getting achey the other night and thought it might be the flu and waited. 24 hours later I was so sick with the chills/fever/incontinent I could hardly navigate.

I don't have decent insurance and can't afford to run into the doctors office everytime I think I might have a bug.

Are labs using a strip of some type to tell if there is an infection or are they looking under a microscope?

[SCI-Nurse]

What is your bladder management method? How often are you having symptomatic UTIs?

While ABs can use special dipsticks to detect a UTI, they are totally worthless for people with a neurogenic bladder. This is because all they do is detect that there are some bacteria in your urine. ABs should have sterile urine all the time. If you have a neurogenic bladder, colonization (bacteria living in the urine) all the time is very common, esp. for those with indwelling catheters, but also for those doing intermittent cath or reflex voiding.

Colonization should not be treated with antibiotics. This only leads to the development of superbug resistant strains of these bacteria. If you have a symptomatic UTI (fever, chills, AD, bad leakage, severe spasticity, malaise, flank pain, elevated WBC in your blood, etc.), it must ONLY be treated based on a test called a culture and sensitivity (C&S), which collects a specimen by sterile methods (not from your drainage bag) and incubates it with little pieces of paper impregnated with various antibiotics. Only those antibiotics that inhibit the growth of bacteria at the end of the test (72 hours) should be used. Most providers will prescribe an antibiotic AFTER collection of the C&S specimen for a symptomatic UTI, but at 72 hours the C&S results MUST be reviewed, and often the type of antibiotic must be changed.

A 10-14 day course of the appropriate antibiotic is needed, because people with SCI should be considered always to have complex (not simple) UTIs.

You should speak to your physician about setting up a method where you can take in a specimen without having to have an appointment and call for the results. Of course if you have a high fever, you may need to go to the ER, as this means you have kidney involvement.

Please refer to the clinical practice guideline on urinary management in SCI that you can find referenced in the Sticky messages at the top of this forum, and also print out and share this document with your providers:

http://www.ahrq.gov/clinic/epcsums/utisumm.htm

(KLD)

[adi chicago]

an urine sample must be sent to the lab to make sure if is an uti and what germ caused the uti[resistance and sensitivity test must be done ]to know what antibiotics will kill the bug.most of the time when i suspect an uti [cloudy,smelly urine,chills,fever,increased pain and spasticity]...i call my family doc first and i send an urine sample to the lab.i always have at home those sterile urine sample little bottles ...i am lucky because my family is taking care about this .good luck and do not hesitate to call your physician.

[Mike_Stan]

I intermittent cath. I have been in the chair for 23 years but have not had a UTI in 20 years. However from past experience I knew this was most likely a UTI because I had a lot of them the first 3 years.

I called the doctor and asked if I could bring up a urine sample so they could test it. I gave them my symtoms and they refused to do it without me seeing the doctor. I told them I don't have good insurance and I didn't feel it was neccesary that I see the doctor(What's he going to do take my temp and charge me $250 ?). Finally she talks to him and he decides instead of me bringing in the urine sample to put me on Levaquin for 5 days. If that doesn't work then they said I have to come in and see the doctor.

The pain/headaches and chills went away. Just waiting to see if this thing comes back and bites me again. Should know in a day or so. Not sure if 5 days will clean something up. Normally I was given antibotics for 10 days.

I would think if they were smart they would taken the urine sample and tested it from the get go.

[SCI-Nurse]

You may need to consider finding a physician who knows more about management of neurogenic bladder. Was this your GP, internist or a neurologic urologist?

They should have collected the specimen before putting you on the antibiotic. If the Levaquin does not work, he will be treated your infection blind.

When did you last have urodynamics? Tests for stones?

(KLD)

[Mike_Stan]

I know they should have collected the urine sample that is what I wanted. Now if this doesn't work I will be back in the same shape I was 6-7 days ago and it will have been time wasted which worries me because I hate getting sick like that. All they cared about was getting me in for an office visit.

But that is what you deal with at these clinics. I don't have options of finding physicians who know more about neurogenic bladder. I would need to go a large city where they deal with paras/neurogenic bladder. My last urologist at this clinic told me he didn't have any other patients with neurogenic bladder. When I asked questions I could tell he didn't know what he was talking about. When you asked to see someone who does specialize in it at the appointment desk they tell you they all do. It gets frustrating.

This doctor I called on this most recent uti was from internal medicine. I don't think it matters at this clinic. I first talked to a nurse in urology and she mentioned that they might send me to urgent care.

I have never been tested for stones or urodynamics. No one has ever mentioned it.

[dnvrdave]

Originally Posted by Mike_Stan

he decides instead of me bringing in the urine sample to put me on Levaquin for 5 days. If that doesn't work then they said I have to come in and see the doctor.

The pain/headaches and chills went away. Just waiting to see if this thing comes back and bites me again. Should know in a day or so. Not sure if 5 days will clean something up. Normally I was given antibotics for 10 days.

The Levaquin will probably work, if it was 750 mg or more. I wouldn't worry about it, esp. since you rarely get UTIs and Levaquin is so good. I've been managing my self-diagnosed UTI's with "telephone" antibiotics for most of my 22 years (to save money and time).

Like me, it sounds like you have a good perception of your symptoms. I get UTI's rarely, too. I just had several urine cultures/sensitivities done and it was interesting, but amounted to nothing. Five days of 750 mg Levaquin killed it (or hid it well).

I think the urology docs under-treat, and the "clueless" docs over-treat, and we need to make the right decisions, and be assertive and sly enough (bounce between docs to find the right one) to get what we want.

[Mike_Stan]

The Levaquin did not work. Probably because it was such a light dose. 250mg once a day for 5 days. Now he put me on amoxycillin 500mg twice a day for 5 days. I could tell that was not working after a couple of days so he switched backed to Levaquin 500mg once a day for 3 days. Not sure if he keeps me on the stuff long enough to do any good.

[SCI-Nurse]

You are right. If you have a SCI, your true UTIs should be treated as complex UTIs, which means 10-14 days of treatment, not the 5 days used for simple UTIs in ABs. I would recommend that you download the CPG on bladder management in SCI (find it from the stickies at the top of this page) and also this document http://www.ahrq.gov/clinic/epcsums/utisumm.htm and seriously discuss your UTI management with your physician. If they are not willing to listen, I would suggest finding another urologist with neurologic urology expertise.

You should also be getting annual screening for stones and other anatomic problems with your urinary track, and if you do intermittent cath or use reflex voiding, you should also have urodyanmic every 2-3 years; more often if you are having leaking, AD or real frequent UTIs.

(KLD)